When Breath Becomes Air Book Review

 In Books

Want to win my copy of When Breath Becomes Air by Paul Kalanithi? Shout me on social media & I’ll send it to you with a favourite passage marked for your enjoyment.

“Ma’am – are you alright?” asks the airline employee at my boarding gate, leaning in as if expecting a discreet confession of some sort.

I’ve tried to hide the flood of tears, but my quivering shoulders give me away. It looks like I’ve gone through something – something really bad. And I have, in a sense. I’ve just experienced the death of Paul Kalanithi.

If you haven’t heard of When Breath Becomes Air, it might be because you’ve somehow missed it at the bookstore’s front table or awards shelf. It’s an extension of Kalanithi’s viral (terrible term) NYT opinion piece titled How Long Have I Got Left? Both chronicle his journey from doctor to patient as he fought stage IV lung cancer…as a non-smoking, thirty-something. There are really two layers to how his story hit me (and thousands of other readers) so deeply – the tragic aspect of a young, successful, essentially healthy member of society facing a cancer diagnosis, and his fluid, frank yet personable writing style.


Facing Death as Doctor

Kalanithi’s career is the stuff dreams are made of – prestigious training and awards for a 36-year-old doctor completing his specialty in neurosurgery. In his job, he helped patients and their families through scary, terrible things like head trauma or brain tumors, operating in a field where a millimetre surgical move could have frightening consequences. He had a unique educational background that blended literature and biology, pondering death and studying it at the same time, and I relate very much with his dual-brain thinking. The summit of the success mountain was just within reach to this exceptional talent.

And then he found his body to be riddled with a rare form of cancer.

It’s the type of tragic twist that makes you want to yell, “Why?! Why this man? Why this valuable member of society who heals people?” As if somehow cancer could pick and choose who to avoid for maximum benefit. This man was incredible in all his accomplishments and ambitions, poised to help the world even more through surgery and studies. But like the friends, family, and coworkers we all love deeply – he was not untouchable. He was human.


Facing Death as Patient

Kalanithi writes extensively about the transition from doctor to patient, from his “doing” to his “being done to.” It’s at this point of straddling the doctor/patient border where his philosophical thinking lets loose and flourishes. He is candid in his struggles and thoughts, whether it be discussing his marriage or his work life or coming to terms with having a limited time left to live. There’s such a power in the level of “normal” he is able to describe, a relatability to his uncommon reality that puts you in the hospital beside him.

One of the angles I enjoyed was his insight into our fixation with numbers and outcomes – why doctors may avoid things like survival curves while their patients obsess over time increments. He writes in his NYT piece:

Physicians think a lot about these curves, their shape, and what they mean. In brain-cancer research, for example, while the numbers for average survival time haven’t changed much, there’s an increasingly long tail on the curve, indicating a few patients are living for years. The problem is that you can’t tell an individual patient where she is on the curve. It’s impossible, irresponsible even, to be more precise than you can be accurate.

Yet when he switched roles into patient-mode, he kept trying to pin his doctor down to a time stamp. He explains of our need for numbers: “People react differently to hearing ‘Procedure X has a 70 percent chance of survival’ and ‘Procedure Y has a 30 percent chance of death.’ Phrased that way, people flock to Procedure X, even though the numbers are the same.”

Kalanithi’s thoughts about death and life have a poetic depth to them that sit in the pit of your stomach. A thought that stood out to me is basically paraphrased as this: I knew that someday I would die (and I was ok with that), but I didn’t know when (and I was not ok with that). It sounds simple enough, but with a disease such as his, is it weeks, months, or years? The healthy take for granted that we’ll be able to deal with things “tomorrow,” and unfortunately it often takes tragic accidents or diagnoses to remember that we may not be fortunate to have a tomorrow.


Life before Death, Life after Death

Kalanithi was able to recover enough to get back to work for a while, even getting back into the operating room. But as is the unpredictability of life, he became ill again before passing away in March of 2015. He and his wife, Lucy, had welcomed their baby girl just months before his death, with gripping descriptions that parallel her birth and his declining state at the time. Kalanithi passed away before being able to finish this book, and Lucy’s closing of his tale is what led to my meltdown at Nashville International’s Gate B13.

No matter race, gender, age, career, good karma, family life – cancer goes where it pleases. But Kalanithi’s words have an honesty and comfort that doctor, patient, or family member can hold close to their hearts to help remind them to live an extraordinary today.

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