Book Review: When Breath Becomes Air

Paul Kalanithi wrote “When Breath Becomes Air” during the trials of his terminal illness of metastatic lung cancer. From the twenty-two months from diagnosis to death, Paul wrote about the course of his disease. Paul offers a unique perspective since he was a medical doctor and neurosurgeon. One does not get a feeling of complaint over life’s unfairness. He could have had plenty of reason since he was about to finish his long residency in neurosurgery and begin a full life with a rewarding career. His wife Lucy is also a doctor. Paul would write with a searching mind seeking meaning during this difficult and painful struggle. The man had a brilliant mind. He graduated from college with majors in English and Biology. At one time he thought of becoming a writer. But he felt to truly understand the human condition; he must see life from a doctor’s perspective.

Initially Paul was put on a treatment of medication that was effective in killing cancer cells and reducing the size of tumors in his lungs. He was able to regain strength and return to neurosurgery. Regarding his cancer he said he knew all the technical jargon, understanding the scientific information of this disease. But he needed more than information. From his highly trained oncologist he needed what he termed “oracular wisdom”. What he meant was the wise counsel of one human being to another. He needed a human voice to help him feel better. Paul wrote “I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.” Interestingly when Paul had his initial meeting with his oncologist, he pressed with a question of how long he had to live, asking about some research on his kind of cancer. The oncologist stubbornly refused to answer that question. Instead she not only recommended treatment, but also encouraged Paul to think about what was important to him in life, and to continue to value and pursue such goals. A diagnosis of cancer does not mean life ends and only focus on months and years to live. Instead understand life in terms of cherished relationships and activity which give the gifts of satisfaction and meaning.

Paul was raised in a Christian home where Scripture, prayer, and church were parts of his upbringing. But in his medical and scientific studies he wandered from faith and entered into a time of hard-core atheism. He quoted a famous biologist, “The ancient covenant is in pieces; man at last knows that he is alone in the unfeeling immensity of the universe, out of which he emerged only by chance.” But he would give up his atheism saying “About God I could say nothing definitive, of course, but the basic reality of human life stands compellingly against blind determinism.” The beauty of the world, love between human beings, the meaning and practice of compassion and mercy argue against thought of a chance existence in universe whose only meaning comes from what science tells us. Paul said “I returned to the central values of Christianity—sacrifice, redemption, forgiveness—because I found them so compelling.” Paul mentioned attending worship services one Sunday in Lent and hearing the gospel reading of Jesus in conversation with the Samaritan woman at the well. Jesus offered to give her “living water”: “Everyone who drinks of this water will be thirsty again; but whoever drinks the water I shall give will never thirst; the water I shall give will become  a spring of water welling up to eternal life.” The woman at the well asked for this water so she would not have to keep coming back to the well. Paul chuckled to himself when he heard this reading because the woman at first took Jesus literally when he was actually speaking figuratively about faith. Paul wrote “It was passages like these, where there is a clear mocking of literalist readings of Scripture that had brought me back around to Christianity after a long stretch, following college, when my notion of God and Jesus had grown, to put it gently, tenuous.” Paul appreciated a deeper meaning from Scripture, not just a surface, literal meaning. He admitted that keeping faith is difficult; it is a lifelong searching for what is true.

Paul and Lucy decided to have a child after a time of deliberation considering his prognosis. A daughter was born, Elizabeth Acadia, nicknamed “Cady” on July 4, 2014. Paul would die on March 9, 2015. Paul would know his daughter for eight months and he wrote to her: “When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied, In this time, right now, that is an enormous thing.”  It is the work of the grace of God, that in those trying moments, what Paul wrote as facing the abyss, joy is known in love and being loved.

Have you read this book?  Share your  thoughts in the comments below?