A Young Doctor Reflecting on His Terminal Cancer Diagnosis

When Breath Becomes Air is a memoir by Dr. Paul Kalanithi that was published after his death; his wife finished the final chapter of the book. The book is for those who want to read about living and dying from the perspective of a doctor’s personal experience. From the very first page, the author is focused on his fascination with the experience of dying, which he believes is universal, yet singular, for all of us.

So knowing this, why read the book? After reading several reviews of the book, I was compelled to read it. To quote Dr. Atul Gawande, author of Being Mortal, “Rattling, heartbreaking, and beautiful, the too-young Dr. Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.”

On the Meaning of Life and Death

The book begins with Dr. Kalanithi’s diagnosis of cancer, at age 36, in the prologue. We then learn about his early life before he entered medical school. He comes from a family of physicians, but he does not aspire to be a physician when he first begins his academic journey. Instead, Dr. Kalanithi first pursues literature and then philosophy when he finds himself drawn into the experience of dying and the meaning of living, especially when facing death. He continues to explore the question of what ultimately makes life meaningful, which becomes a strong fascination early in his literary exploration and later propels him into the field of medicine.

Throughout his study of medicine, in the forefront of his learning, is the question of mortality, trying to make sense of the experience. He chooses neurosurgery as his specialty, which he believes will further his understanding of the experience of dying.

Dr. Kalanithi provides rich and compelling stories of the patients he cared for, and how he tenderly discussed their mortality with them, and the difficult choices they faced, such as choosing to live longer but never being able to speak again.

As I read this book, I found Dr. Kalanithi a kind, compassionate physician who grapples with fully understanding the patient perspective. He can empathize completely with the choices he outlines for patients or family members, offering assistance in navigating these difficult choices that emphasize quality of life in the face of the end of life.

I hope that if I am faced with these choices, I have such discussions with someone who is as empathetic and honest. If nothing else, this book raises our expectations of how end-of-life conversations can be handled to inform and support those who face these tough decisions.

From Denial to New Priorities

What is surprising in this story is the strong sense of denial that Dr. Kalanithi had toward his own diagnosis early on. He had many symptoms that would warrant further investigation, yet he and his wife, who is also a physician, managed to push them aside as they faced their extremely demanding lives as medical residents. When he finally can’t ignore the symptoms anymore, he is diagnosed with metastatic (stage IV) lung cancer that had spread throughout his lungs, spine, and liver.

It is at this point that Dr. Kalanithi decides he must write his life story and record in a journal how he copes with his experience. His goals are to help others see what facing death means to him, to identify how his realization of mortality alters his priorities, and to ultimately show how his personal experience can inform and enlighten others.

His decision to focus on what is most important to him and to his wife, and to prioritize his time and energy to achieve his goals make this book worth reading.

Dr. Kalanithi also details his discussions with his oncologist, who is another example of a hero of medicine. Her empathy and strong support of Dr. Kalanithi are inspiring, and once again his experience raises our expectations of what we would want from our own doctor when faced with life-and-death decisions. Their open, two-way conversations focus on quality of life, similar to the examples Dr. Kalanithi provides earlier in the book from when he was the doctor. Now, he is writing from the perspective of a well-informed, but nevertheless, patient.

A Personal Journey of Dying

This book is a wonderful journey of a very personal experience of dying. Dr. Kalanithi is an excellent writer who draws us into his story. His courage, honesty, and the examples of his choices to maintain quality of life on his own terms and to reprioritize to achieve his personal goals are what makes this book so intriguing.

Although each of us has unique goals and ideas of what is most important in life, Dr. Kalanithi is an example of how to pursue those goals under dire circumstances that occur at a young age.

This book is about how Dr. Kalanithi prolonged living at the end of his life instead of prolonging dying. Ultimately, I found this book inspiring: it is well worth the journey I took with Dr. Kalanithi and his wife, Lucy. This book was a major goal at his end of life and is a wonderful gift given from a courageous, honest man whose life ended far too soon.

His wife, Lucy, said it best in the book: “Relying on his own strength and the support of his family and community, Paul faced each stage of his illness with grace—not with bravado or a misguided faith that he would ‘overcome’ or ‘beat’ cancer but with an authenticity that allowed him to grieve the loss of the future he had planned and forge a new one. He cried on the day he was diagnosed. He cried while looking at a drawing we kept on the bathroom mirror that said, ‘I want to spend all the rest of my days here with you.’ He cried on his last day in the operating room. He let himself be open and vulnerable, let himself be comforted. Even while terminally ill, Paul was fully alive; despite physical collapse, he remained vigorous, open, full of hope not for an unlikely cure but for days that were full of purpose and meaning.”