When Breath Becomes Air: Pulitzer Prize Finalist

This book is a must-read. Wonderfully written, the story unfolds when a renowned surgeon receives a diagnosis of cancer. It is a book so honest, the grief will take your breath away. It is also so honest that your heart will soar at the beauty of life. Paul Kalanithi had much he wanted to accomplish in his work life, but even more with his wife and new baby. Dr. Kalanithi's wife, Lucy, who completed Paul's work, is my hero. She wears her grief well and has survived. A blessing. Read this book. It teaches us how to live.

I listened to When Breath Becomes Air on Audible during my commute, and it’s one of those rare audiobooks that stays with you long after it ends. Paul Kalanithi’s story is thoughtful and deeply personal, reflecting on what it means to live a meaningful life even in the face of death. The narration is calm and respectful, capturing both his medical precision and quiet vulnerability. It feels more like being spoken to than being read to, which makes the experience even more powerful. The only small drawback is that a few sections are emotionally heavy, definitely something to listen to when you can focus. Overall, it’s a beautifully written and narrated memoir that I’d recommend to anyone who appreciates introspective, life-affirming stories.

I re-read this book after having read it some years ago. It was a good book then, but it meant so much more this time. A little over two years ago I was diagnosed with cancer. Although I have no evidence of disease now, Paul’s story takes on a deeper meaning than it did the first time I read it. I recognize the feelings and thoughts from being diagnosed to going through treatments. It was also helpful to read what his wife experienced, because although my husband spoke to me of his feelings, there are some thoughts he never voiced.

4.5 stars At age 36, in the last year of his neurosurgery residency, Paul Kalanithi discovered he had stage IV lung cancer. For the next 22 months, he and his wife Lucy, an internal medicine physician, awoke each day focused on living, not “living until...” When Breath Becomes Air was written largely because Dr. Kalanithi had the soul of a poet and turning to words to express any experience in life was as instinctive to him as breathing itself. His intent was that his story could aid in the healing of others and that one day his own daughter would read it and get a sense of the father she would never remember. The book’s format, like the author’s writing style, is simple, straightforward, eloquent, and unflinchingly honest – Prologue, Part I and Part II. In the prologue, Paul describes the first step in his diagnosis, getting x-rays for his recurring severe chest pain. It was 15 months prior to the end of his residency. He could see the light at the end of the long 10-year tunnel of preparation for his work in neurosurgery. There would be wonderful opportunities to practice as well as conduct research, offer of a professorship, a huge increase in income, a new home and starting a family with Lucy. The x-rays were fine, he was told. But he had lost weight and the pain was not letting up in severity. He began researching incidence of cancer in his age group. Things with Lucy were strained at that time, partly because he was not sharing his concerns about his condition. She decided against going with him on a vacation with old friends in order to sort out her own feelings about their relationship. He came home in severe pain after just a couple of days. She picked him up from the airport. After he told her about his symptoms and his self-diagnosis, she took him to the hospital that night where a neurosurgeon friend admitted him. Most of Part 1, In Perfect Health I Begin, describes life prior to the diagnosis, obviously back to his childhood. Both of his parents were immigrants from India, his father a Christian and his mother Hindu. Both families disowned them for many years. They moved their own family of three sons from Bronxville, New York to Kingman so Paul’s father could establish a cardiology practice, which he did very successfully. Paul’s mother had been trained as a physiologist in India before eloping with Paul’s father when she was 23. Her own father had defied the traditions of 1960s rural India and insisted that his daughter be educated and trained for a profession. She was horrified to discover that Kingman’s school district was among the lowest performing in the entire country. Her eldest son had been educated in Westchester County, New York schools, where graduates were assured of admission to the nation’s most prestigious universities. He had been accepted at Stanford before the move to Kingman. What would happen to 10-year-old Paul and his 6-year-old brother Jeevan? Instead of wringing her hands, Mrs. Kalanithi threw herself into supplementing her sons’ educations and improving that of all the children in the area. She gave Paul a reading list intended for college prep students and at age ten he read 1984, followed by many other modern and traditional classics. He discovered a love for words as an expression of the human spirit. His mom got elected to the school board and worked with teachers and others to transform the school district. After a few years their 30+% dropout rate was greatly reduced and graduates were getting accepted at universities of their choice. No doubt Paul was born with that poetic soul, but it was his mother’s guidance that led him to read the literary giants who nourished that soul. It was his parents’ examples of excellence in their own lives, their faith, and service to their community, in this strange land that they made their own, that formed Paul’s desire and need to serve. In When Breath Becomes Air, he writes of vocation, a term you rarely hear people use these days. A thousand years ago when I was growing up, vocation was ubiquitous. We were told time and again that discerning our vocation was one of our prime responsibilities as human beings. It was our reason for being here, what we were called to do in service to humankind. Teaching, medicine, religious ministry, musicianship, military, etc. By knowing our natural talents we could know our vocation. Paul had many talents and interests, complicating his vocation decision. He studied both English literature and human biology in college. “I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Also a man of deep spirituality, Paul reflected, “Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.” The intersection of science and morality was of prime interest to Paul. The rest of Part I describes how Paul came to see medicine and then neurosurgery as his vocation. He forthrightly deals with the idealism of medical students and residents and how that idealism is dimmed or completely snuffed out by the realities of giving medical care to other human beings. His explanation of cadaver dissection and why physicians and their families do not donate their own bodies to medical science is eye opening. “Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.” This is the kind of honesty displayed throughout the entire book. He writes of his own loss of idealism and how the recognition of that affected his own self-image as well as his job performance. “I wondered if, in my brief time as a physician, I had made more moral slides than strides.” That earlier mentioned phrase, “the messiness and weight of real human life” describes this book. The author has given the world not a mere recollection of events or achievements, but has laid bare his soul, exposing the very marrow of his being. This book should be read by every premed student in the world before they commit to a decade or more of study and relentless hard work. In Part II , Cease Not till Death, the author details the diagnosis, the immediate aftermath, the determination to emphasize living not dying, the quest to conceive a child, and the agony involved in treatment. I think Part II should be experienced by each reader. Most readers will find it extremely compelling and very personal. It is the nitty gritty of this man’s inner being. Lucy, his wife, wrote an eloquent epilogue further detailing Paul’s experience while writing this book, the support they received from colleagues, friends, family, and others after his death on March 9, 2015. I found this book soul wrenching, but also witty, uplifting and hopeful. Without preaching, he reveals some deep flaws in the way we do health care and the price that not just patients but the care providers sometimes pay. In our war with cancer, it won a battle here by taking this remarkable man so early. He would have touched hundreds of students and thousands of patients with the professorship that would have been his. But When Breath Becomes Air is sure to touch millions of us. Cady Kalanithi will one day be able to read for herself just who her father really was. Rating: 4.50/5.0.

