ideas || When Breath Becomes Air by Paul Kalanithi

I am so relieved to be finished with this book.

But.. it was also incredible.

Those aren’t contradictory statements. Thinking and talking about this book is exhausting. Each chapter was more frightening than the last, although perhaps I read it wrong. It made me question everything, made me think about values and careers and how I want to spend my time. It made me question the purpose of everything I do. It’s made me think about death and long-term thinking, and everything that can go wrong when we cross our fingers, pack our bags, and venture forward into the future. It also came at a time when the medical part of the book is really topical, so it made me think about medicine and health, and doctors.

When Breath Becomes Air is a memoir written by Paul Kalanithi, a neurosurgeon who was diagnosed with cancer at 36 years old. His story – his love of literature, his neurosurgery career and years and years of work for a long-term goal that he never got to realize, and his general attitude towards things is inspiring. But it’s also a tragedy, about a man with so much potential whose life was cut short by cancer.

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I said I might have read it wrong because I really got into his perspective, rather than focusing on what they call the “life-affirming” messages in the book. Putting myself into his shoes was just gut-wrenching. Everything was unfair.

The first half of the book focuses on his childhood. One of my favourite quotes from this part is:

After I was caught returning at dawn from one such late-night escapade, my worried mother thoroughly interrogated me regarding every drug teenagers take, never suspecting that the most intoxicating thing I’d experienced, by far, was the volume of romantic poetry she’d handed me the previous week.

Paul Kalanithi, When Breath Becomes Air

health and imperfection

I’ve always known that medicine would never be in my future. It’s not that I’m squeamish around blood or bodily fluids. But the unknown scares me and I just don’t think, mentally, I could withstand or deal with the infinite possibilities. I would be incredibly anxious trying to control things I have no control over, and with not knowing the exact consequences of each little action I take. Not just for patients – which is a whole other responsibility – but for me, even! I’d be paralyzed thinking about all the gambles inherent in each day. I guess you could summarize it by saying that a job managing risk isn’t in my future, maybe?

I also read this at the perfect time for it to have the biggest possible impact on me. We’re in the middle of a pandemic, so the fear of things going wrong medically was amplified by reading about yet another way things can go wrong in our body: cancer. Some people are scared of dark spaces, or spiders, or public speaking. My two biggest fears are car accidents and cancer, for as long as I can remember. So Paul’s story makes me question everything.

His account of going through medical school, and his thoughts on the cadavers, was so strange – especially since in the second half of the book, he focused on his own experience with his own death. That contrast was powerful. I think it takes the reader through what resembles their own current experience with death: seeing it take place from afar, but knowing – or hoping – that it’s a long way off, to a point where you are forced to face the reality that it’s a part of your future. The odds of getting cancer in a lifetime are something around 1 in 3 right now.

So it reads like a simple, universal story: this is his story, but it’s just as much your story, my story, everyone’s story.

The medical, doctor, part also made me scared. I know nothing about my own health – except that I pay attention to be active, eat well, sleep, and so on. But there are so many things you can’t control. And lots of things doctors just can’t control either. We all know that doctors are only human, but I think lots of us still have this notion that when we go to the doctor, everything will be okay. That’s just not the case, because there is so much imperfection inherent in the industry: not just because of the doctors’ humanity, but because every human body is a complex orchestra.

The closest thing I could relate to was building my computer a few months ago, which was incredibly stressful and during which I couldn’t stop the inflow of thoughts, “Is this component screwed on too tight? Is it too loose? Is it perfect? How would I even know if it’s the best that it could be, if it turns on in the end?”

values and career

Lastly, I thought a very interesting part of the book was his exploration of his “values”. His primary care doctor, Emma, had this quote that was repeated often in the book:


“Many people, once diagnosed, quit work entirely,” she said. “Others focus on it heavily. Either way is okay.”

Paul Kalanithi, When Breath Becomes Air

I don’t know which one is the right answer. But if you think about it, it’s extendable to everybody. If you don’t have a diagnosis right now, you have a diagnosis that life will, inevitably, end. It could be anytime. So how do you live with that? The pertinence of that question is closer than it seems. It asks: how do you want to spend your life?

some positivity

Just as I was in the middle of writing this, my new poetry book (a purchase largely inspired by Paul Kalanithi’s literature and poetry references in this book) arrived in the mail, and I laughed at a text reference from my boyfriend to the movie “Silence of the Lambs”, which since watching a couple of months ago, we both can’t stop referencing.

So I think I’ll wrap up by saying that, after all, the thing that keeps you going is seeing beauty and humour in the smallest of things. Forget the people who laugh at you for it, but it really is the one truly best thing you can do for yourself.

Look around and just allow things affect you positively – as much as you might be inclined to let them affect you negatively.

So that’s my review! Go read the book – it’s great! But be prepared … it’s a lot.

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Have you read “When Breath Becomes Air”? What did you think of it?

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