When Breath Becomes Air by Paul Kalanithi
This book was emotional and written with true heart from the perspective of a dying man. He was not only a man, but a physician. I cannot fathom understanding terminal illness as the doctor and then experiencing it as the patient. What a difficult understanding of death this man must have gone through. He says: “Death, so familiar to me in my work, was now paying a personal visit (page 121).” I don’t know if I would have been as noble and brave knowing exactly what was happening to my body. “I hadn’t ever considered that I could release myself from the responsibility of my own medical care. I’d just assumed all patients became experts at their own diseases (page 182).”
I loved Paul Kalanithi’s insight as to how he dealt with giving bad news and dealing with losing a patient. I also liked that he was honest about his cockiness and showed a boundless desire to be the best. I feel like it gave me a better understanding of the doctor’s bedside manner because they aren’t trying to be rude or aloof but they are trying to be the best at getting you the care needed to treat your disease. However, I did feel like he was treating the diseases over the patients.
His ability to convey what it’s like to be in medicine and to be on the receiving end of medicine is insightful and educational. I really learned so much about the process of determining who needs chemo and why and at what stage in their individual process. It’s not just chemo across the board. His vulnerability at becoming terminally ill is sudden and it seems to hit the reader quickly, just as it hit the narrator. He muses that “…without the duty to care for the ill pushing me forward, I became an invalid (page 125).”
Enlightened is how I feel after reading this book. Paul states that “We would carry on living, instead of dying (page 144),” when he and his wife, Lucy, decide to have a child during his illness. They had released the pause button on their life and decided to continue to live instead of dwelling on his impending death. This moment where he chooses life over dying is paramount to what we need to do in our own lives, whether we are ill or not.
I was enlightened by a physician’s work. “Doctors, it turns out, need hope, too (page 194).” I was enlightened by the acknowledgement of death. I was enlightened by Paul’s story of life. I was enlightened by what this story taught me. In his hour of uncertainty, Paul states that he has stopped dwelling on his illness and embraced the fact that he had time left “…to return to neurosurgery, to return to life (page 150).”
Although this story ends with his death, I felt like his life had a beginning, middle and end. I feel like he lived the time he had to the best of his ability and he was surrounded by his loving friends and family. Nothing was left unsaid or undone. After all, he did have his novel published just as he wished. I love that his wife wrote the Epilogue to his story. She was good at filling in some of the gaps and telling us what happens to the people we leave behind.
Was this story enlightening to you? In what way did it give knowledge or understanding to death?
How did the perspective of the author affect your understanding of healthcare/death?
Was it more/less emotional because of the technical jargon used by Paul?
After diagnosis, he drastically declines in health but is because he knows he is sick or that he finally has nothing else to distract him?
Did you feel that Paul spent his remaining time doing what he loved?
What would you do if you knew you had a terminal illness?
This book was a heartbreaker! Moreover, it was a powerful, well-read, poignant and touching memoir. Paul divulged dissonance with, “Everything teeters between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito.” Paul talks about life’s most fundamental taboos, desecrating or mutilating the body, as he is performing a cadaver dissection.
When Paul picked Emma as his doctor, Emma thought she was a great fit for Paul but showed some concern and replied to Paul, “Well, there’s that study that says doctors do a worse job prognosticating for patients they’re personally invested in.” Paul’s response was both funny and on point. He said, “On our list of things to worry about, I think that’s in the bottom quartile.”
I loved that he quoted all of the beautiful writers and tied his love of literature in with his love of science. “Years ago, it had occurred to me that Darwin and Nietzsce agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes,” Paul said. And then in the next breath he talks about Hemingway and explains his need to write, “The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language. Hemingway described his process in similar terms; acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward.”
This book was rich with humor, love, and honesty. One of my favorite excerpts was Paul trying to do a little bargaining with God…”God, I have read Job, and I don’t understand it, but if this is a test of faith, you now realize my faith is fairly weak, and probably leaving the spicy mustard off the pastrami sandwich would have also tested it? You didn’t have to go nuclear on me, you know.”
Paul and Lucy had a tumultuous marriage that had its ups and downs, but their love for one another was unrivaled. A few weeks before Paul died Lucy asked him, “Can you breathe okay with my head on your chest like this?” Paul quickly responded, “It’s the only way I know how to breathe.”
Never before has a book had such an insight to the meaning of life and human existence as this one had for me. Many times throughout my reading I would come across something so profound and enlightening that I had to put the book down to simply process what I just read. Kalanithi was taken way too soon and he left quite an impact on my life and mortality. Live Life Fully.
I was so happy reading your post! I am so glad that this book had such a strong impact on you. When I saw the news story about him (just posted to the blog), I was so compelled to read it because of its irony and his ability to look beyond this stroke of bad luck. How could a revered doctor be reduced to the patient? How could this young doctor, husband, father, and son die from cancer? It was a daunting question but one that I feel Paul and Lucy answered with bravery and truth. I loved that they showed the good and the bad parts of their relationship. So many times we sugar coat things to make ourselves look better. But I think that in their case, the show of struggles in their marriage and overcoming them at the worst time is what makes them good people, well worth revering. He has a way of enlightening his readers and showing us what we should be doing on Earth versus the time we waste here. I think he knew it before his diagnosis but it was more profound during his illness. Great thoughts and great quotes!
