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"For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living? At the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both. Advance praise for When Breath Becomes Air "Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi's memoir is proof that the dying are the ones who have the most to teach us about life."--Atul Gawande "Thanks to When Breath Becomes Air, those of us who never met Paul Kalanithi will both mourn his death and benefit from his life. This is one of a handful of books I consider to be a universal donor--I would recommend it to anyone, everyone."--Ann Patchett"--
"At the age of 36, on the verge of a completing a decade's worth of training as a neurosurgeon, Paul Kalanithi's health began to falter. He started losing weight and was wracked by waves of excruciating back pain. A CT scan confirmed what Paul, deep down, had suspected: he had stage four lung cancer, widely disseminated. One day, he was a doctor making a living treating the dying, and the next, he was a patient struggling to live. Just like that, the future he and his wife had imagined, the culmination of decades of striving, evaporated. With incredible literary quality, philosophical acuity, and medical authority, When Breath Becomes Air approaches the questions raised by facing mortality from the dual perspective of the neurosurgeon who spent a decade meeting patients in the twilight between life and death, and the terminally ill patient who suddenly found himself living in that liminality. At the base of Paul's inquiry are essential questions, such as: What makes life worth living in the face of death? What happens when the future, instead of being a ladder toward the goals of life, flattens out into a perpetual present? When faced with a terminal diagnosis, what does it mean to have a child, to nuture a new life as another one fades away? As Paul wrote, "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. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live." Paul Kalanithi passed away in March 2015, while working on this book"--
On the verge of completing a decade's worth of training as a neurosurgeon, Kalanithi was diagnosed with stage IV lung cancer. Just like that, the future he and his wife had imagined evaporated. Kalanithi chronicles his transformation from a naïve medical student into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.… (mer)
This is an interesting book. I'm not sure how I feel about it. It's the very sad story of a smart man who trained in neurosurgery and English literature who became too ill to survive past his residency. It's an odd book. The author spends a great deal of time in self-praise and self-congratulation, something which I don't fault him for, given that the writing was done after he became ill. There's a natural tendency to look back over your life and try to make it meaningful when life throws you a curveball. It saddens me a bit, since he is so obviously intelligent and well-read to feel the distance from him in this memoir. Others who have been in similar situations are able to bring forth some humanity or deep connectedness; in this book Kalanithi comes across as surprisingly uninvolved in his life. Part of this no doubt is due to his chosen specialty - neurologists play with the brain, and this gives them often a feeling of being above, separate, somehow closer to God. That said, this book is written by a man who was treated badly by fate, whose life was completely disrupted. As someone who lives with a chronic, progressive disease, I know the inward focus this can give you, as you cope with having to change your world plan every few months. I wish his family well, and I am sorry for their loss. This does remind me of the insignificance of much of what we brag to ourselves about, achievements and degrees, prizes and worldly successes. It is very thought-provoking, especially in a story about one who lived such a privileged life. I wonder how this story would work out in a poorer family, one, say, whose Medicare has been capped. Whose options are foreshortened. It all makes me quite sad. ( )
Yeah, this was definitely a tough one to read (for the right reasons, obviously). I will say that I preferred the first half of the book to the second half, though. The first half is just so raw, insightful, and depressing. Paul's journey through medical school and residency has genuinely made consider whether or not I really want to go down the same route (for context, I'm currently applying to medical school and am also considering doing neurosurgery after graduating). It is just so blunt. Paul did not hold back with his choices of patient interactions to include; furthermore, the sheer number of work hours, the razor-sharp precision required, the enormous responsibilities held by the doctor, and the monumental risk of causing harm all contribute to making neurosurgery seem extremely daunting. The story of one of Paul's surgeon colleagues committing suicide after the death of one of his patients was unbelievably depressing to me. Worst of all was Paul's story: going through hell and back with medical school and residency, reaching the promised land of graduation, and getting offered a dream job with an insane salary, only for cancer to take it all away. The last few paragraphs written by Paul almost made me tear up, man.
Of course, I can't review this book without discussing its philosophical side. Now, just so you know, my reading literacy is atrocious; I suffer from certain mental health problems that give me a lot of issues with focus and critical thinking; consequently, my brain power is extremely low. If you're looking for insightful analytical reviews from people who are good at this stuff, my reviews (of any form of media) are not for you. Anyway, I found Paul's thoughts to be quite interesting. I don't agree with all of them (mainly because of my existential crises and lack of meaning in life), but it was quite intriguing reading about a dying man's search for meaning. I also love how it all fit together. Paul's motivations to understand the brain, meaning, life, and death were what drove him to enter medical school. Eventually, he wanted to put his patients at the forefront of his care and become a guider through their futures; he didn't want them to just be "boxes to tick off". Ultimately, the roles would reverse, and he would have to be guided through the last years of his life by his doctor. It was quite mesmerizing to read about, honestly.
