4.5 stars At age 36, in the last year of his neurosurgery residency, Paul Kalanithi discovered he had stage IV lung cancer. For the next 22 months, he and his wife Lucy, an internal medicine physician, awoke each day focused on living, not “living until...” When Breath Becomes Air was written largely because Dr. Kalanithi had the soul of a poet and turning to words to express any experience in life was as instinctive to him as breathing itself. His intent was that his story could aid in the healing of others and that one day his own daughter would read it and get a sense of the father she would never remember. The book’s format, like the author’s writing style, is simple, straightforward, eloquent, and unflinchingly honest – Prologue, Part I and Part II. In the prologue, Paul describes the first step in his diagnosis, getting x-rays for his recurring severe chest pain. It was 15 months prior to the end of his residency. He could see the light at the end of the long 10-year tunnel of preparation for his work in neurosurgery. There would be wonderful opportunities to practice as well as conduct research, offer of a professorship, a huge increase in income, a new home and starting a family with Lucy. The x-rays were fine, he was told. But he had lost weight and the pain was not letting up in severity. He began researching incidence of cancer in his age group. Things with Lucy were strained at that time, partly because he was not sharing his concerns about his condition. She decided against going with him on a vacation with old friends in order to sort out her own feelings about their relationship. He came home in severe pain after just a couple of days. She picked him up from the airport. After he told her about his symptoms and his self-diagnosis, she took him to the hospital that night where a neurosurgeon friend admitted him. Most of Part 1, In Perfect Health I Begin, describes life prior to the diagnosis, obviously back to his childhood. Both of his parents were immigrants from India, his father a Christian and his mother Hindu. Both families disowned them for many years. They moved their own family of three sons from Bronxville, New York to Kingman so Paul’s father could establish a cardiology practice, which he did very successfully. Paul’s mother had been trained as a physiologist in India before eloping with Paul’s father when she was 23. Her own father had defied the traditions of 1960s rural India and insisted that his daughter be educated and trained for a profession. She was horrified to discover that Kingman’s school district was among the lowest performing in the entire country. Her eldest son had been educated in Westchester County, New York schools, where graduates were assured of admission to the nation’s most prestigious universities. He had been accepted at Stanford before the move to Kingman. What would happen to 10-year-old Paul and his 6-year-old brother Jeevan? Instead of wringing her hands, Mrs. Kalanithi threw herself into supplementing her sons’ educations and improving that of all the children in the area. She gave Paul a reading list intended for college prep students and at age ten he read 1984, followed by many other modern and traditional classics. He discovered a love for words as an expression of the human spirit. His mom got elected to the school board and worked with teachers and others to transform the school district. After a few years their 30+% dropout rate was greatly reduced and graduates were getting accepted at universities of their choice. No doubt Paul was born with that poetic soul, but it was his mother’s guidance that led him to read the literary giants who nourished that soul. It was his parents’ examples of excellence in their own lives, their faith, and service to their community, in this strange land that they made their own, that formed Paul’s desire and need to serve. In When Breath Becomes Air, he writes of vocation, a term you rarely hear people use these days. A thousand years ago when I was growing up, vocation was ubiquitous. We were told time and again that discerning our vocation was one of our prime responsibilities as human beings. It was our reason for being here, what we were called to do in service to humankind. Teaching, medicine, religious ministry, musicianship, military, etc. By knowing our natural talents we could know our vocation. Paul had many talents and interests, complicating his vocation decision. He studied both English literature and human biology in college. “I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Also a man of deep spirituality, Paul reflected, “Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.” The intersection of science and morality was of prime interest to Paul. The rest of Part I describes how Paul came to see medicine and then neurosurgery as his vocation. He forthrightly deals with the idealism of medical students and residents and how that idealism is dimmed or completely snuffed out by the realities of giving medical care to other human beings. His explanation of cadaver dissection and why physicians and their families do not donate their own bodies to medical science is eye opening. “Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.” This is the kind of honesty displayed throughout the entire book. He writes of his own loss of idealism and how the recognition of that affected his own self-image as well as his job performance. “I wondered if, in my brief time as a physician, I had made more moral slides than strides.” That earlier mentioned phrase, “the messiness and weight of real human life” describes this book. The author has given the world not a mere recollection of events or achievements, but has laid bare his soul, exposing the very marrow of his being. This book should be read by every premed student in the world before they commit to a decade or more of study and relentless hard work. In Part II , Cease Not till Death, the author details the diagnosis, the immediate aftermath, the determination to emphasize living not dying, the quest to conceive a child, and the agony involved in treatment. I think Part II should be experienced by each reader. Most readers will find it extremely compelling and very personal. It is the nitty gritty of this man’s inner being. Lucy, his wife, wrote an eloquent epilogue further detailing Paul’s experience while writing this book, the support they received from colleagues, friends, family, and others after his death on March 9, 2015. I found this book soul wrenching, but also witty, uplifting and hopeful. Without preaching, he reveals some deep flaws in the way we do health care and the price that not just patients but the care providers sometimes pay. In our war with cancer, it won a battle here by taking this remarkable man so early. He would have touched hundreds of students and thousands of patients with the professorship that would have been his. But When Breath Becomes Air is sure to touch millions of us. Cady Kalanithi will one day be able to read for herself just who her father really was. Rating: 4.50/5.0.

