When Breath Becomes Air Summary

Dr. Paul Kalanithi

When Breath Becomes Air

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When Breath Becomes Air Summary

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When Breath Becomes Air, a memoir by Dr. Paul Kalanithi, was published posthumously in 2016. It details his journey to becoming a neurosurgeon, his fatherhood, and his eventual death from stage IV lung cancer.

At 36, Kalanithi had nearly finished his training as a neurosurgeon, almost a decade’s worth, when he was diagnosed with terminal stage IV cancer. In the book, he attempts to answer the question of what life is worth, and why it is worth living.

His diagnosis completely changes the future he had envisioned for himself and his wife. As a child, Kalanithi had hoped to become a writer. The medical field was something that he’d come to despise because it kept his father, a cardiologist, away from home for long hours. He’d been homeschooled, in part by his mother, and because of that, had read increasingly more intricate and beautiful works of literature and poetry.

Eventually, he decided to go to medical school because medicine had become a calling for him. It would allow him the opportunity to forge relationships with people who were suffering and give him the chance to explore what life offers in meaning and scope. It was this idea that suffering and decay does not preclude the possibility of deep meaning within the human experience that ultimately decided his career.

It was not an easy path. Kalanithi and his wife were both in medicine, and their residencies took a toll on their relationship. In the last year of his residency, they almost called it quits. He decided that if he had cancer or some other disease, and she left, he would not tell her. If she stayed, they would deal with it together.

Horrendous back spasms and weight loss were the first clues that his health was declining, and he snuck in visits to the doctor between the responsibilities of his residency. All the typical types of cancer for young ages were ruled out. At the last minute, he worked in a chest x-ray and was not surprised to see the result: masses and tumors all throughout his lungs.

At this moment, he steps over the line between doctor and patient. Just a few hours before, he had been the one examining x-rays such as this one, looking for any sign of hope, and now the x-ray was his own.

From here, the narrative moves through his struggles with treatment and his decision to rebuild his relationship. Chemotherapy is difficult and does not offer much hope, but he decides to try it. He discusses the philosophical part of medicine in light of his new experiences. He writes that his relationship with statistics changed once he became part of the statistics he had once studied. He remembers times when he ignored his patients’ pain, discharged patients despite their discomfort, and times when he was not as merciful or understanding as he could have been.

He and his wife wrestle with the decision of whether to have a child in light of his diagnosis. He wonders if it will make it more difficult for him to let go and die, but they decide that this is not the case. Their daughter is born in 2014, and his cancer improves enough that he returns to work and gets to spend some time with his daughter.

In the end, he succumbs to cancer and passes away in 2015 before he can finish the manuscript. His wife takes over from here and pieces together the last bits of the narrative from other sources such as emails exchanged with the book’s original editor.

The memoir revolves around the idea of what makes life meaningful in the face of death. This mystery propels the book forward. Death comes in many forms, not just in Kalanithi’s diagnosis, but life appears as well. When his daughter is born, he describes holding her in the hospital and facing his own finite existence in the face of this life just beginning. The possibilities of life are so apparent, but he also wrestles with his death at this moment, knowing that he will not likely see much of her life.

The other theme is that of memory and the way our words can live on long after we die. Kalanithi originally wanted to be a writer, and when he is diagnosed, he realizes that he has outlived a few famous writers, but he has not written anything yet. He uses his memoir to process what is happening and to examine his life. He asks, “if the unexamined life is not worth living, is the life not lived worth examining?

This is a poignant question as he addresses the things he will never do, and the things he will never experience being diagnosed with terminal cancer so young. He will never have the career he imagined, nor see his child grow up, but the experiences he has had so far are worth looking back upon. He takes account of what he has done and lives each day until the very end.