When Breath Becomes Air – Paul Kalanithi

Book finished: 23rd July

‘When Breath Becomes Air’  is an autobiography written by Paul Kalanithi in his final year of residency in neurological surgery, when he is diagnosed with stage-4 non-small-cell EGFR-positive lung cancer. The book carries an urgency of racing against time and having important things to say, where Paul is completely upfront with the reader, accepting no pity and leaving no detail untouched. Paul, as a patient and a doctor, managed to confront death, examine it, adapt to it and accept it.

In the book, Paul often refers to and approaches the idea and contrast between life and death. The theme is prominent throughout the book,  taking place in quotes, experiences and stories. From working as a neurosurgeon, Paul confronts death more often than most, but he also encounters life in a way different from everyone else.  He was involved in births, medical breakthroughs and people overcoming the most traumatic of injuries and illnesses. Death also takes many forms in the memoir of When Breath Becomes Air. From cadavers in anatomy class, premature twins that didn’t make it and eventually Paul’s experience of his very own – tumours infesting his lungs and organs. Paul shares with the reader many of his philosophical insights towards working as a doctor, being sick and the fine line between the living and the dying. One quote that stood out to me in the book, was when Paul said: “Even if I’m dying, until I actually die, I am still living.” This quote illustrated to me as the reader that as Paul began to underatand his circumstances as someone with cancer, he was not only grasping his illness but also maturing with death not as a doctor who grappled with it everyday, but as a patient who could confront with the fact that he would not let the inevitable take over the rest of the life he had to live. Throughout the book, and as Paul’s illness developed, I could tell he was really maturing with this idea of a fine line between the living and the dying and the way we live our lives even during the darkest of times and I think this sets a really good example for the reader. 

I think the way Paul approached and explored this theme is really important to share within society today. Coming from the perspective of someone with a terminal illness, it is kind of enlightening for the reader to see the way he is still able to continue on with his life and not let it stop him from reaching some of his biggest dreams – such as having a child. 

Aside from providing physical care for their patients, Paul protests throughout the book that two of a doctor’s most important responsibilities lie within having mental fortitude themselves and being able to use that strength to provide emotional support to their patients where needed. Sharing with the reader, the theme of mental strength and responsibility. Though only being a reader of the book and not experiencing this in real life, I can see through the content the amount of mental strength that is required for Paul and other doctors to overcome such trauma and tragedy through their jobs every day. Sadly at the conclusion of Part 1 in the book, when Paul is off getting treatment, he receives a call from another resident. She tells Paul that one of his closest friends and colleagues Jeff had committed suicide due to being so overcome after one of his patients died from a difficult complication. “…Jeff and I had trained for years to actively engage with death, to grapple with it, and, in so doing, to confront the meaning of a life.” Paul opens up in this quote about his friend’s death, demonstrating that the life of a doctor can end tragically without the mental strength and support to endure constant death and changing around them. Paul experiences his own struggles maintaining his mental stability in the face of his job. He shared how difficult it was for him to go through telling a mother her newborn was born without a brain and how to tell families a loved one had not made it. “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.” Through this quote, Paul illustrates to the reader just the weight and pressure a small failure in his job can cost. But due to these experiences, Paul understands how important it is for him to stay strong 100% of the time during his job as he knows it is vital to keep striving and being a support force for his patients. 

This theme made me think about the way mental health and someone’s mental strength can affect their everyday life and their workplace. Not only the way your workplace can develop and maybe strengthen your mental strength but also how your mental strength can change the way you act in your workplace and how that can work as both an advantage and a disadvantage. This is so important to share with high school students today, as mental health is worth as much attention as any other type of health concern that Paul may come across in his job, and the more it is found in books like this, the more people are talking about it, reducing stigma and growing off of one another’s experiences as we get older. 

I would recommend When Breath Becomes Air to year 12 and 13 students because it confronts and explores many important themes that can relate to our everyday lives in a way different to any normal novel or other books. With being an autobiography, we know that everything we read, Paul himself has gone through and he shared this information and these experiences with us before he passed so that we can take something away from reading this book and hopefully use that to move forward in our own lives and live in the present, like he aimed to do.