When Breath Becomes Air
[{'review_meta': 'Reviewed in the United States on August 19, 2018', 'review_star': 'a-icon a-icon-star a-star-3 review-rating', 'review_body': 'When Breath Becomes Air (2016) made a huge splash, becoming a NYT bestseller, etc. Even Bill Gates read (and reviewed, and loved) it. In it, Dr. Paul Kalanithi basically tells his life’s story in two main threads: how he came to choose, learn, and practice medicine, and how he’s fighting late-stage lung cancer in only his mid-30s. The situation has (had…) all the makings of a kind of hero’s journey, and no wonder it grabbed people’s attention. A superstar young doctor dying of lung cancer right after bringing home a new baby, imagine that.\n\nBut as far as I can tell, the Paul Kalanthi described in the book would want me to write an honest critique of his work, and I can’t be 100% positive. I have no problem with the lofty philosophical bits, but many other prospective readers will. Kalanithi seems to think that his decision to study medicine is deeply interesting (he studied literature first, and first bristled at the thought since there were doctors in the family). But I didn’t care so much – who among us hasn’t changed their college major or master’s program once or thrice? Depending on your existing worldview, you’ll either find Kalanithi’s ultimate choice of neurosurgery as either inspired or eye-rollingly hubristic.\n\nKalanthi is interested in the mind-body problem, and I know that he would have studied it specifically. But, disappointingly, he can’t muster much more to say about it than platitudinous rhetorical questions (“There must be a way, I thought, that the language of life as experienced – of passion, of hunger, of love – bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats.”)\n\nFor someone who decided (years ago, as a student) that “human relationality” “undergirds meaning,” it’s a little rich that Kalanithi had become estranged from his wife prior to his diagnosis and then barely mentions her pregnancy in passing. I do believe it’s noble that Kalanithi tried to relate to his patients on a human level, especially seeing as how he operates on what he takes to be the seat of their souls. But readers are just as likely to feel alienated by Kalanithi’s focus on strangers to the detriment of those close by. It’s like an overdone character in a book: doctor too busy caring for patients to care for his own wife, oops! The very last paragraphs Paul wrote are about his infant daughter Cady, and the joy she brought him as he died. But that’s why those bits seem a little surprising. Perhaps, due to Kalanithi’s increasing frailty, the part of the journey that turned him from arrogant doctor into sated family man simply went mostly unwritten.\n\nTo be clear, producing a single book that encapsulates everything someone with a full professional and personal life might want to say is a totally Herculean task (especially to undertake while already critically/terminally ill). It’s certainly no surprise that When Breath Becomes Air isn’t completely satisfactory in that regard. You don’t have to be a perfect person to write a good book, either. But since this is a book review…\n\nThe highlight reel of Kalanithi’s life doesn’t make you feel especially connected to him, but you feel obligated to preemptively develop some empathy because you know what’s coming next. His experiences training as a doctor are sort of depressing and cliched: start ambitious, end desensitized. His experiences as a student shouldn’t have to be that significant. But because his life is turning out to be rather short and he was a student for most of it, they become forced into significance. I don’t know exactly what I’d want anyone, dying or not, to say about “human relationality” vis a vis meaning in life (personally, I don’t think there’s any such meaning to be had, but the question comes up often enough that there has to be something to say).\n\nThroughout, Kalanithi’s writing is alternately beautiful and cringe-worthily heavy-handed (“in taking up another’s cross, one must sometimes get crushed by the weight”). It’s clear that he’s trying to find a comfortable writing voice (while also grappling with the weightiest possible subject matter), and under such pressure. What a shame that he got only an ill-fated Titanic crack at writing a book. If this material had spanned a few decades instead, who knows how it could have come out.