I found this book to be fascinating. I have always really enjoyed Michael Crichton’s work, primarily because he was so good at applying his medical knowledge (he has a degree from Harvard med) to his writing. In the same way, I love that Paul Kalanithi was able to use his writing skills to translate medical speak into a understandable and relatable way. I also love that his two biggest passions were literature and medicine. Left brain and right brain. What a beautiful medley. And what a wonderful way to convey the intricacies of medical school, neurology residency, and the challenges of lung cancer.
As Jennifer Baker pointed out above, I really appreciate that Paul tackled these difficult and taboo subjects head on and with no apology. His honesty and candor from beginning to end was truly a fresh breath of air.
I thought about the title of the book often as I was reading. About how air and breath were often metaphors for so many situations Paul faced. But they were also true examples when applied to his medical situation.
I was also so appreciative of Lucy’s epilogue. It provided a lot of additional insight into Paul’s life and thought process. It also provided some much-needed closure that I think the readers needed. But Lucy probably needed as well.
On a personal note, I wish Paul had not reverted back to working so much after he began seeing some improvements in health. It seems like that time was very precious and may have been better spent with his family. But I’m not judging him. Seriously. This is just me picturing myself in the same situation and thinking “would I rather be working or home with my family?” I know he was doing what he loved and it made him happy. He was also helping others and saving lives during that period, which is also very important. Were it me, I don’t think I would have gone back so soon to a job with such immense responsibility and hundred hour work weeks. I think I would have spent more time focusing on recovery and spending time with my family.
I like your reference to the right brain and left brain functions of creativity versus logic. He really was the epitome of using the full brain. I think that his ability to use the left and right brain, helped to convey his story with the compassion and love he embodied for his family but with the nuance of medical knowledge to mark the intensity of the situation.
I agree with you about not wasting time by going back to work but I also feel like his line of work impacted more than just himself and I think he had a true calling to help others even during his own suffering. I think he had difficulty deciding if it was time to let go or try to live on. I guess that none of us truly know how much time we have left and we tend to be optimistic that we will live to old age. Maybe this was his attempt at optimism? Either way, I think going back actually helped him to make the decision to go live his final days doing something else he was passionate about.
Great post Jessica!
I really enjoyed reading this book! It was so hard to put it down because you wanted to see how he would keep living his life, even with this terrible disease. This story was definitely eye-opening. It makes you realize that life is short and I think he did his best to keep going despite his illness.
I think it enlightened me to the view that a doctor has to their patient’s and to death. You never know how they see it from their point of view. What I found interesting was when he said they pick and choose the patients that have a better chance at a better life depending on the procedure that they do. I thought that was one of the most eye-opening aspects to his profession. I didn’t see it as playing God, but what a way to look at a patient and truly understand what their life could be if you do or don’t do a certain procedure. I think this was the main theme of the entire book – how to maintain and create quality of life.
I think we all think we understand death and healthcare from our own experiences and thoughts/beliefs. This book really made me understand that there are so many ways to treat different diseases in different ways. I thought it was interesting that you would treat different cancers differently. I was like you where I thought chemo was the only thing you can do.
I think it was much more emotional because he had true understanding of his illness. I think most of us would just see it as cancer and then we get treatment and then you hope for the best. With doctors, they see it in a whole other way and understand the effects on other parts of the body and how treatment will affect them. I think since he understood it so well, it made me sad that he really did have an understanding of what his body would go through and also that he may not be able to do the things that he was used to doing. I think patients have so much hope and doctors see the other side, the side where things may not go as planned.
I do think he was very sick and that was the cause of the massive decline. I really think the cancer “attacked” him rapidly.
I think he was torn in what to do with himself with his remaining time. I think he chose what would keep him going and also what he set out to do. I think his goal was to graduate from residency and he wanted to fulfill that goal. I think he would have much rather done the writing full time or just spent time with his family, but with this huge goal in his life, I think he wanted to accomplish that and see what else he could do after, depending on the illness.
If I had a terminal illness, I would like to think that I could tie up loose ends and then be able to fulfill some of my wishes with my family by my side. I would like to think that I could keep working for a while and then travel or just spend time with the people I love. But then there’s a part of me that thinks, I would be scared all the time. I honestly don’t think you know how you will react or live until you are handed that fate. It’s hard to have a mentality about it until it actually happens to you.
Great book that actually makes you think! And also any disease can affect anyone…
I agree that we all deal with the fate we are handed in different ways. I agree with your assessment that ignorance is bliss. Paul knew so much more about the affects of cancer and the levels of survival. As patients, we have so much hope because we don’t know what to expect and we don’t know the tolls disease takes on our bodies. But being a doctor, Paul knew everything that was happening to him and he knew his fate almost immediately. I think the only thing he didn’t know was how much time he had left. I think his doctor actually gave him hope, which allowed him to fulfill his residency completion and to start the book he always wanted to write. Its ironic that in the end he was the patient and that he embraced it.
I’m so glad you liked this story. It really was a heartfelt story with a lot for us to learn about life and death.