One of the best books I’ve ever read. As an ICU nurse, I think a lot about life and death, and Paul captures these topics with raw authenticity. He puts you right in his shoes, and by the end, you feel deeply grateful and inspired to live more meaningfully. It’s thoughtful, purposeful, and never drags—every word matters. I was hooked from start to finish. Profoundly deep and unforgettable.

Reflections on “When Breath Becomes air” by Paul Kalanthini By Bob Steele December 25, 2016 I have read many books in my lifetime, likely several thousand, but this is one of the rare ones. It is a profound, beautifully written book that reached out and touched me on many levels. It triggered deep reflection about health and disease, living and dying, wisdom and folly. This is a sad story, a memoir written by a brilliant, young neurosurgeon who loses his fight with lung cancer. And yet I am so glad I read it and hope that my family and friends will do so. Paul Kalanithi deals with death, looking at its many facets, but never in a morbid or clinical way. Paul spent a third of his life in his quest to become a neurosurgeon. The book reflects some of the many lessons learned in that journey. It includes a helpful treatise on doctor-patient relationships that should be required reading for doctors, nurses, and caretakers for people who face terminal cancer/illness diagnosis. There are literally dozens of quotations that I want to share from this remarkable journey of self-growth as he transitioned from doctor to patient. However, I am resigned to citing these few. * * * * * I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death. Amid the tragedies and failures, I feared I was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient. Technical excellence was not enough…. When there's no place for the scalpel, words are the surgeon's only tool. In those moments, I acted not, as I most often did, as death's enemy, but as its ambassador. A tureen of tragedy was best allotted by the spoonful. How little do doctors understand the hells through which we put patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving. Doctors, it turns out, need hope, too. And finally for his infant daughter, Cady: When you come to one of the many moments in life where you must give an account for yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing. * * * * * More poignant words, I have yet to read. A sense of sadness fell over me as I reread the book to collect my thoughts and considered how many more lives he could have saved, how many more he could have touched with his new-found sense of empathy and wisdom. But then I realized that through this book he can reach out and touch the lives of so many more than he could have done as one of the best doctors. He has yet much to share and teach. Thank you, Paul.