\n\nI did especially enjoy (???) the section on glioblastoma, from a neurosurgeon’s point of view. It helped me to more fully envision the events that unfolded around my family member’s recent diagnosis. The epilogue, by Paul’s widow Lucy Kalanithi, is quite beautiful (a number of Amazon reviewers like it better than the rest of the book). It helps to drive home that Paul is gone, his life’s previous work (doctoring), new work (writing), and would-have-been-future-work (parenting) all left unfinished. She too must find her voice for this task under immense pressure, kudos for that. I have only begun to dip a toe into the mental fog of grief and it’s enough to make you forget how to brush your teeth, let alone how to write something huge numbers of strangers would want to read.\n\nAll of the above notwithstanding, I read the book very quickly and definitely cried at the end.\n\nRead this book if you’re interested in how a doctor thinks about his own death and if you don’t mind stories without silver linings.\n\nDon’t read this book if you’re very put off by arrogance or intellectualism.'}, {'review_meta': 'Reviewed in the United States on December 2, 2015', 'review_star': 'a-icon a-icon-star a-star-5 review-rating', 'review_body': 'I read this book in one sitting, long after the lights should have been turned off. I felt like not doing so would have been a disservice to Paul Kalanithi. After reading the book I felt stunned and hopeful in equal parts. Stunned because of the realization that someone as prodigiously talented and eloquent as Dr. Kalanithi was taken from the world at such an early age. Hopeful because even in his brief life of thirty-seven years he showcased what we as human beings are capable of in our best incarnations. His family can rest assured that he will live on through his book.\n\nWhen Breath Becomes Air details Dr. Kalanithi\'s life as a neurosurgeon and his fight against advanced lung cancer. Even in his short life he achieved noteworthy recognition as a scholar, a surgeon, a scientist and now - posthumously - as a writer. The book is a tale of tribulations and frank reflections. Ultimately there\'s not much triumph in it in the traditional sense but there is a dogged, quiet resilience and a frank earthiness that endures long after the last word appears. The tribulations occur in both Dr. Kalanithi\'s stellar career and his refusal to give in to the illness which ultimately consumed him.\n\nThe first part of the book could almost stand separately as an outstanding account of the coming of age of a neurosurgeon and writer. Dr. Kalanithi talks about his upbringing as the child of hardworking Indian immigrant parents and his tenacious and passionate espousal of medicine and literature. He speaks lovingly of his relationship with his remarkable wife - also a doctor - who he met in medical school and who played an outsized role in supporting him through everything he went through. He had a stunning and multifaceted career, studying biology and literature at Stanford, then history and philosophy of medicine at Cambridge, and finally neurosurgery at Yale.\n\nAlong the way he became not just a neurosurgeon who worked grueling hours and tried to glimpse the very soul of his discipline, but also an eloquent writer. The mark of a man of letters is evident everywhere in the book, and quotes from Eliot, Beckett, Pope and Shakespeare make frequent appearances. Accounts of how Dr. Kalanithi wrested with walking the line between objective medicine and compassionate humanity when it came to treating his patients give us an inside view of medicine as practiced at its most intimate level. Metaphors abound and the prose often soars: When describing how important it is to develop good surgical technique, he tells us that "Technical excellence was a moral requirement"; meanwhile, the overwhelming stress of late night shifts, hundred hour weeks and patients with acute trauma made him occasionally feel like he was "trapped in an endless jungle summer, wet with sweat, the rain of tears of the dying pouring down". This is writing that comes not from the brain or from the heart, but from the gut. When we lost Dr. Kalanithi we lost not only a great doctor but a great writer spun from the same cloth as Oliver Sacks and Atul Gawande.