Review: When Breath Becomes Air, Paul Kalanithi

Review: When Breath Becomes Air, Paul Kalanithi

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 making a living treating the dying, and the next he was a patient struggling to live… 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?

When Breath Becomes Air details the way neurosurgeon Paul Kalanithi handles his cancer diagnosis at just thirty-six years old. For him, the world is ripe with promise until he stares back at black and white images of a body riddled with metastatic tumours. His own body. His tumours. It was then he stepped out of his scrubs, and into the shoes of a patient. A sobering holiday read I’ll admit, but one many nurses have recommended. Spoilers below, of course…

Paul dies. He dies at thirty-seven years old. I should warn you that reading his book is essentially reading a self-penned obituary. And when the reader accepts that fact – something that is unashamedly screamed right from the prologue – the way we read the book shifts from hope, hope that he (and the thousands of other cancer patients) somehow makes it, to bleakness. Knowing that there is no happy ending, really. And no real universal ‘this is the hope for mankind’ answer to the questions Paul wanted answers to.

One theme that lingers on Paul’s mind as he writes, is time. When he receives his diagnosis, he wants to know the time he has left. As a nurse, I’ve been privy to a few of those Breaking Bad News conversations. Patients always want to know how much time. Do I have days? Weeks? Months? Will I see my next birthday? Will I see the next decade? You see, a day is just a day. For many of us, a day is spent on things that probably don’t matter too much. Work. Seeing friends. Making those banal phone calls, heading to the shops to pick up groceries on the way home. But Paul asks us to think about a Day, the last Day, and how we would spend it. Would we spend it the same way if we knew it was our last?

‘The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases.’

Paul needs to know – but would never actually find out – how much time he had left.

As a book detailing the insight into our own mortality, and the dedication of medical professionals who place their lives on hold to learn their craft, it’s fascinating. His accounts of coming face to face with cadavers – ‘donors’ – and performing autopsies, his experiences with patients as he gave good and bad news, his mistakes as a surgeon which caused irreparable damage coupled with his success as a physician are an incredible insight into his life’s work.

Paul was a doctor, and having worked alongside some incredibly intelligent doctors, surgeons and consultants myself it’s clear that while brimming with knowledge about how and why things are done after a terminal diagnosis, many – and I say this as an anecdotal generalisation based on my own experience – don’t have a natural empathy for people and their emotions. Generally, the focus is on self-betterment, and disease, injury and illness is a method by which to propel them further. The person at the other end is of secondary concern, a case study, a cadaver. Nurses, however, seem to be born dripping with the stuff, placing ourselves in the shoes of our patients as they celebrate and commiserate fears and hopes, rather than focusing on the success or failure of a treatment. The contrast in practice was immediate to me and perhaps this is why so many nurses have recommended the book, as a peek into the side of medicine we aren’t interested in.

Ignore the flowery poetry – much of the language felt forced, using prose far too complicated to fit with the autobiographical nature of what was being discussed. I’ve never been one to enjoy literary classics and having to read, re-read and read (yet) again entire paragraphs to get some sense of meaning jilted me out of the scene entirely. Also, read quickly Paul’s witterings about his education. At times, it felt like I was reading an elaborate (and pretentious) ego-focused resume rather than a reason as to why Paul ended up studying medicine over literature. He was a doctor’s son. His journey to medicine would not be unique or a struggle with his father’s connections. Would the story be affected negatively had we not known about those late-night conversations pondering the meaning of life with fellow upper-class Cambridge students? Not at all.

Of course, it’s difficult to forget that this book wasn’t written with what most authors have: time. It was written as the last works, a final self-indulgence by a man who knows each chapter would never be as finished, as detailed, as perfect, as he would have liked.

I must add – the reader should decide their own answer to Paul’s question. What makes life worth living? Initially, Paul looked down at fellow students who put ‘lifestyle’ before their career and opted for ‘jobs’ in ‘easy’ subjects such as dermatology, rather than his own forty-year career plan for perfection. It took him his diagnosis and impending mortality to realise that perhaps, perhaps, his thinking was skewed. For him, his meaning arrived when having a child, and his closing paragraph is dedicated to her. In fact, this shift from career to care is reflected in his opening chapters; just a page is given to the near-irreversible breakdown of his marriage, while entire pages wax lyrical about his own pursuit of education and desire to be better than his fellow high school students.

For many of us who don’t have the privilege of a stellar career or letters after our names, do we need to be told this? No. Many of us who stumble through life making the best of it we can know the value of friends and family. They are what matters, and while careers are a worthwhile flourish, when a simple day becomes a Day, it doesn’t matter.

Overall, the book was a good – if quick – read. The epilogue by his wife, Lucy, answered many questions Paul didn’t have the time or inclination to delve deeper into. And really, when faced with our impending mortality, nothing we do will feel like we’re ready to say, ‘I’m done.’ A melancholic read that I’d recommend to all student nurses, and anyone interested in reading the final thoughts of a doomed surgeon.

When Breath Becomes Air
ISBN-13: 9781784701994
ISBN-10: 1784701998
Publisher: Vintage
Published: December 2016

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