When Breath Becomes Air is the memoir of Paul Kalanithi, a neurosurgeon who was diagnosed with terminal cancer in 2013, and died two years later. Published a little under a year after his death it’s a distillation of his thoughts on life, seen through the lenses of a lifelong passion for literature and the arts, and a keen awareness of mortality. Not many people see both sides of the doctor/patient relationship, nor have the combination of medical understanding, emotional awareness and literary skill to be able to offer such an honest and vivid depiction of this awful illness.
As well as being a talented doctor (you don’t become a neurosurgeon without being talented) Paul Kalanithi was clearly a gifted writer, and in his hands this is a spellbinding, heartbreaking story. Opening with the moment he was first diagnosed he builds up an honest, modest picture of a man who was about to reap the rewards of years of hard work and determination, only to see it all disappear in front of him. We see his formative years as a young man in love with literature and language but (like so many of us) without a clear sense of what he wants to do, until his path to medicine eventually opens up before him. His early years are crucial to the story, as they demonstrate the fierce desire in Kalanithi to find a way to understand and explain the human relationship between life and death, and the way in which he drew upon both his literary and medical studies and knowledge to help him come to terms with what happened.
Throughout the book there’s a sense of honesty on display, from the description of Kalanithi’s friendships and relationships to the depictions of the challenges he faced, first in striving to achieve his goals and then later in dealing with his illness. It’s all written clearly and simply, his descriptions of medical cases he worked on given the same level of attention as his own illness, and is utterly compelling despite the at times almost unbearable sense of inevitability that runs through the whole thing. After all this is the last thing he worked on, a heartbreaking testament to a fascinating man, made more poignant by knowing that he didn’t actually finish the book. His wife Lucy contributes the epilogue, her slightly more matter of fact tone feeling like an appropriate contrast to Paul’s more poetic language, but providing an even more emotional ending to a powerful book.
Some books stay with you for a long time, not because of their length or the skill of the author, but because of their heart. This is one of those books. It’s beautifully readable and impossible to put down, but at the same time it’s deeply sad, the sort of book that leaves you with an absence that’s slowly filled the more you think about it and live with it. It’s emotionally draining, but absolutely worth it.