This brief memoir is interposed between a foreword by Abraham Verghese, the brilliant author of “Cutting for Stone” and an epilogue by author’s wife, Lucy Kalanithi. It is a beautifully, heartrending, deeply philosophical piece by an accomplished young man who dedicated heart and mind to his work and study in neurosurgery. He discovers that he has terminal lung cancer at the age of 36, just before completing his grueling neurosurgical residency and embarking on the career he has worked so hard to attain. The book is very thoughtful and reflective in nature, especially upon the meaning of life. It made me wonder if the author was truly always so interested in finding the meaning of life, or if only when told of this terminal diagnosis, that reflection back on his life made this search so apparent. As one nears death, what is most important, becomes glaringly more obvious, and Paul Kalanithi describes this so well. Abraham Verghese speaks in the foreword of how he had met Paul in person several times before his death, but it was not until he read his book that he felt he really knew him. I too, felt like I got to know Paul through this book. He is very open and honest about himself, his sickness, his relationships, and struggles and triumphs throughout the process of dealing with cancer. I find it interesting that Paul did not always think he wanted to be a physician, but rather thought he might be a writer. He may not have realized his full potential as neurosurgeon and professor, but he surely achieved his goal to be a writer. He has left behind a beautiful book that will be read for many years to come. It will be of great interest to those with life-threatening disease, their family members, and really everyone, because we will all be in those shoes at some point. He has also left behind a wonderful gift of himself to his daughter. She will not remember her time with him, but she will be able to know him through this book and well as through the memories that I’m sure his close relations will share with her. Aside from writing and even delving back into neurosurgery residency at one point, he spent the last years of his life following his diagnosis, building closer bonds with his family, and the love there was overflowing. Aside from being an important read for anyone facing a life-threatening illness themselves or loving someone who is, I think it is a very important read for all medical professionals. It puts a face behind a patient, who is clearly able to articulate the thoughts and feelings of being a patient in our medical system. It emphasizes and highlights the importance of the physician-patient relationship. I gave this book 5 stars for it’s thought provoking, beautiful prose, as well as for writing it’s way through a death with utmost dignity. He strengthens his belief systems, forges stronger relationships with family and loved ones, and finds greater meaning in life once he is given this terminal diagnosis. For discussion questions, please visit book-chatter.com

We live in a society that esteems the young, beautiful and vibrant above all things. We live in a society that thinks it is invincible and that we will live forever. Doctors are Gods who bring us miracles every day and the advances that they lead are truly astounding. We turn away from death embarrassed, scared, and nervous. When the doctors fail us we sue them. We want them to do everything they can to save us without any examination of what that means. This book is so beautiful and profound because Paul Kalanithi and his wife Lucy stand tall in the face of illness and death and just talk about it. This book is refreshing for its honesty and especially for Paul's refusal to give in to platitudes like, "We are going to beat it!" "We will win!" I understand why people choose that approach, but I think Paul's book and the way he lived his life after his diagnosis shows what a disservice that can be to living the life you have been handed. This is best exemplified in the exchange between Lucy and Paul about whether or not to have a child: ""Will having a newborn distract from the time we have together?" she asked. "Don't you think saying goodbye to your child will make your death more painful?" "Wouldn't it be great if it did?" I said. Lucy and I both felt that life wasn't about avoiding suffering." That's not to say that Paul did not fight his cancer. He did. He desperately wanted to live. But as he said "...I would have to learn to live in a different way, seeing death as an imposing itinerant visitor, but knowing that even if I'm dying, until I actually die, I am still living." I also liked this book for the lessons that physicians can learn from how they talk about treatment and death. I have been blessed to have dealt with some fantastic health care providers in recent years. The doctors and nurses who cared for my father when he was dying last year were fantastic, especially his oncologist. But there were some doctors and nurses who still seemed to side-step the conversation. I know they do not want to be wrong and that there is always hope, but there were so many euphemisms. Instead of telling us that he was in fact dying, there was a lot of talk about labs, and phrases like, "He is a very sick man." When I pressed they agreed wholeheartedly that my brother should come now. But no one said "death." No one said "dying." Paul's desire to understand human relationality and death lead him to medicine. He is honest that he was seeking a kind of transcendence there. But he comes to learn that, "As a resident, my highest ideal was not saving lives - everyone dies eventually - but guiding a patient or family to an understanding of death or illness." And that, "Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can." I could share quote after quote here, but that understanding and transcendence is the meat of this book. Go read it! This book was sad because Paul was so talented and he left behind so much. He was a brilliant and thoughtful doctor. He was also an incredible writer. As I read his book, I was fascinated by his time as a neurosurgeon, but I was equally sad that he would not be writing any more. I wished he had chosen a writing career so that we would have more of his words to read. A writer that can use the word "pluperfect" so well to make his point and to capture his struggle with tense is wonderful. This is another example of his talent: "At moments, the weight of it became palpable. It was in the air, the stress and misery. Normally, you breathed it in, without noticing it. But some days, like a humid muggy day, it had a suffocating weight of its own. Some days, this is how it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down." The book was also sad because it was so clearly not finished. It felt like the solid beginning of a book and as I neared the end I was a little let down. But Lucy Kalanithi's Epilogue saved it for me. Lucy is a talented writer in her own right. Lucy's Epilogue gave the book the balance and the ending that it needed. Lucy writes, "Although these last few years have been wrenching and difficult - sometimes almost impossible - they have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love." Lucy signs off her epilogue, "I was his wife and a witness." I loved this book for allowing me to witness Paul's journey. I was honoured to witness his death from afar. I hope this book reminds us all what an honour it is to witness life, and death in particular, and to embrace that more.