\n\nIt is in the second part of the book that the devastating tide of disease and death creeps in, even as Dr. Kalanithi is suddenly transformed from a doctor into a patient. It must be slightly bizarre to be on the other side of the mirror and intimately know everything that is happening to your body and Dr. Kalanithi is brutally frank in communicating his disbelief, his tears, his hope and his understanding of his fatal disease. It\'s worth noting that this candid recognition permeates the entire account. Science mingles with emotion as compassionate doctors, family and a battery of medications and tests become a mainstay of life. The painful uncertainty which he documents - in particular the tyranny of statistics which makes it impossible to predict how a specific individual will react to cancer therapy - must sadly be familiar to anyone who has had experience with the disease. As he says, "One has a very different relationship with statistics when one becomes one". There are heartbreaking descriptions of how at one point the cancer seemed to have almost disappeared and how, after Dr. Kalanithi had again cautiously made plans for a hopeful future with his wife, it returned with a vengeance and he had to finally stop working. There is no bravado in the story; as he says, the tumor was what it was and you simply experienced the feelings it brought to your mind and heart.\n\nWhat makes the book so valuable is this ready admission of what terminal disease feels like, especially an admission that is nonetheless infused with wise acceptance, hope and a tenacious desire to live, work and love normally. In spite of the diagnosis Dr. Kalanithi tries very hard - and succeeds admirably - to live a normal life. He returns to his surgery, he spends time with his family and most importantly, he decides to have a child with his wife. In his everyday struggles is seen a chronicle of the struggles that we will all face in some regard, and which thousands of people face on a daily basis. His constant partner in this struggle is his exemplary wife Lucy, whose epilogue is almost as eloquent as his own writing; I really hope that she picks up the baton where he left off.\n\nAs Lucy tells us in the epilogue, this is not some simple tale of a man who somehow "beats" a disease by refusing to give up. It\'s certainly that, but it\'s much more because it\'s a very human tale of failure and fear, of uncertainty and despair, of cynicism and anger. And yes, it is also a tale of scientific understanding, of battling a disease even in the face of uncertainty, of poetry and philosophy, of love and family, and of bequeathing a legacy to a two year old daughter who will soon understand the kind of man her father was and the heritage he left behind. It\'s as good a testament to Dr. Kalanithi\'s favorite Beckett quote as anything I can think of: "I can\'t go on. I will go on".\n\nRead this book; it\'s devastating and heartbreaking, inspiring and edifying. Most importantly, it\'s real.'}, {'review_meta': 'Reviewed in the United States on September 4, 2018', 'review_star': 'a-icon a-icon-star a-star-5 review-rating', 'review_body': 'Dr. Kübler-Ross defined five stages of grief – denial, anger, bargaining, depression, and acceptance. It was a compassionate system intended to help patients and their families process a terminal diagnosis. I would add regret to that list. Regret for the life you wanted, but will not have. Regret for the people you will not know and love, the places you will not go, and things you will not accomplish. Many of us don’t have to be in the process of dying in order to feel that level of grief. The urgency of now is more acute, however, with a death sentence looming on your scorecard.\n\nAuthor Paul Kalanithi is a young man of 36 years when he is diagnosed with late-stage lung cancer. He had spent almost his entire life studying – first obtaining degrees in English Literature and Human Biology, then earning master degrees in both English and Philosophy, before finally deciding on medical school. His illness interrupts a life right on the cusp of realizing his hard-earned ambition to become a neurosurgeon. He channels his profound grief - and regret - into action, capturing his hopes, dreams, and aspirations into this book.\n\nKalanithi’s writing reminds me of British surgeon Henry Marsh, who wrote so eloquently about the intersection of life and medicine in his latest book, “ Admissions .” Like Kalanithi, Marsh’s studies were on a more humanistic path before he decided on the scientific one of neurosurgery. Like Marsh, Kalanithi’s brings lyrical discipline to the story of his life. He offers his observations on life, relationships, family, career, his illness and pending death, in an achingly poetic way. He completes his circle of life in the writing of this book. I wept when I finished his story.\n\nJacqueline Onassis is credited with saying that you haven’t lived until you’ve written a book. In writing his, Dr. Paul Kalanithi lives forever.'}, {'review_meta': 'Reviewed in the United States on August 13, 2018', 'review_star': 'a-icon a-icon-star a-star-1 review-rating', 'review_body': 'As a cancer survivor I expected to love this book, I did not. It was beautifully written and very in depth but I just felt no emotional connection to the writer at all, and I am not sure why. Maybe it was just too technical for my uneducated brain. What I got from him and my own experience is that you should never give up, believe you will get well always. Sadly he did not get well and that is tragic, but his life was not a tradgedy, it was full of hope, and while going through chemo treatments hope was everything to me!!'