I did find Paul's writing style somewhat weak, unfortunately. It wasn't bad by any means, but it wasn't that great either. The constant literary references and overlong descriptions did slow the pace of book quite a bit. Furthermore, while I found Lucy's epilogue to be poignant, I felt that it dragged on for a bit too long. Maybe, I'm a really impatient reader. I don't know. Though, I will say that I found her writing style to be easier to read than Paul's.
At the end of the day, this is going to be a tough one to get through, no matter which way you look at it. It is definitely not for the faint of heart. You'll come out of it realizing the cruelty of life. Paul and Lucy's thoughts on living and dying may give you some comfort, but you'll end up just wishing that things went a different way. It is insanely difficult not to feel that way after spending so much time in this great man's thoughts and perceptions. ( )
The autobiography of the author, a neurosurgeon, who is diagnosed with stage 4 cancer at age 36. I admire both him and his wife for the courageous, yet calm, fight and then acceptance of the inevitable. The book is based on the question, "what makes life worth living?" 276 pages ( )
I can see how this could be really moving for people who haven't read much about dying in America in the 21st century... but I've done a lot of that, so I was frequently distracted by a couple of things:
1. No matter how much you know, the American medical system is still more fucked than you realize. 2. The American system for training doctors is profoundly fucked. 3. People who are much smarter and vastly more hardworking than me still miss the point. A lot.
Still, accounts like this are rare and always worth reading. Just don't let yourself get swept up in the idea that he got it all figured out before passing. ( )
“When Breath Becomes Air” is gripping from the start. But it becomes even more so as Dr. Kalanithi tries to reinvent himself in various ways with no idea what will happen.
Part of this book’s tremendous impact comes from the obvious fact that its author was such a brilliant polymath. And part comes from the way he conveys what happened to him — passionately working and striving, deferring gratification, waiting to live, learning to die — so well. None of it is maudlin. Nothing is exaggerated. As he wrote to a friend: “It’s just tragic enough and just imaginable enough.” And just important enough to be unmissable.
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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, while you be, But steps to your eternity.
— Baron Brooke Fulke Greville, “Caelica 83”
Dedikation
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Inledande ord
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I knew with certainty that I would never be a doctor. — Part One
I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumours, the spine deformed, a full lobe of the liver obliterated. — Prologue
Citat
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I knew with certainty that I would never be a doctor. I stretched out in the sun, relaxing on a desert plateau just above our house. My uncle, a doctor, like so many of my relatives, had asked me earlier that day what I planned on doing for a career, now that I was heading off to college, and the question barely registered. If you had forced me to answer, I suppose I would have said a writer, but frankly, thoughts of any career at this point seemed absurd. I was leaving this small Arizona town in a few weeks, and I felt less like someone preparing to climb a career ladder than a buzzing electron about to achieve escape velocity, flinging out into a strange and sparkling universe.
Though we had free will, we were also biological organisms -- the brain was an organ, subject to all the laws of physics, too! Literature provided a rich account of human meaning; the brain, the, was the machinery that somehow enabled it. It seemed like magic.
Literature provided, I believed, the richest material for moral reflection.
Moral speculation was puny compared moral action.
I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion.
In anatomy lab, we objectified the dead, literally reducing them to organs, tissues, nerves, muscles. On that first day, you simply could not deny the humanity of the corpse. But by the time you'd skinned the limbs, sliced through inconvenient muscles, pulled out the lung, cut open the heart, and removed a lobe of the liver, it was hard to recognize this pile of tissue as human. Anatomy lab, in the end, becomes less a violation of the sacred and more something that interferes with happy hour, and that realization discomfits. In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.
It was not a simple evil, however. All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escoret them into the world, and then back out. Seeing the body as matter and mechanism is th eflip side to easing the most profound human suffering. By the same token, the most profound human suffering becomes a mere pedagogical tool.
Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: neurosurgery, ICU medicine, neurology, radiology. Not only would I have to train my mind and hands, I realized; I'd have to train my eyes, and perhaps other organs as well. The idea was overwhelming and intoxicating; perhaps I, too, could join the ranks of these polymaths who strode into the densest thicket of emotional, scientific, and spiritual problems and found, or carved, ways out.
