Book of the Week: When Breath Becomes Air, by Paul Kalanithi

This beautiful book is perfect reading for Easter week. It’s hard not to admire an author who explains his career choice—medicine over literature—by citing St. Augustine: “Augustine’s voice in the garden commanded, ‘Take up and read,’ but the voice I heard commanded the opposite: ‘Set aside the books and practice medicine.’” In response to that voice, Kalanithi attended Yale Medical School after finishing his undergraduate degree at Stanford, deciding that it “was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action.”

The author never lost his passions for literature and philosophy while pursuing his medical career. Those interests undoubtedly influenced his decision to become a neurosurgeon, a career that he describes with profound intelligence and empathy:

While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability— or your mother’s— to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

Dr. Kalanithi tells compelling stories about his efforts to become the type of neurosurgeon who can help patients in such circumstances, honestly tracing his successes and failures as a young resident learning his field and recognizing that you can’t save everybody. The brilliant young neurosurgical resident is not satisfied with technical excellence, which is necessary but “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 or illness.” Like Augustine, Kalanithi confesses his failures and successes, acknowledging that the “cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”

Then the doctor became a patient, diagnosed with a fatal cancer at the very beginning of his promising career. As he writes, “[m]y life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close.” His passion for literature produced this book, which traces with his lucid literary prose his journey from health to illness and death.

Paul’s wife, Dr. Lucy Kalanithi, wrote the book’s poignant epilogue about the last days of his life and his death, and fulfilled her promise to bring his book to life after he died. Writing without rose-colored glasses, both authors described their strong yet difficult relationship and how the young couple endured a future so different from the one they anticipated when they met in medical school in what turned out to be a short time before Paul’s death. Adding to their sense of purpose was their decision to bear a child together despite Paul’s illness; fatherhood and authorhood sustained Paul to the end.

Lucy’s epilogue admires Paul’s grace, which “allowed him to grieve the loss of the future he had planned and forge a new one,” remaining “fully alive” to the very last day, “vigorous, open, full of hope not for an unlikely cure but for days that were full of purpose and meaning.” As his wife concludes, “What happened to Paul was tragic, but he was not a tragedy.” The book proves her point.

Leslie C. Griffin

Leslie C. Griffin

Dr. Leslie C. Griffin is the William S. Boyd Professor of Law at the University of Nevada, Las Vegas, William S. Boyd School of Law. Professor Griffin, who teaches constitutional law, is known for her interdisciplinary work in law and religion. She holds a Ph.D. in Religious Studies from Yale University and a J.D. from Stanford Law School.