}, {'review_meta': 'Reviewed in the United States on July 20, 2022', 'review_star': 'a-icon a-icon-star a-star-5 review-rating', 'review_body': 'Paul Kalanithi began to read books at a very young age, and he has always wanted to someday write his own book. In fact that was what led him to study English literature for his BA and MA in Stanford. But life had a different plan for him, as after two more impressive degrees he found himself in Yale Medical School, dealing directly face to face with life and death in his 7 years of residency.\n\nThis book is the culmination of his 2 loves, literature and medicine, where he eventually gets to write a beautifully written memoir about his experience as a top notch neurosurgeon who abruptly turned into a patient himself after he was diagnosed with a stage IV metastatic lung cancer.\n\nIndeed, this book has a sad ending, as it is published posthumously a year after he passed away. But this isn’t a spoiler because the main point of the book is not about the ending (we’re all going to die eventually), but it’s about the journey, about hopes and dreams as a medical student, all the sleepless on-calls, the emergency room drama, the extraordinary hard work to become a neurosurgeon, the life-changing split-second decision makings in the operation room, and finally about dealing with illness and mortality along with his deteriorating health condition, the 5 stages of grief, the in and out of therapy, and the emotional toll on the family and close friends.\n\nAnd somewhere between his face-to-face encounter with death as a doctor and patient lies a space and time where Kalanithi ponders about the meaning of life, and he learned them one lesson at a time in the hospital, where births meet deaths meet every disaster, hope, loss, recovery, and the mess in between, and the zen clarity of a wisdom that can only be obtained by someone who is dying but have accepted their fate.\n\nAll of these are written in a first-person vantage point that brings us the reader into his shoes, as if we’re the ones who are living it. And it was all so very moving and inspiring. The last chapter in particular almost reduced me to tears. Incredible, incredible book.'}, {'review_meta': 'Reviewed in the United States on April 3, 2017', 'review_star': 'a-icon a-icon-star a-star-4 review-rating', 'review_body': 'At the age of thirty-six, Paul Kalanithi is diagnosed with stage IV lung cancer. “When Breath Becomes Air” is his unfinished memoir. From an early age, Paul became interested and searched for what makes life meaningful. This book walks us through some of the profound moments of Paul’s life, what he saw and how he felt, and how these events impacted and shaped his life.\n\nIt was Paul’s love of literature, and his interest in biological philosophy that would one day lead him to become a neurosurgeon. Books and words connect people and it’s this connection – relationships – that make life meaningful. The process of experiencing life occurs in the brain, but sometimes the brain is broken or isn’t working properly. Paul wanted to help people, and to understand for himself, just what makes life worth living.\n\nThe beautifully written epilogue, which was written by his wife Lucy, will break your heart, and give you hope at the same time. Here are a couple of quotes from this section.\n\n"… [W]e knew that one trick to managing a terminal illness is to be deeply in love-to be vulnerable, kind, generous, grateful."\n\n"I expected to feel only empty and heartbroken after Paul died. It never occurred to me that you could love someone the same way after he was gone, that I would continue to feel such love and gratitude alongside the terrible sorrow, the grief so heavy that at times I shiver and moan under the weight of it."\n\nThis was a beautiful story that made me cry, it made me think, it made me appreciate life, and I will never be the same because I read it.'