I wondered if, in my brief time as a physician, I had made more moral slides than strides.
I feared I was on the way to becoming Tolstoy's stereotype of a doctor, preoccupied with empty formalism, focused on rote treatment of disease -- and utterly missing the larger human significance.
As a resident, my highest ideal was not saving lives -- everyone dies eventually -- but guiding a patient or family to an understanding of death or illness.
Any major illness transforms a patient's -- really, an entire family's -- life.
The root of disaster means a star coming apart, and no image expresses better the look in a patient's eyes when hearing a neurosurgeon's diagnosis.
A tureen of tragedy was best alloted by the spoonful.
Second, it is important to be accurate, but you must always leave some room for hope . . . I came to believe that it is irresponsible to be more precise than accurate. Those apocryphal doctors who gave specific numbers ("The doctor told me I had six months to live"): Who were they, I wondered, and who taught them statistics.
Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.
Being with these patients in these moments certainly had its emotional cost, but it also had its rewards. I don't think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life -- and not merely life but an another's identity; it is perhaps not too much to say another's soul -- was obvious in its sacredness.
Before operating on a patient's brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burderns are what make medicine holy and wholly impossible: in taking up another's cross, one must sometimes get crushed by the weight.
Perhaps unique in medicine, the ethos of neurosurgery -- of excellence in all things -- maintains that excellence in neurosurgery alone is not enough. In order to carry the field, neurosurgeons must venture forth and excel in other fields as well.
Certain brain areas are considered near--inviolable, like the primary motor cortex, damage to which results in paralysis of affected body parts. But the most sacrosanct regions of the cortex are those that control language . . . What kind of life exists withouth language?
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. The problem wasn't a scientific one. The fact of death is unsettling. Yet there is no other way to live.
It occurred to me that my relationship with statistics changed as soon as I became one.
What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find on her own. Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing morality has no remedy in probability.
I had passed from the subject to the direct object of every sentence of my life.
"Will having a newborn distract from the time we have together?" she asked. "Don't you think saying goodbye to your child will make your death more painful?" "Wouldn't it be great if it did?" I said. Lucy and I both felt that life wasn't about avoiding suffering. Years ago, it had occurred to me that Darwin and Nietzshe agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes. After so many years of living with death, I'd come to understand that the easiest death wasn't necessarily the best. We talked it over. Our families gave their blessing. We decided to have a child. We would carry on living, instead of dying.
I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again. The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language. Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward. And so it was literature that brought me back to life during this time.
Even working on the dead, with their faces covered, their names a mystery, you fund that their humanity pops up at you—in opening my cadaver’s stomach, I found two indigested morphine pills, meaning that he had died in pain, perhaps alone and fumbling with the cap of a pill bottle.
Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dyung, until I actually die, I am still living.
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.
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There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past. That message is simple: 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 a 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.
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"For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living? At the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both. Advance praise for When Breath Becomes Air "Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi's memoir is proof that the dying are the ones who have the most to teach us about life."--Atul Gawande "Thanks to When Breath Becomes Air, those of us who never met Paul Kalanithi will both mourn his death and benefit from his life. This is one of a handful of books I consider to be a universal donor--I would recommend it to anyone, everyone."--Ann Patchett"--
"At the age of 36, on the verge of a completing a decade's worth of training as a neurosurgeon, Paul Kalanithi's health began to falter. He started losing weight and was wracked by waves of excruciating back pain. A CT scan confirmed what Paul, deep down, had suspected: he had stage four lung cancer, widely disseminated. One day, he was a doctor making a living treating the dying, and the next, he was a patient struggling to live. Just like that, the future he and his wife had imagined, the culmination of decades of striving, evaporated. With incredible literary quality, philosophical acuity, and medical authority, When Breath Becomes Air approaches the questions raised by facing mortality from the dual perspective of the neurosurgeon who spent a decade meeting patients in the twilight between life and death, and the terminally ill patient who suddenly found himself living in that liminality. At the base of Paul's inquiry are essential questions, such as: What makes life worth living in the face of death? What happens when the future, instead of being a ladder toward the goals of life, flattens out into a perpetual present? When faced with a terminal diagnosis, what does it mean to have a child, to nuture a new life as another one fades away? As Paul wrote, "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. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live." Paul Kalanithi passed away in March 2015, while working on this book"--
On the verge of completing a decade's worth of training as a neurosurgeon, Kalanithi was diagnosed with stage IV lung cancer. Just like that, the future he and his wife had imagined evaporated. Kalanithi chronicles his transformation from a naïve medical student into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.
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