When Breath Becomes Air

At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. When Breath Becomes Air is Paul’s profound memoir, which he wrote and nearly completed during the final months of his life. 

The first time I read the book I was deeply moved by how bravely Paul faced his death; how methodically he thought about and planned how to spend his remaining time. Upon reading the book a second time, what struck me was how mindfully Paul faced his life – equally if not more so than how he faced his death.

In one entry Paul wrote:  I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but didn’t know when. But now I knew it acutely.

Paul’s quest to live a life of deep meaning and purpose was reflected in his decision to become a neurosurgeon –a unique choice among his medical school peers. As he watched others choose areas of medicine that offered more humane hours, higher salaries, and lower pressures, Paul’s intentions were elsewhere. What gnawed at Paul were some of the most difficult questions faced by medical practitioners. He grappled with predicaments that ask more than whether to live or die – but about what kind of life is worth living. Paul wrote: Would you trade yours or your mother’s ability to talk, for a few extra months of mute life? How much neurological suffering would you let your child endure before saying that death is preferable? … What makes life meaningful enough to go on living?

Paul’s wife Lucy, who finished the last few pages of the book after Paul’s death, captured Paul’s essence poignantly: Even while terminally ill, Paul was fully alive; despite physical collapse, he remained vigorous, open, full of hope – not for an unlikely cure but for days that were full of purpose and meaning.

This book is truly a tour de force.

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