}, {'review_meta': 'Reviewed in the United States on December 9, 2018', 'review_star': 'a-icon a-icon-star a-star-5 review-rating', 'review_body': "I have been on the same journey as Dr. Paul was since the age of six when I announced to my atheist family that I remember coming from somewhere before coming here to be me now. I have studied death, where we come from, our purpose, where we are headed in this what I know to be a chapter in the book of eternity that we all are traveling together. I have read over seven hundred books on death, life after death, hospice, shared death experiences, after death communication , life between life and many more stories about this experience so many fear yet we will all take. I have lost all three of my parents to terminal cancer and my best friend, I cared for my Mom, and Step Dad at home where they both died in my arms. The most profound experience of my life. I am now a certified Saint Francis Hospice Volunteer as I want to continue to get as close to death as possible to help unlock the mystery of death and be a part of sharing information I observe to help people not be so closed off from fear of the unknown. This book is so beautiful, raw, and real yet Dr. Paul sparkles with a knowing, a hope that makes one able to read on to the end and instead of cry be filled with that feeling one gets on a beautiful fall day when nothing seems impossible. Thank you Dr. Paul and your beloved family for sharing your deeply beautiful, and meaningful life. Until we all meet again on the other side. I highly reccomend this Book.\nSincerely Suzanne Andrew's. Honolulu Hawaii"}, {'review_meta': 'Reviewed in the United States on December 2, 2020', 'review_star': 'a-icon a-icon-star a-star-1 review-rating', 'review_body': 'This book is essentially the final ego stroke of a dying man. That might sound harsh, but it reads like a self-aggrandizing epitaph of a man with very little insight to offer. I especially found the “I’m an important doctor, why me?!” tone of the memoir tiring. The epilogue was the best part of the book and it was written by the author’s wife. At the end of the day I feel like this book has value for the author’s daughter, who will learn about her father through his own immortalized words, but as far as its value for the rest of us... nah. Skip it and read Viktor Frankl’s “Man’s Search for Meaning” instead.'}, {'review_meta': 'Reviewed in the United States on January 15, 2017', 'review_star': 'a-icon a-icon-star a-star-5 review-rating', 'review_body': 'I heard this author interviewed on an NPR show. His courage was so obvious, and his honesty in facing death so (to me) authentic, that I made a note of title and author and later downloaded the sample for Kindle.\n\nOur book club selected this book, so I could no longer ignore reading what I expected to be a life changing description of what happens after a diagnosis of a terminal disease. This is extremely articulate honest writing from a person with a masters degree in philosophy, as well as writing and a cum laud medical degree from Harvard. What a wealth of considerations he brings to the experience of hopes and dreams, diagnosis, choices after diagnosis, and final stages of life.\n\nSome parts were so painful I skimmed through them. I will go back and read them in depth because I want to experience and remember what this philosopher scientist doctor said about life and his impending death.\n\nThis book will likely change some part of your life. Download a sample and see if you want to continue reading after you complete the first part of the book.'}, {'review_meta': 'Reviewed in the United States on May 27, 2019', 'review_star': 'a-icon a-icon-star a-star-5 review-rating', 'review_body': 'My reading of this book was timely. I had bought it a year ago, but I did not seek it out until we learned that my Mother’s cancer has outlived her treatment options. She is also a physician. This book so well captures the process of life and how it transitions with a life-threatening illness. In this case, the author, Paul Kalanthini, a neurosurgeon, is diagnosed with aggressive lung cancer while he is finishing his medical residency. He writes about how this affects his sense of self, of time, and of identity, and how he has seen that happen with his patients, too. He intersperses his observations and musings with literary quotes. He is a doctor, scientist, poet, and that combination makes his perspective empirical, wholistic and connected to the human conception of mortality and ourselves within the “mortal coil”. I had been afraid to read this book, because it seemed so tragic that such a promising man was diagnosed with such a lethal cancer. Instead, his honesty, intelligence and humor made this a book I could not put down. I feel so much less lonely regarding my Mother’s illness. He, and his wife, Lucy, gave a language to the experience of living and loving while coping with life-threatening illness, and grappling with to connect with death while living life. Nothing like reading a book by someone who gets it and shares that with readers. I highly recommend this book.'}]