When Breath Becomes Air

When Breath Becomes Air

by Paul Kalanithi, Abraham Verghese

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'Finishing this book and then forgetting about it is simply not an option...Unmissable' New York Times

At the age of thirty-six, on the verge of completing a decade’s training as a neurosurgeon, Paul Kalanithi was diagnosed with inoperable lung cancer. One day he was a doctor treating the dying, the next he was a patient struggling to live.

When Breath Becomes Air chronicles Kalanithi’s transformation from a medical student asking what makes a virtuous and meaningful life into a neurosurgeon working in the core of human identity – the brain – and finally into a patient and a new father.

What makes life worth living in the face of death? What do you do when when life is catastrophically interrupted? What does it mean to have a child as your own life fades away?

Paul Kalanithi died while working on this profoundly moving book, yet his words live on as a guide to us all. When Breath Becomes Air is a life-affirming reflection on facing our mortality and on the relationship between doctor and patient, from a gifted writer who became both.

Product Details

ISBN-13: 9780812988413
Publisher: Random House Publishing Group
Publication date: 01/12/2016
Sold by: Random House
Format: NOOK Book
Pages: 256
Sales rank: 1,427
File size: 6 MB

About the Author

PAUL KALANITHI was a neurosurgeon and writer. He held degrees in English literature, human biology, and history and philoso­phy of science and medicine from Stanford and Cambridge universities before graduating from Yale School of Medicine. He also received the American Academy of Neu­rological Surgery’s highest award for research.

His reflections on doctoring and illness have been published in the New York Times, the Washington Post and the Paris Review Daily.

Kalanithi died in March 2015, aged 37. He is survived by his wife, Lucy, and their daughter, Elizabeth Acadia.

Read an Excerpt

Part I

In Perfect Health I Begin

The hand of the Lord was upon me, and carried me out in the spirit of the Lord, and set me down in the midst of the valley which was full of bones,

And caused me to pass by them round about: and, behold, there were very many in the open valley; and, lo, they were very dry.

And he said unto me, Son of man, can these bones live?

—­Ezekiel 37:1–­3, King James translation

I knew with certainty that I would never be a doctor. I stretched out in the sun, relaxing on a desert plateau just above our house. My uncle, a doctor, like so many of my relatives, had asked me earlier that day what I planned on doing for a career, now that I was heading off to college, and the question barely registered. If you had forced me to answer, I suppose I would have said a writer, but frankly, thoughts of any career at this point seemed absurd. I was leaving this small Arizona town in a few weeks, and I felt less like someone preparing to climb a career ladder than a buzzing electron about to achieve escape velocity, flinging out into a strange and sparkling universe.

I lay there in the dirt, awash in sunlight and memory, feeling the shrinking size of this town of fifteen thousand, six hundred miles from my new college dormitory at Stanford and all its promise.

I knew medicine only by its absence—­specifically, the absence of a father growing up, one who went to work before dawn and returned in the dark to a plate of reheated dinner. When I was ten, my father had moved us—­three boys, ages fourteen, ten, and eight—­from Bronxville, New York, a compact, affluent suburb just north of Manhattan, to Kingman, Arizona, in a desert valley ringed by two mountain ranges, known primarily to the outside world as a place to get gas en route to somewhere else. He was drawn by the sun, by the cost of living—­how else would he pay for his sons to attend the colleges he aspired to?—­and by the opportunity to establish a regional cardiology practice of his own. His unyielding dedication to his patients soon made him a respected member of the community. When we did see him, late at night or on weekends, he was an amalgam of sweet affections and austere diktats, hugs and kisses mixed with stony pronouncements: “It’s very easy to be number one: find the guy who is number one, and score one point higher than he does.” He had reached some compromise in his mind that fatherhood could be distilled; short, concentrated (but sincere) bursts of high intensity could equal . . . whatever it was that other fathers did. All I knew was, if that was the price of medicine, it was simply too high.

