When Breath Becomes Air is the poignant and true story of Dr. Paul Kalanithi who died of lung cancer in 2015 at the age of 36. A gifted neurosurgeon in his residency at Stanford University Hospital, in one moment he was saving the lives of others and the next struggling to save his own. In this powerful memoir, Kalanithi describes his cancer experience as a physician and healer, husband, friend and father. With a foreword written by Abraham Verghese, author of Cutting for Stone and a fellow physician, Verghese prepares readers for the impact of this amazing journey. “Be ready, be seated. See what courage sounds like” (pg. xix).

The opening chapter rivets the reader as the author learns of his grave diagnosis and then, later, to his remarkable revelations as we witness a doctor become a patient. Stories of medical school are woven into the book as he recounts both success and failure as physician—“a glimpse into both life, but also death.” Kalanithi writes of his years as an intern and resident, caring for the sick and dying. “At moments the weight of it became palpable. It was in the air, the stress and misery. It had a suffocating weight of its own” (pg. 78). Dr. Kalanithi eloquently describes that his ability to heal and cure was both a blessing and burden. “Being with patients in these moments certainly had its emotional costs but also 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” (pg. 97).

Struggling with significant issues such as work, family, relationships, pain and illness, he found that hope and his future was a rapidly changing scenario. Being trained as a physician enabled him to understand his diagnosis and prognosis but what it did not provide was clarity as a patient. Decisions involving his medical practice, to have a child or to completely alter the course and direction of his life threatened his sense of stability. “Like my own patients, I had to face my mortality and try to understand what made my life worth living” (pg. 71).

The author describes in meaningful and powerful words the roller coaster that is the cancer experience. From the diagnosis to initiation of treatment, we follow him through the chemotherapy, scans, lab work, appointments and schedules. Eventually, hope arrives in the form of a PET scan showing stable disease, which allows him an opportunity to re-evaluate his life. It was during this time Dr. Kalanithi discovered language and literature. “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. I felt that to understand my own direct experiences, I would have to translate them back into language” (pg. 148). Writing would become the way he would feel reborn in the experience and cancer would provide the landscape that lends itself to his written word.

Dr. Kalanithi eventually decides to return to his work as a neurosurgeon and complete his residency at Stanford. Faced with a grueling surgery schedule, he remained committed to graduation with his peers. Entertaining a job interview with a prestigious university hospital offered him a glimpse of a life’s work that would not be realized. The impact of a life limited by cancer came back to a harsh reality. “The curse of cancer created a strange and strained existence, challenging me to be neither blind to, nor bound by, death’s approach. Even when the cancer was in retreat, it cast long shadows” (pg. 165).

Eight months before his death, Paul’s wife, Lucy, gave birth to their baby daughter, Cady. Knowing his time with her would be brief, he found true joy in experiencing this newborn life, calling his beautiful daughter “a blank page on which I would go on.”

When Breath Becomes Air gives the reader an inspiring glimpse into a highly personal cancer story. Page after page we are observers of a brilliant mind’s ability to comprehend what is often incomprehensible—our own mortality. Exploring existentialism and traditional religions, the author sought answers to questions not found through the science of microscope or lab, but those truths discovered only by being human. “Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life; hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue. No system of thought can contain the fullness of human experience” (pg. 170). The title of the book takes its roots from an important poem,

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

To those of us who care for individuals with cancer, this influential book provides an understanding of how words can have vast meaning in reconciling emotional and psychological conflict when faced with terminal illness. Oncology professionals have been given a gift by Dr. Kalanithi’s written word. In sharing his story, he reveals to us how to help our patients find meaning both in living and in dying.