When Breath Becomes Air


I had been avoiding reviews of this book, as they tend to go all hyperbolic. And it can do bad things to expectations. They probably had already when I picked this up.

Paul Kalanithi was a literature major, he was then a neurosurgeon, and then he contracted lung cancer and died in 2 years and wrote a book in the meanwhile. It felt almost miraculous, all these things coming together. And I use the word miraculous in a crass way. I refused to believe. I still expected a book about the grandioseness of life, meaning, a lot of philosophy, deep insights on mortality. I expected to be swept away by the sheer enlightenment and perspective it would give me.
There was none of that. What I found instead, was that Paul Kalanithi was a human being. Like all humans. He had ambitions, he had plans, for a career, for a life, he was thinking of mortgages, kids, the relationship with his wife. And then after cancer struck, he was still thinking mostly along those lines. While not losing his mind over the fact that life had handed him a raw deal.

And that’s where the miracle lies. That he was able to lucidly deal with his suddenly shortened life, that none of his plans were stretching into decades, but for the next few years when in the prime of his life. That he was able to pen a book which is mostly about dealing with aggressive lung cancer and falling into the depths of it. That he makes it all so approachable, so relatable – “This is what you do when you get lung cancer, don’t worry or fret, it’s mapped out, right from diagnosis to death. Nothing to worry here. ”

The first half is about a normal surgical resident growing up in the US, a second generation American, his ambitions, his college life, his worries, just normal life. The second half is about this planned and controlled life falling apart, while he still struggles to cobble together some sense of normalcy. For the most part, that’s what it is, fight cancer, try to get back to some normal, while knowing not to look too far ahead. Then cancer strikes back, fight a bit more, but fall back farther and farther each time before succumbing.

When you finish the book, it’s not the eloquence that strikes you, nor the grandiose insights a dying man might provide, but the sheer normalcy of his life. It could be anyone. Even you. But again, that’s the miracle you were looking for.

RIP Paul Kalanithi. And thanks for struggling through it all to write this.


At many points I was reminded of Atul Gawande’s ‘Being Mortal‘, which looked at mortality from the perspective of the Doctor, and medicine. It wasn’t that the author was going to be immortal, but death was still at arm’s length from him. It was something he dealt with on a regular basis and wished would come to people with a lot more dignity.

His other book Complications looks at medicine from the Doctors’ perspective and talks of how they’re also human, and have their own crises to deal with in personal life while working on surgeries or dealing with others’ crises.

With Kalanithi, he makes the choices, and we see the side of the person facing death, but choosing to do so with dignity. And as a practising surgeon while still dealing with his cancer you see the vulnerable side of surgeons and the level of detachment needed to keep going when your own insides are burning.

There’s so much here that isn’t too apparent on first reading, a Doctor used to consoling patients and their relatives, seeing their reactions to news of diagnoses, and relating to that with his own. The blatant optimism of “We’ll beat it!” rings so hollow for him. And a person used to being in control of information and making decisions from them, struggling to let go and have others do it for him. To step back, such a small thing, but still such a big thing.



5 thoughts on “When Breath Becomes Air

  1. Well written Doctor! The miracle (in a convoluted way) also lies in the transition from “being immortal” (aka worldly) to looking at the end – the ensuing thoughts about leaving some footprints..

    1. Yes. That too! As he says we’re all aware of it, while still not being aware. Not being able to put a time frame helps. And we associate that only with the aged too, like in Being Mortal.

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