breath becomes air

When Breath Becomes Air: what to do with that one day

Book Review: When Breath Becomes Air by Paul Kalanithi

After years of study, hard work and dedication, Paul Kalanithi hovered on the brink of a brilliant career as a neurosurgeon/scientist. Then he discovered he had lung cancer and the future, meant to be filled with a growing family and work he loved, dissipated like warm breath in cold air. He was 36-years-old.

“I had reached the mountaintop: I could see the Promised Land, from Gilead to Jericho to the Mediterranean Sea. I could see a nice catamaran on that sea that Lucy, our hypothetical children, and I would take out on weekends… I could see myself finally becoming the husband I’d promised to be.”

In his short memoir, When Breath Becomes Air, Kalanithi documents the sudden, brutal shift in his world, and the consequences of that shift. The title is taken from the first lines of Baron Brooke Fulke Greville’s  poem, Caelica 83:

You that seek what life is in death,/Now find it air that once was breath.

breath becomes air
Source: Neurology Blog

The book begins with the diagnosis and tracks backwards across his years of becoming, his preoccupations, hopes and dreams. We are at his side as he looks to statistics to predict a prognosis only to discover his relationship with statistics changes when he becomes one.

Kalanithi guides us, with grace and wit, through every twist and turn in his treatment. In the beginning, it’s a ‘two-steps forward, one-step back’ dance; for a time, he resumes his career. Then the dance becomes one-step forward and two-steps back.

At times, I wondered how he could push himself forward, but I think it came down to his values. He recounts how, on several occasions, his oncologist asked him to consider his values before making decisions. Values, as a concept, may have lost meaning in recent times, possibly because the word is overused by politicians and leaders who hawk “family values” or “(insert nationality) values” when they seek to push specific buttons.

For me, Kalanithi’s story is a compelling reminder that we need to re-focus on the true meaning of the word, i.e what is important to us, what do we cherish, what do we value? Only then can we discover how best to live rich lives, be they long or brief.

“Death may be a one-time event, but living with a terminal illness is a process… The truth that you live one day at a time didn’t help: What was I supposed to do with that day?”

Kalanithi never stops asking questions, never stops searching for the intersection between biology, morality, literature, and philosophy.” At its heart, When Breath Becomes Air, offers insight into how to live in the face of death from the unique perspective of a doctor/patient who is also an accomplished writer. It struck me as both sad and wonderful that Kalanithi fulfilled his potential in medicine and in literature.

He was also a loving and much-loved colleague, friend, brother, son, husband, and for a few shining months, father. As he writes towards the end, in a heartbreaking message to his baby daughter, “Words have a longevity I do not.” Paul Kalanithi’s beautiful memoir is a gift to us all.

YouTube Channel: Stanford

This post is a compilation of two posts by the author which first appeared on

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