From my desert plateau, I could see our house, just beyond the city limits, at the base of the Cerbat Mountains, amid red-­rock desert speckled with mesquite, tumbleweeds, and paddle-­shaped cacti. Out here, dust devils swirled up from nothing, blurring your vision, then disappeared. Spaces stretched on, then fell away into the distance. Our two dogs, Max and Nip, never grew tired of the freedom. Every day, they’d venture forth and bring home some new desert treasure: the leg of a deer, unfinished bits of jackrabbit to eat later, the sun-­bleached skull of a horse, the jawbone of a coyote.

My friends and I loved the freedom, too, and we spent our afternoons exploring, walking, scavenging for bones and rare desert creeks. Having spent my previous years in a lightly forested suburb in the Northeast, with a tree-­lined main street and a candy store, I found the wild, windy desert alien and alluring. On my first trek alone, as a ten-­year-­old, I discovered an old irrigation grate. I pried it open with my fingers, lifted it up, and there, a few inches from my face, were three white silken webs, and in each, marching along on spindled legs, was a glistening black bulbous body, bearing in its shine the dreaded blood-­red hourglass. Near to each spider a pale, pulsating sac breathed with the imminent birth of countless more black widows. Horror let the grate crash shut. I stumbled back. The horror came in a mix of “country facts” (Nothing is more deadly than the bite of the black widow spider) and the inhuman posture and the black shine and the red hourglass. I had nightmares for years.

The desert offered a pantheon of terrors: tarantulas, wolf spiders, fiddlebacks, bark scorpions, whip scorpions, centipedes, diamondbacks, sidewinders, Mojave greens. Eventually we grew familiar, even comfortable, with these creatures. For fun, when my friends and I discovered a wolf spider’s nest, we’d drop an ant onto its outer limits and watch as its entangled escape attempts sent quivers down the silk strands, into the spider’s dark central hole, anticipating that fatal moment when the spider would burst from its hollows and seize the doomed ant in its mandibles. “Country facts” became my term for the rural cousin of the urban legend. As I first learned them, country facts granted fairy powers to desert creatures, making, say, the Gila monster no less an actual monster than the Gorgon. Only after living out in the desert for a while did we realize that some country facts, like the existence of the jackalope, had been deliberately created to confuse city folk and amuse the locals. I once spent an hour convincing a group of exchange students from Berlin that, yes, there was a particular species of coyote that lived inside cacti and could leap ten yards to attack its prey (like, well, unsuspecting Germans). Yet no one precisely knew where the truth lay amid the whirling sand; for every country fact that seemed preposterous, there was one that felt solid and true. Always check your shoes for scorpions, for example, seemed plain good sense.

When I was sixteen, I was supposed to drive my younger brother, Jeevan, to school. One morning, as usual, I was running late, and as Jeevan was standing impatiently in the foyer, yelling that he didn’t want to get detention again because of my tardiness, so could I please hurry the hell up, I raced down the stairs, threw open the front door . . . and nearly stepped on a snoozing six-­foot rattlesnake. It was another country fact that if you killed a rattlesnake on your doorstep, its mate and offspring would come and make a permanent nest there, like Grendel’s mother seeking her revenge. So Jeevan and I drew straws: the lucky one grabbed a shovel, the unlucky one a pair of thick gardening gloves and a pillowcase, and through a seriocomic dance, we managed to get the snake into the pillowcase. Then, like an Olympic hammer thrower, I hurled the whole out into the desert, with plans to retrieve the pillowcase later that afternoon, so as not to get in trouble with our mother.

Of our many childhood mysteries, chief among them was not why our father decided to bring his family to the desert town of Kingman, Arizona, which we grew to cherish, but how he ever convinced my mother to join him there. They had eloped, in love, across the world, from southern India to New York City (he a Christian, she a Hindu, their marriage was condemned on both sides, and led to years of familial rifts—­my mother’s mother never acknowledged my name, Paul, instead insisting I be called by my middle name, Sudhir) to Arizona, where my mother was forced to confront an intractable mortal fear of snakes. Even the smallest, cutest, most harmless red racer would send her screaming into the house, where she’d lock the doors and arm herself with the nearest large, sharp implement—­rake, cleaver, ax.

