When Breath Becomes Air
by Paul Kalanithi
(Spoilers: People die. The meaning of life is work.)
Some of my college friends entered careers in medicine. Some of them have been entering or exiting residency the past couple years. They love this book. I can see why. You could also subtitle it “Don’t Worry: Med School Was Worth It.”
The first half of the book is about Kalanithi’s path from undergrad through med school and residency and a career as a neurosurgeon. He makes a detour of a degree in literature. The story is garnished with references to classics and poetry and philosophy.
In the second half, Kalanithi is diagnosed with lung cancer. The prognosis is not good. His role flips from doctor to patient. Sometimes that background helps him navigate the medical system. Sometimes it depresses him.
There’s a memorable scene where he describes how doctors measure life expectancy: as probability distributions over a median expected lifespan. He wants to know how long he has to live. But he knows he would never give a patient those numbers. There’s a three-way argument between his doctor, and Kalanithi the patient, and Kalanithi the doctor about whether or not he wants to know them.
The persistent arc of the book is how Kalanithi’s work dovetails with his search for meaning. He finds that meaning in his career. Surgery had been his lifelong goal. Even after he is diagnosed with cancer, he tries to push through and continues working at the hospital. He had always planned to write books after a decades-long medical career. His illness means that he has to start writing sooner. His path reminds me of “Arrowsmith” by Sinclair Lewis, about a medical student who agonizes about science vs. prestige vs. helping others vs. authenticity, and what he wants out of his life & career.
He is sometimes dismissive of his colleagues. Some of his med school friends go into other specialties. He observes that not everyone can meet the physical and mental demands of neurosurgery. When a doctor late in the book won’t sign off on a certain medication, Kalanithi suspects that he’s at the end of his shift and doesn’t want to do the paperwork. Kalanithi would probably say he holds the people in his life to a higher standard.
I laughed out loud when his wife, in the epilogue, reflected on how serious this book is. “Not fully captured in these pages are Paul’s sense of humor — he was wickedly funny…But this is the book he wrote.”
His sentences are earnest and austere. I only felt cynical about it a few days after I put the book down. While reading it, I admired him. I felt inspired to do good. I read it all in a sitting and booked a blood donation the next day.
