Written by Paul Kalanithi
Audiobook read by Sunil Malhotra, Cassandra Campbell
Published by Random House Publishing Group on February 16th 2016
Genres: Biography & Autobiography, Personal Memoirs, Medical
Source: public library via Overdrive
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#1 NEW YORK TIMES BESTSELLER • For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living?
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. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.
What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.
Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. “I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything,” he wrote. “Seven words from Samuel Beckett began to repeat in my head: ‘I can’t go on. I’ll go on.’” When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.
Before Paul Kalanithi decided to follow family tradition into a career in medicine, he followed his love of writing and literature into a graduate program. If he had chosen to go into medical school immediately after college, he might have had more time a neurosurgeon. However, if he hadn’t nurtured his writerly ambitions, he might not have been able to produce his remarkable document of the last years of a life ending much too early, When Breath Becomes Air.
At thirty-six years old, on the verge of completing almost a decade of neurosurgical training, Kalanithi was diagnosed with advanced (Stage IV) lung cancer. He talked about it in an opinion piece in the New York Times a little more than a year before his death:
“As soon as the CT scan was done, I began reviewing the images. The diagnosis was immediate: Masses matting the lungs and deforming the spine. Cancer. In my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to see if surgery offered any hope. I’d scribble in the chart ‘Widely metastatic disease — no role for surgery,’ and move on. But this scan was different: It was my own.
“The scan looked bad. I looked bad. I’d lost 30 pounds, developed excruciating back pain and felt more fatigued every day. My tests revealed severely low protein levels and low blood counts consistent with the body overwhelmed, failing in its basic drive to sustain itself.
“For a few months, I’d suspected I had cancer. I had seen a lot of young patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief. The next steps were clear: Prepare to die. Cry. Tell my wife that she should remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes, there were lots of things I had meant to do in life, but sometimes this happens.
“…The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day?”
The diagnosis brought Paul and his wife Lucy, a fellow physician with a specialty in internal medicine, firmly back together after a shaky period in their marriage. Kalanithi initially responded well to treatment, but when he relapsed shortly before the end of his neurosurgical residency, he began conventional chemotherapy with an extended hospitalization. But while death was imminent. so was new life; before Paul’s treatments began, he and Lucy had moved forward with plans to have a baby, and their daughter was born just days after his release from the hospital. He reflected on this in an essay for Stanford Medicine published around the time of his death in March 2015:
“Part of the cruelty of cancer is not only that it limits your time, it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. But even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder, some days I simply persist.
“Yet one thing cannot be robbed of her futurity: my daughter, Cady. I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters — but what would they really say? I don’t know what this girl will be like when she is 15; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past. That message is simple: When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”
Both of these essays are woven into the narrative of When Breath Becomes Air, and I think they provide a good sample of the thoughtfulness, honesty, and raw beauty of this book. I’m not sure it’s right to describe this as memoir, really. While it does include a recounting of Kalanithi’s life before the diagnosis, the bulk of it was written as he was experiencing cancer, and as his decline continued, it became apparent he wouldn’t write the ending; the book concludes with an epilogue written by Lucy.
When Breath Becomes Air is intelligent, intense, and emotionally devastating. The book is beautifully written, and Sunil Malhotra’s reading of Paul Kalanithi’s words is an excellent fit. (Lucy Kalanithi’s epilogue is read equally ably by Cassandra Campbell.) Since my overall opinion of this one is in sync with Jill’s at Rhapsody in Books, I’ll quote from her review:
“How do we manage to look death in the eye and face death with integrity? Kalanithi not only tells us, but shows us through the way he lived his final two years after receiving his diagnosis…(T)his book filled me with a profound sadness. Nevertheless, I consider this book to be a must-read, and highly recommend it.”
I borrowed this audiobook from the library, because apparently I forgot I’d already purchased a copy from Audible. I’m not at all sorry to own it, and there’s a good chance I’ll buy it in print as well.
WHEN BREATH BECOMES AIR by Paul Kalanithi: Opening Lines
“I knew with certainty that I would never be a doctor. I stretched out in the sun, relaxing on a desert plateau just above our house. My uncle, a doctor, like so many of my relatives, had asked me earlier that day what I planned on doing for a career, now that I was heading off to college, and the question barely registered. If you had forced me to answer, I suppose I would have said a writer, but frankly, thoughts of any career at this point seemed absurd. I was leaving this small Arizona town in a few weeks, and I felt less like someone preparing to climb a career ladder than a buzzing electron about to achieve escape velocity, flinging out into a strange and sparkling universe.
I lay there in the dirt, awash in sunlight and memory, feeling the shrinking size of this town of fifteen thousand, six hundred miles from my new college dormitory at Stanford and all its promise.”