Book: When Breath Becomes Air

When Paul Kalanithi was very young, his mother decided she would make damn sure that her kids were properly educated, and began making him and his siblings read classic literature. All of this reading prompted in Kalanithi a longing to find the things that gave meaning to human life. His search initially continued deeper into literature: what better way to understand the meaning of life than to study that which was assigned to it by others? A novel given to him by his high school girlfriend, however, brought him around to the idea that meaning originated and resided in the brain, which, at the end of the day, was an organ; thus began his parallel interest in biology.

A double major, two graduate degrees in English literature and Philosophy, and four years of medical school later, Kalanithi found himself drawn to neurosurgery. The brain was what defined a person’s identity, and operating on it meant, quite literally, changing a patient’s world. In residency, he continued to grapple with the question of what gave life its meaning, as oftentimes there was a tradeoff to be made between prognosis and quality of life — perhaps an operation would extend a patient’s expected lifespan by a year, but costing their ability to speak, while a less radical operation might only grant three months, but with much less disruption to quality of life. As a doctor, Kalanithi considered his greatest responsibility not to be saving lives, but to be guiding patients and their families to an understanding of the situation, and to a place where they can all determine what means the most to them. He worked to become one of the best residents at his hospital, and found out shortly before graduation that a new lab was opening up at Stanford, and that a number of faculty wanted him to lead it.

And then, in his final year of residency, after a lifetime of toil in the name of preparation, he was diagnosed with lung cancer.

When Breath Becomes Air was Paul Kalanithi’s final project, the one that he relentlessly worked on all the way until the very end. In those last days, he found it necessary to share his story, his own search for meaning, after decades of studying others’ searches. Probably everyone’s search is different — it is unlikely, after all, that the same things matter to everybody. Kalanithi realized that even after decades of studying death, both through written pages and face-to-face, he found it impossible to navigate the path to his own. When death was decades away, he felt it easy to enumerate his priorities, but now with it coming possibly sometime in the next year, and almost certainly in the next five, all of his original priorities seemed irrelevant.

After his diagnosis, Kalanithi and his wife decided to have a child. Their reasoning behind this decision was, in my opinion, one of the most significant pieces of wisdom in this book: that life was not about avoiding suffering. Having a child was important to both of them, and that importance outweighed the fact that it would be harder to say goodbye when the time came (“Wouldn’t it be great if it [was]?”). If finding joy in meaning necessitates some amount of suffering before the fact, down the road, or during, then so be it — if not for what means most to you, what are you living for? A similar line of reasoning led Kalanithi back into the OR; neurosurgery was important to him and he would continue with it, cancer and all of its associated difficulties be damned. He resumed operating a full load as soon as he could, and still managed to fulfill all of his requirements for graduation on time. And of course, he did everything that he could to finish this book; having spent so much of his life studying literature, Kalanithi couldn’t leave the world without sharing what he had learned.

I think that many young people (myself included) have trouble understanding the concept that life is finite — of course I know that my years are limited, but only in the same sense that I know that the sun is 93 million miles away; I have no intuition whatsoever for just how vast that distance is. Without this sense of understanding, I never really felt the need to figure out what it is that I live for; I have a general sense of what I want out of my life in the next few years (e.g. get closer to financial freedom), but I can’t really justify why I want those things (what am I going to do after I’m financially free?). I think a lot of us need a prompt to think about these tough questions, and if nothing else, Kalanithi’s book reminds us that the relevance of these questions may not be so far off.

Show your support

Clapping shows how much you appreciated Thom Lu’s story.