Book Review – When Breath Becomes Air by Paul Kalanithi
July 07, 2022
When breath becomes air book


The book stood silently on my bookshelf, awaiting its turn. Perhaps it heaved a sigh every time I picked something else – a glossy new read from the library, a highly recommended audiobook or even a classic. I love memoirs yet I hesitated to pick this one. Why? Because I knew the story. Or thought I knew it. A tragedy. 

The author, a brilliant neurosurgeon on the threshold of embarking on the glorious career he had worked so hard for, had died without fulfilling his potential. He had left behind his widow, his infant and a heap of unfulfilled dreams. It was only after I read it did I understand what he had truly left behind – a legacy.

Reading a medical memoir takes stamina

Stories like Paul Kalanithi’s need a different kind of mindset for reading. You need to give yourself over to the narrative and be prepared to jump on an emotional rollercoaster. At the very least, you need to give it respect by giving it your full attention. And so I decided to read in on my flight to India. I figure the five-hour journey from Singapore would be perfect for this compact hardcover book with a pale blue feather that epitomized the title.

I was prepared for tears. I was prepared to be moved. What I was not prepared for was the beauty of his prose. How can a neurosurgeon wield both the scalpel and words with such exquisite precision? Turns out Kalanithi was a student of literature and philosophy much before he turned his focus to medicine. And he was a master of both these tools.

Of doctors and patients

The book starts at the beginning – with the dark diagnosis of metastatic lung cancer. For someone who can read the scans as easily as we read words, he knew his prognosis was not good. But hope is what keeps both doctors and patients going. Kalanithi was now seeing it from the other side of the table. In the same hospital where he came to work, he now came for treatment and consultation. 

Without an iota of self-pity, he tells us his story. Of growing up in Kingman, Arizona as a second-generation Indian American, the second son in a family of doctors. We get to learn of his roundabout way into medical school and from details about his surgical experiences, we learn about the precision required to perform brain surgery where an operation is not simply a matter of accurately excising tumors but carries with it the possibility of altering or taking away the faculties or worse, the essence of the person. 

Interspersed with medical descriptions are amazing quotes, some by literary greats, but also beautiful observations by Kalanithi himself. There is much to learn from Kalanithi’s short life. 

Making sense of life

For those of us struggling to find clarity, it is a reminder to live life knowing that it is a terminal condition. We have all heard this before but what does it really mean?

“Death may be a one-time event, but living with terminal illness is a process.” 

What is one to do when handed a diagnosis of advanced stage cancer?

The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?” 

Each of us has to ultimately find the answer to this question – “What makes life meaningful enough to go on living?” It may change over time but it is one we must grapple with, again and again, to shape the years that still remain.

Does living get easier once you have enough practise? Once you have blown a large number of candles on your birthday cake? Or does it gain significance only when we study it?

“If the unexamined life was not worth living, was the unlived life worth examining?” 

Ultimately, we come to the realization that all life is beautiful and sacred. Whether it belongs to the brilliant surgeon wielding the tools to heal a human or the helpless patient who turns over his fate to the physician. Kalanithi gets to see both sides in his brief life and the book is a meditation on the human aspect of living, not a chronicle of medical treatment.

Life is not lived in the balance sheet that we contemplate at the end, it is in every moment that we take for granted, every idle thought we entertain and in each breath we take.

 “There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.” 

My opinion: For all fresh graduates and to those contemplating retirement and everyone in between, this is the book you must read if you want clarity and meaning in your life.


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