Review: When Breath Becomes Air by Paul Kalanithi

When Breath Becomes Air by Paul Kalanithi

I say this red-faced: I admit that I was skeptical of this book. Back when I first saw it being talked about on well, almost all social media accounts, tv shows and high raves on book reviews.

I’ve been burnt one too many times by ‘best-sellers’, especially as every bookshop I go to, whether online or physical, had this book front and centre in various editions / covers. And I tend to be wary of overexposed / overly marketed titles.

The cynic in me thought this was another case of posthumous accolade. After all, how can one critique a dead man?

A couple of weeks ago, I “gave in” when a friend recommended this and many others said they liked it after I did a poll on Instagram.

My Random House paperback edition was just a mere 228 pages. And it took me more than a week (almost two weeks) to finish it. I deliberately read it in slow motion, re-reading phrases over and over.

Knowing how it ends, I simply did not want to finish the book that quickly.

I did not want Paul Kalanithi to die.

I wanted his brilliant mind to keep writing.

I’ve always appreciated perceptive minds and Paul Kalanithi was exceptionally intelligently insightful.

My copy has been delightfully highlighted and dog-eared. Many have said that When Breath Becomes Air taught them much about living and dying.

That wasn’t my main takeaway. I appreciated his thoughts on particular things. I’ve often wondered what it’s like to be a doctor dealing with death and people’s lives and Paul Kalanithi has shone insights in a very compassionate and human way.

Some things that stand out for me:

His thoughts on English literature and human biology (when he was tossing up which classes to take and why he ultimately decided to take both):

I was less driven by achievement than by trying to understand, in earnest: What makes human life meaningful? I still felt literature provided the best account of the life and the mind, while neuroscience laid down the most elegant rules of the brain. Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection.

His ardent love for literature combined with his natural fascination with human biology and neuroscience is very evident throughout the book. I came across a review that said they felt Paul Kalanithi’s literature ‘name-droppping’ seemed pretentious and snobbish.

I beg to disagree. Not because I love literature (I admit I didn’t even know half of the names he ‘dropped’), but I saw the relevance to correlation, and moreover, I understand what it’s like to really passionately love something and the tendency to associate it with what occurs in real life.

Not because you want to name-drop but it’s one of the methods you know in order to best understand things, especially as Paul Kalanithi grew up an ardent reader in a small town in Arizona.

I liked that he regularly critiqued himself. It speaks of humility and a desire to become a better version of himself as a neurosurgeon and a human being:

I feared I was on my way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focused on the rote treatment of disease–and utterly missing the larger human significance.

Amid the tragedies and failures, I feared I was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient. Technical excellence was not enough. As a resident, my highest ideal was not saving lives–everyone dies eventually–but guiding a patient or family to an understanding of death and illness.

Paul Kalanithi’s last day as a surgeon

I also liked how, as a harbinger of grim news, he found the best way to break it to his patients:

A tureen of tragedy was best allotted by the spoonful.

And how patients normally react to such news:

Patients, when hearing the news, mostly remain mute. Whether out of dignity of shock, silence usually reigns, and so holding a patient’s hand becomes the mode of communication.

And how he values this role.

Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life–and not merely life but another’s identity; it is perhaps not too much to say another’s soul–was obvious in its sacredness.

How he took his role as a physician seriously:

The pain of failure had led me to understand that technical excellence was a moral requirement. Good intentions were not enough, not when so much depended on my skills, when the difference between tragedy and triumph was defined by one or two millimetres.

Paul Kalanithi and his family. Image from The Times

The book ends almost abruptly. That’s because Paul Kalanithi wasn’t able to finish writing. And I appreciated the rawness of it. You can also almost see the change in his writing from the beginning to the middle and tail-end of the book. There’s a marked difference in verbosity, yet it remains consistently human.

This was the last paragraph of the book. I appreciated that the message he left for his daughter didn’t have too much drama. It was very real as he never had the chance to know what his daughter would be like.

Words have a longevity I do not. I had thought I could leave her a series of letters–but what would they say? I don’t know what this girl will be like when she is fifteen. 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 where 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 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.

Another thing that’s enormous beyond measure is my respect to Paul Kalanithi who faced death with dignity.

Paul’s wife Lucy Kalanithi writes the epilogue of the book. Here’s an excerpt:

When Paul emailed his best friend in May 2013 to inform him that he had terminal cancer, he wrote: ‘The good news is I’ve already outlived two Brontes, Keats, and Stephen Crane. The bad news is that I haven’t written anything.’ His journey thereafter was one of transformation–from one passionate vocation to another, from husband to father, and finally, of course, from life to death, the ultimate transformation that awaits us all. I am proud to have been his partner throughout, including while he wrote this book, and act that allowed him to live with hope, with that delicate alchemy of agency and opportunity that he writes about so eloquently, until the very end.

When Breath Becomes Air has received the following awards and honours:

  • 2017 Wellcome Book Prize short list
  • 2017 Pulitzer Prize, Biography or Autobiography, finalist
  • 2017 Jan Michalski Prize second selection
  • 2016 Goodreads choice winner

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