Rebecca's Reviews > When Breath Becomes Air

When Breath Becomes Air by Paul Kalanithi
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it was amazing
bookshelves: illness-and-death, read-via-netgalley, best-of-2016, cancer-memoirs, wellcome-prize-shortlist, posthumous-publication
Read 2 times. Last read April 21, 2017 to April 22, 2017.

Our shadow panel selection for the Wellcome Book Prize 2017. I first read this book a year and a half ago; when I picked it back up recently, I thought I’d give it just a quick skim to remind myself why I loved it. Before I knew it I’d read 50 pages, and I finished it the next night in the car on the way back from a family party, clutching my dinky phone as a flashlight, awash in tears once again. (To put this in perspective: I almost never reread books. My last rereading was of several Dickens novels for my master’s in 2005–6.)

What struck me most on my second reading is how Kalanithi, even in his brief life, saw both sides of the medical experience. He was the harried neurosurgery resident making life and death decisions and marveling at the workings of the brain; in a trice he was the patient with terminal lung cancer wondering how to make the most of his remaining time with his family.

Yet in both roles his question was always “What makes human life meaningful?” – a quest that kept him shuttling between science, literature and religion. In eloquent prose and with frequent scriptural allusions, this short, technically unfinished book narrates Kalanithi’s past (his growing-up years and medical training), present (undergoing cancer treatment but ultimately facing death) and future (the legacy he leaves behind, including his daughter).

Looking back once again at the guidelines for the Wellcome Book Prize (“At some point, medicine touches all our lives. Books that find stories in those brushes with medicine are ones that add new meaning to what it means to be human”), When Breath Becomes Air stands out as a perfect exemplar.


My original review from October 2015:

I’m something of an aficionado of cancer memoirs, a subgenre that appeals for family history reasons but also because I appreciate stories lived right on the knife edge of life and death. Here’s one I would recommend to anyone for the beauty of its prose – a fine blend of literature and medicine – and the simple yet wholehearted picture of a life cut short.

Paul Kalanithi was 36 and just completing his neurosurgery residency in Stanford, California when he was diagnosed with advanced lung cancer that did not respond well to treatment. It came as a complete surprise and set the young surgeon’s life on a new course. He and his coterie of doctors managed his symptoms so he could operate for as long as he could, but when the time came he knew he wanted to devote his last year to writing this memoir. In addition, he would get a brief, sweet taste of fatherhood: he and his wife Lucy, also in the medical field, decided to have a child.

Kalanithi grew up the son of Indian immigrants in Arizona. “I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful?” he recalls. Degrees in English literature and human biology were disparate attempts to find an answer. Like Henry Marsh (Do No Harm), he has a surgeon’s knowledge of the anatomy of reasoning, but realizes that does not provide a full picture. He recognizes the responsibility of holding others’ lives in the balance, and regrets occasional failures of empathy.

“Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.” It’s intriguing to see religious language in that statement – indeed, Kalanithi saw his work as a calling, and one with moral connotations. Christian imagery shows up repeatedly:

Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused.

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.

When’s the last time you encountered the word “narthex”?! The vocabulary is striking throughout, as in another favorite passage: “A tureen of tragedy was best allotted by the spoonful. Only a few patients demanded the whole at once; most needed time to digest.”

Paul Kalanithi died in March 2015. There’s a lovely epilogue from his wife – like Marion Coutts, the author of The Iceberg, she’s more than competent to carry on his story.
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Reading Progress

August 20, 2015 – Shelved
August 20, 2015 – Shelved as: to-read
October 4, 2015 – Shelved as: illness-and-death
October 11, 2015 – Started Reading
October 11, 2015 – Shelved as: read-via-netgalley
October 28, 2015 – Finished Reading
January 19, 2016 – Shelved as: best-of-2016
April 12, 2016 – Shelved as: cancer-memoirs
March 19, 2017 – Shelved as: wellcome-prize-shortlist
April 21, 2017 – Started Reading
April 22, 2017 – Finished Reading
January 25, 2019 – Shelved as: posthumous-publication

Comments Showing 1-10 of 10 (10 new)

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Lisa Vegan My kind of book!!! Adding it. Family history here too, Rebecca.


message 2: by Carol (new)

Carol It's on my list. Thanks for your thoughts.


Ammar I think this book is one of my favorite reads this year. I totally agree with you, the prose is amazing in it and the epilogue is well written


Rebecca I imagine it will be one of my top reads of the year, too (though I read it in 2015 so have been forgetting about it a bit) -- time for me to start a "Best of 2016" shelf!


message 5: by Natalie (new)

Natalie My best friend's mother was just diagnosed with stage IV lung cancer. As they face a similar situation I'm wondering: do you think this book would be a helpful read for her and her mother or too raw of a read? I'd love to hear your opinion.


Rebecca It's so hard to say. Books are how I approach the world, so I think I would always be looking for reading that would mirror my own situation. However, thinking back to when my brother-in-law was diagnosed with brain cancer, for the first three years the LAST thing he wanted was to think or read about cancer in his leisure time.

I think there would be no harm in telling them about the book and letting them decide. It's more about facing life with bravery and finding meaning in suffering than it is about the nitty-gritty of cancer treatment, so perhaps that is an advantage.


message 7: by Lei (new) - rated it 5 stars

Lei Cao Finishing the book I feel like losing a friend.. Thanks for the comment, same as you I'm a bit positively surprised by the narrative by Lucy in epilogue, how beautiful the writing is and how deep the love goes...


Kelli Beautiful review!


Rebecca Thank you, Kelli!


message 10: by Jeanette (new)

Jeanette You made me laugh about the word "narthex" too. Because we hear that word all the time at Church. We have the crying room and all the sign up tables, plus food pantry drop offs in our Narthex. I believe for the most part that word is 99% Catholic.


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