Table of Contents

Foreword Abraham Ferghese xi

Prologue 3

Part I In Perfect Health I Begin 17

Part II Cease Not till Death 117

Epilogue Lucy Kalanithi 201

Acknowledgments 227

Reading Group Guide

1. How did you come away feeling, after reading this book? Upset? Inspired? Anxious? Less afraid?

2. What did you think of Paul’s exploration of the relationship between science and faith? As Paul wrote, “Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue. Between these core passions and scientific theory, there will always be a gap. No system of thought can contain the fullness of human experience.” Do you agree?

3. How do you think the years Paul spent, tending to patients and training to be a neurosurgeon, affected the outlook he had on his own illness? When Paul wrote that the question he asked himself was not “why me,” but “why not me,” how did that strike you? Could you relate to it?

4. Paul had a strong background in the humanities, and read widely throughout his life. Only after getting a Master’s in English Literature did he decide that medicine was the right path for him. Do you think this made him a better doctor? A different kind of doctor? If so, how? How has reading influenced your life?

5. What did you think of Paul and Lucy’s decision to have a child, in the face of his illness? When Lucy asked him if he worried that having a child would make his death more painful, and Paul responded, “Wouldn’t it be great if it did,” how did that strike you? Do you agree that life should not be about avoiding suffering, but about creating meaning?

6. Were there passages or sentences that struck you as particularly profound or moving?

7. Given that Paul died before the book was finished, what are some of the questions you would have wanted to ask him if he were still here today?

8. Paul was determined to face death with integrity, and through his book, demystify it for people. Do you think he succeeded?

9. In Lucy’s epilogue, she writes that “what happened to Paul was tragic, but he was not a tragedy.” Did you come away feeling the same way?

How did this book impact your thoughts about medical care? The patient-physician relationship? End of life care?

11. Is this a book you will continue thinking about, now that you are done? Do you find it having an impact on the way you go about your days?

12. Lucy also writes that, in some ways, Paul’s illness brought them closer – that she FELL feel even more deeply in love with the “beautiful , focused man” he became in the last year of his life. Did you find yourself seeing how that could happen?

