Book Review: When Breath Becomes Air – Paul Kalanithi

29 Jun 2017

It must be confessed that there should have been four – not three – copies of this book available to give away to HGI Insight subscribers. And there would have been, it is true, if it weren’t for the completely unprecedented and unintentional destruction of one copy of Dr. Paul Kalanithi’s post-humously published “When Breath Becomes Air”. For this I take no responsibility. Technically, yes, it was my fingers that dog-eared every third page, my weather-beaten, over-sized handbag that housed it for many weeks, where within its cavernous confines it encountered all manner of perils such as leaking water bottles and lid-lacking-pens, and my very own hands were responsible for bending, scrawling, underlining and other such ungodly behaviours.

And yet, I maintain my innocence. You see, this is a book that stays with you. You will find yourself needing to know the exact page it was that prompted you to stare out the window for forty-five minutes thinking about what is really driving you forward, and where you are going, and why. You will need it by your side as you go about your routine daily existence. You will feel an urge to show a friend in conversation, that precise moment where the author recalls Shep Nuland’s treatise on mortality, How We Die, and how such literature helped convince him to pursue medicine – in part to ‘bear witness to the twinned mysteries of death’. You cannot leave it at home, and its central themes and questions shall remain percolating in the recesses of your mind long after you come to its final page – as things do when they end, unfinished.

When Dr. Paul Kalanithi was diagnosed with lung cancer he was a 36-year old, highly talented neurosurgeon at what should have been the peak of his career. After spending many gruelling years of neurosurgical training where residents would work as much as one hundred hours per week, this was supposed to be his time to finally live. And yet what he discovered when confronted with the results of his own CT scans in his final year of neurosurgical residency was that after so many years dealing with death – patients, friends, colleagues – he now had to deal with his own.

Thanks to the rapidity of his decline in health, ‘When Breath Becomes Air’ is in a sense, unfinished. Kalanithi emailed his best friend when he was diagnosed with terminal cancer, writing, “The good news is I’ve already outlived two Brontes, Keats, and Stephen Crane. The bad news is that I haven’t written anything’. From this moment, Kalanithi wrote vigorously, honestly and without bravado as he explored this new phase of life.

The ‘Contents’ page breaks it down as follows:

Foreword by Abraham Verghese (although he notes that in this case it might be better thought of an afterword, considering the circumstances)


Part 1: In Perfect Health I Begin

Part 2: Cease Not til Death

Epilogue, written by Kalanithi’s wife, Lucy.

Who can tell in this summary, where life ends and death begins? Or vice versa?

The arc of the story is personal and yet widely applicable, dealing with the intensely complex and yet horribly unremarkable matters of life and death. It is reminiscent of Atul Gawande’s 2014 greatly acclaimed ‘Being Mortal’ (which I also reviewed earlier in the year) in terms of its themes and core ideas, and its ability to challenge the ‘normal approach’ to mortality, confronting its readers with the uncomfortably un-confrontable.

One might assume a neurosurgeon to be wholly his position title, including the neurosurgeon itself – just as we often assume people are their diseases. Someone with a mental illness or a serious disease becomes so buried in the identity of their affliction that their sense of self is often lost in their vulnerability. The neurosurgeon, the doctor, the healer, the carer – who might guess they are human, beneath it all? Until they become, as Kalanithi describes, a statistic themselves.


Dr. Kalanithi left behind a loving wife, Lucy, and an eight-month-old daughter, Cady. In short, he left this life leaving other lives behind, and a book that contains within its pages remnants of his own life, and pieces of others. Brilliant, moving and jolting, ‘When Breath Becomes Air’ is a compelling and extraordinary read.

And so now you understand, obviously… that the absolute ravaging of my own copy was entirely beyond my control. In fact one might even say that the wrinkled, pillaged pages tell their own story of having lived a very full life indeed.