Paul Kalanithi’s WHEN BREATH BECOMES AIR is one of my favorite memoirs (along with Carmen Maria Machado’s In The Dream House). Full disclosure: I also write memoirs and read a variety of them. BREATH is in many ways a straightforward memoir. It’s a sickness memoir where the writer struggles with a debilitating condition. And I knew the ending before I started reading. Still the ending moved me more deeply than it should have. What distinguishes this book from others is the purity of Kalanithi’s voice. It is a voice that is urgent, beautiful, and outrageously kind. In the first half of the book, we see his struggle to become a doctor. In the second half, we see him navigate soul-crushing news. I wish we could have more books from Paul, but am grateful for this one. My own memoir is a bit more metaphorical as I explore the wondrous magic and terrifying monsters I’ve encountered in my sixty-year life. Kalanithi’s book is a reminder to me of the power of an author’s voice and story over an author’s style. It’s a lesson I won’t soon forget. Dwight Okita, The Invention of Fireflies (A Memoir), and The Hope Store

Talks and gives real life testimony to the life and death question we all face and what becomes of it when we have to look it in the eye. Great read

This truly is a MUST read for medical professionals and to be enjoyed by all. Beautifully written, thought-FULL, and an HONOR to read and share. A hearty congratulations for a profound book and many blessings to his family as they create their future without Paul but enjoying his continued love and legacy.

Paul Kalanithi was a neurosurgeon, a scientist, and an English literature and a philosophy graduate degree recipient. And at 36 years old, at the cusp of becoming all he worked so hard to achieve, he got the catastrophic diagnosis that he had terminal lung cancer. This sudden devastation concerning someone so accomplished and so promising is the starting point for a sincere, sensitive, and inspiring journey that you will take with him in his memoir to discover the meaning of existence and the acceptance of the inevitability of death. In his struggle to stave off the ravages of cancer and deal with the uncertainty of when he will “shuffle off this mortal coil,” he grapples with the most fundamental philosophical questions a human mind and heart and soul can imagine. And we are fortunate that he has written so eloquently and intelligently about those struggles in his memoir entitled When Breath Becomes Air. This is a hard and a glorious autobiography. It is hard because of the harrowing topic, but it is glorious because of what it teaches us as humans lost in a sea of confusion about the whys of living and the limits of life and knowledge—the search for meaning in a meaningless world. You will be captivated and enlightened by this amazing man, and you will be engrossed by the significance of his life and the meaning of his illness and death. The book is slim (229 pages) but extraordinarily powerful, moving, poetic, and philosophical. You will admire Paul Kalanithi for his decency and humanity, and you will lovingly respect his posthumously published last wondrous gift to us. As his wife Lucy says in her epilogue to the book: “He wanted to help people understand death and face their mortality.” With husband Paul’s wisdom and grace in this memoir, you will. On a personal level, this book was difficult but important as well. That is because I lost my spiritual father and mentor, who was a physician and psychiatrist, to the same cancer as Paul had. He, too, died too young. But he too would talk about facing mortality, about existential surprises, and the meaning of life. His voice accompanied Paul’s throughout my reading of this work. They were both comforting and inspirational. There is also a dear friend, a psychiatrist who helps many with grieving and is and has been my friend for many years and was my grief counselor. She is also like Paul and my spiritual dad in many ways. She was supportively with me in spirit as well when I was reading this beautiful and powerful memoir. When Breath Becomes Air is one of the most important books I have ever read, ranking up there with Night by Elie Wiesel and Man’s Search for Meaning by Viktor Frankl. It is that special.