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When Breath Becomes Air 4.8 out of 5 based on 0 ratings. 143 reviews.
Anonymous More than 1 year ago
This reveals and rips the vain between Now and Forever. Thank you for writing and sharing. And God bless.
Anonymous More than 1 year ago
Inspiring, heartbreaking, and uplifting...all at the same time. Thank you for letting the world learn of this incredible journey. A beautiful and powerful book.
Anonymous More than 1 year ago
Being a wife who's husband is dying of a terminal illness and working in medicine this book hit home. An amazing view on life and death, filled with compassion and hope as well as reality and truth. Tears and smiles, I read this book in one sitting and wished I knew more of this man.
Anonymous More than 1 year ago
This book let me open my mind up to the other world - death. It's something we all think about and have to go through. This book touched my heart and made me realize what I take for granted. This doctor will never be forgotten. All the sacrifices he made in his last couple years alive is truely humbling and inspirational. To the other review that was disappointed that he never found God: No one should judge or expect another person to think the way you do. He overcame what he had to do and found his own way to cope through this tragedy.
Anonymous More than 1 year ago
I was incredibly moved by this story, thinking of recent losses and my own future. Very moving and written so well.
Anonymous More than 1 year ago
Beautifully and honestly written account of a thinking man's experience in dealing with his own mortality. Add to this, his being a neurosurgeon struggling with helping his patients and their families through this process of dying, makes this memoir so unforgettable. Read it. Make it a reading requirement for all medical students.
Anonymous More than 1 year ago
A thread of life and the incredible mysteries that accompany it run through every page. Bravery, vulnerability and end of being human while knowledgeable, loved and loving. This is a must read for anyone in the medical field who has recognized, "there by the grace of God go I."
Anonymous More than 1 year ago
This is one book that I will never forget. Thank you to Paul for sharing the most precious part of life....and death.
Penmouse More than 1 year ago
When Breath Becomes Air is a elegantly written and moving book about the life and death of Dr. Paul Kalanithi. Kalanithi. could truly be called a renaissance man as he loved both arts and science. Thanks to his love of writing and science we are left with his legacy of how he learned to view life and death. Kalanithi left his earthly bounds too soon as his gift for medicine and writing will be greatly missed. Recommend. Review written after downloading a galley from NetGalley.
Anonymous More than 1 year ago
This book connected me with a family’s journey similar to my own. My beloved husband died nine months ten days after his diagnosis. Next week will be twenty years since his death. I love and miss him still and want to believe our energies will never part though I am now older than he was when he died. I was so fortunate to share ten years with him. Especially the last year.
Anonymous More than 1 year ago
I was drawn to this book because I am battling cancer, not terminal. This book defies comparison. To have the perspective of patient and Doctor so brilliantly and beautifully described is gift to us all. Thank you Paul and Lucy! Your love conquers all.
Anonymous More than 1 year ago
I am battling cancer and I thank Paul, Lucy and Cady for affirming so much of what I've been feeling. There is no false hope presented here and no focus on the afterlife....something I think Paul must have believed was beyond knowing until we get there. The man simply lived in the time he had and appreciated what he had been given. I don't think any of us should expect to do more than that when we find our time is running short. It's no more profound than that. I highly recommend this book.
Anonymous More than 1 year ago
Beautiful without even trying . Witty, engaging, heart breaking, and most of all thought provoking. What is the meaning of life? And maybe, more importantly, what is the meaning of death?
Anonymous More than 1 year ago
A profound and inspiring read....
Anthony_Positively_Fil More than 1 year ago
I just finished the book yesterday. In a few days, I’ll move beyond the immediate heartbreak of the loss of a talented, brilliant surgeon and scientist who was prepared to make a great difference in medicine. Dr. Paul Kalinthi writes so that you care about him, his dreams and his family. Beyond the grief, you’ll appreciate his example of bravery in the face of diminishing odds of survival about which he is always candid. He tells us of how his medical knowledge and experience working with patients influenced him to experience Kubler-Ross Five Stages of Grief in reverse. He is a realist but also a man with faith. The latter ― faith or God ― may appear antithetical for a scientist, but he manages to eloquently show the fatal flaw in an all-encompassing empirical view, even factoring in Occam’s razor. If we believe in only things we can see, then emotions, love and meaning have no place. This memoir covers more than just religion. Paul tackles many ideas on life and death in this short book he dedicated to his daughter, Cady, whom both he and we regret was too young to remember his time with her. Every moment is heartfelt and relevant for us mortals who soldier on. I don't normally comment on books, but for this one, I had to say something.
Anonymous More than 1 year ago
A very moving and thought provoking book about a brilliant neurosurgeon who is faced with a tragic diagnosis. As a doctor, he has always been on the other side of the equation and suddenly he finds he is having to face his own mortality. Paul does a wonderful job of helping us all to remember the importance of life. But it’s the epilogue by his wife Lucy that brings it all together. The book would have been incomplete without her voice. Wonderful read !
Anonymous More than 1 year ago
This book is so touching and makes you want to search for the importance of life.
Anonymous More than 1 year ago
So eloquently written, so heartwrenchingly raw and real, what a true gift he left the world. Brave, honest and an incredibly unflinching depth of character and grace. A book you won't forget.
Anonymous More than 1 year ago
Very well wrtten and even though sad at times the message about living while dying is so inspirational. This is a must read.
Anonymous More than 1 year ago
I wish this was mandatory reading for all in health care!
Anonymous More than 1 year ago
Must read, creates overwhelming empathy; rips your heart out
Anonymous More than 1 year ago
This book is a beautiful Journey of one man's life. It is his quest defined Beauty and meaning in life and in the brain. I wish I had the words like he did to spin you a beautiful description of what he wrote. I cannot. Read this book of Sorrow and find joy too. Death was hard-but he met it unflinchingly- a man who made a difference. I highly recommend this book.
Anonymous More than 1 year ago
What a beautiful testament of life and facing death. It truly defines a human being facing the only guarantee in life which is death.
Anonymous More than 1 year ago
A powerful book, beautifully written. Tears fell as I read this amazing story. Paul was a brilliant physician and inspiring person. A must read for everyone.
Anonymous More than 1 year ago
A beautiful and unforgetable book. I loved it. A book everyone should read.