Review of “When Breath Becomes Air” by Paul Kalanithi

I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.

Like the rest of his memoir, this first paragraph of When Breath Becomes Air leaves the reader with the wind knocked out of them. It is not a book easily forgotten. Kalanithi poetically leads readers through the story of his early childhood, journey into the medical world to the diagnosis and treatment of his cancer.

He passed away in March of 2015. His wife, Lucy, worked to finish the book, writing the epilogue herself. It is a short book (you could probably read it on a plane flight across the country) but its story and message will stay with you long after you flip the last page.

Kalanithi’s reflections on medicine from the combined perspective of a doctor and a patient expose many truths about medicine that are too infrequently recognized for their importance:

Lesson 1: You – whether you are the doctor, patient, or family member – do not know everything.

Kalanithi writes, “each of us can see only part of the picture. The doctor sees one, the patient another…. Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world.” Especially as medicine becomes more personalized, we must recognize the wealth of knowledge that patients and family members bring to clinical care. Cara Coleman speaks to this in her recent blog post, I Am Not A Layperson. As she says “Patient and family [are] crucial members of the healthcare team.”

Lesson 2: Have a plan A and a plan B. And maybe even a plan C. Life happens.

Kalanithi had “mapped out this whole forty-year career for [himself] – the first twenty as a surgeon-scientist, the last twenty as a writer.” However, when his diagnosis unexpectedly set his life to fast-forward, Kalanithi struggles to reconcile those plans with the physical limitations of his strength, energy, and time.  He writes, “the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.” This conflict is central to many patient experiences. As a doctor, Kalanithi understood why his oncologists were incapable of providing a definitive timeframe. But as a patient, he felt the pain of uncertainty. “If I had ten years, I would get back to surgery, if I had two, I’d write.” It is the duty of providers to guide patients through these difficult decisions as ambassadors reminding continuously that “even as [one is] dying, until [they] actually die, [they are] still living.”

Lesson 3: Reflection is essential.

Whether in processing a new diagnosis, grieving a loss, or caring for others with compassion, taking the time to define one’s emotions can be exponentially helpful. This book is evidence. Kalanithi’s wife, Lucy, has spoken nation-wide about the publication of When Breath Becomes Air and her role in writing the epilogue. She has said that although her emotions were raw at the time, concluding her husband’s story was therapeutic. She emphasizes, in an interview with Charlie Rose, that what was most helpful was “to not be afraid to name things, whether it’s a strong emotion or sort of the pain of going through [a tough time] or the pain of facing uncertainty.” The importance of reflection is becoming more prominent in medical education as well. Humanities curricula give students the tools and opportunities to take a step back and appreciate the meaning in their work. David Kopacz wrote an engaging blog post on this topic in which he shows that caring for yourself can only aid in your ability to care for others.

It is hard to give adequate praise to a book that so poignantly depicts life, death, suffering and meaning without over exaggeration. Kalanithi somehow puts into words experiences that are incredibly hard to talk about and in doing so, he teaches us much about finding what truly matters in the face of the invincible.

Molly Olmsted

Intern, Research Institute

Molly Olmsted is an intern at the Arnold P. Gold Foundation Research Institute, a 2015 graduate of Whitman College, a clinical research coordinator at the Dana-Farber Cancer Institute. She hopes to attend medical school in the future and is excited to contribute to the Gold Foundation’s work.