It is a strange experience to pick up a book imbued with death. On lifting When Breath Becomes Air from the library shelf and reading the summary, I sensed a subtle shift in the air — or perhaps within me. I stood beneath the artificial lights, surrounded by the sounds and movements of life, grasping death in my fingers.
Unsettled but deeply intrigued, I leafed through the memoir, feeling the fragments of shattered dreams, relationships, and life permeate the pages. I paused as my eyes fell across a poem, Caelica 83 by Baron Brooke Fulke Greville, inscribed in the opening pages:
You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! then make time, will you be,
But steps to your eternity.
The lines beckoned to me like a sliver of light beneath a closed door. Breathless, I turned the knob, descending into the depths of meaning and mortality. Fear, sorrow, joy, confusion, peace enveloped me in waves. Can the presence of death cause such a contrast of emotions? It can, it seems. Dr. Paul Kalanithi’s life, the epitome of juxtaposition, pulled me from the heights of occupational utopia to the depths of mortal uncertainty. Yet, his words dispelled the silence of death, filling it with moving anecdotes from his personal and medical experience.
When I picked up this book, I expected a compelling but technical lecture on dying from a clinical viewpoint. But what I found transcended this presumption. I found compassion where I thought only mechanism occurred. I found hope where I thought only shadows reigned. I found a soul struggling to make sense of life’s meaning in the face of death. And is not that the story of humanity?
When Breath Becomes Air opens a window into the life of Dr. Paul Kalanithi. The son of first-generation immigrants, Kalanithi grew up in Kingman, Arizona. From an early age, his life was cluttered with nature, literature, and a burning ache for knowledge. Kalanithi’s mother, dissatisfied with the curriculum at his public high school, helped ameliorate the syllabus, a factor that aided in Kalanithi’s Stanford acceptance letter. After earning a B.A. and M.A. in English literature and a B.A. in human biology from Stanford, Kalanithi received an MPhil in History and Philosophy of Science from Cambridge University. At this time, Kalanithi realized that he desired “direct experience”; “it was only in practicing medicine,” he writes, “that I could pursue a serious biological philosophy.” By pursuing a path in medicine, Kalanithi hoped to answer “the question of what makes human life meaningful, even in the face of death and decay.”
After attending Yale School of Medicine, Kalanithi entered a residency program at Stanford. During his internship, he encountered suffering and death — things he had only read about in books — first-hand. In his observations, Kalanithi guides readers through the waiting rooms and the sterilized offices, unveiling scenes of profound loss and quiet hope. Through these raw accounts, Kalanithi sets the stage for his own tragedy. He prepares readers in part one of the memoir for his wrestle with death in part two. When the results arrive, a glaring image of stage IV lung cancer, Kalanithi is under death’s shadow, grappling with his mortality through the words he weaves.
What struck me most about Kalanithi’s writing is the degree of empathy with which he conveys not only his anguish, but that of his patients. In one poignant scene, Kalanithi describes relating the option of brain surgery to a terrified patient. He acknowledges that he could have listed to her “all the risks and possible complications… [documented] her refusal in the chart,” and departed. However, in line with the resolve he made to treat his “paperwork as patients, and not vice versa,” Kalanithi gathers her and her family together, and they discuss the options. In doing this, Kalanithi writes that he “had met her in a space where she was a person, instead of a problem to be solved.”
Conversely, while in the trenches of death, he cautions readers of the “inurement” and objectivity that can arise through this persistent confrontation. Kalanithi entered the field with noble intentions, yet, he admits, he felt at one point that he was “on the way to becoming Tolstoy’s stereotype of a doctor… focused on the rote treatment of disease — and utterly missing the larger human significance.” In the end, technical excellence is not enough. Mechanical words and statistics cannot balm the wound of fearful uncertainty; true healing lies in the relationship between doctor and patient. “Before operating on a patient’s brain, I must first understand his mind,” Kalanithi explains. By separating the physical from the mental, the tangible from the intangible, Kalanithi can recognize the patient not as an object, but as a soul, a being in possession of an “identity,” “values,” and knowledge of “what makes his life worth living, and what devastation makes it reasonable to let that life end.” At heart, technical excellence without relationality is like a stained glass window without light. In a society that too often reduces human beings to numbers — the effect of a worldwide prosopagnosia — Kalanithi urges readers to view humanity as a group of individual beings, not a mere collection of data.
Once Kalanithi was diagnosed with cancer, his perspective on death changed. Kalanithi writes:
I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely.
Previously, as a doctor, Kalanithi saw death as the force he grappled with to attain several more grains of time. In relation to himself, like many human beings, he viewed death as inevitable but not imminent. Death’s shadow was omnipresent, but it was forgotten amidst achievement, distraction, and the sense of immortality that accompanies the two. But now, as a patient encountering the fatal presence in his own body, he felt it. He tasted it. At the pinnacle of his career, Kalanithi was greeted with his finitude.
And his response?
Finding meaning in the life that remained. To acknowledge one’s mortality is to acknowledge time’s transience. In the face of these two giants, Kalanithi searches for what is significant and what makes his life meaningful. This search results in two significant decisions: the decision to have a child and the decision to write this book.
Kalanithi explains, “If human relationality formed the bedrock of meaning, it seemed to us [he and his wife] that rearing children added another dimension to that meaning.” At heart, this line confirms one of the memoir’s underlying messages: life’s meaning is rooted in relationality. Kalanithi found value in his relationships with his patients, his family, his friends, the world, and God.
When Breath Becomes Air is both practical and deeply personal. It reads as both a guide to living well and a love letter to Kalanithi’s daughter. Death is integral to the memoir, laced between the lines and stamped in the cover Kalanithi never held. Like his life, the book was half-finished; his wife and a team of editors worked to publish it posthumously in 2016. Even so, the memoir radiates with life — as Kalanithi quotes Samuel Beckett, “birth astride of a grave.” In Kalanithi’s poignant reflections and in the promise of his child’s life, death and life compose the pages of the memoir.
When Breath Becomes Air offers readers a new perspective on mortality, an echo of memento mori, and reveals, through Kalanithi’s life experience, how to live and find meaning when breath is still breath.
Although of American descent, Abigail Blessing was born in Pakistan and has lived nearly all fifteen years of her life in Malaysia. From an early age, she has been intrigued by the dark and the deep dimensions of life, prompting her to take an interest in topics of art, death, isolation, and morality. When Abigail is not penning stories or essays, she takes pleasure in reading classic literature, wading through nature, playing the violin, and blogging at abigailblessing.com.