When Breath Becomes Air by Paul Kalanithi | Sister Review

When Breath Becomes Air by Paul Kalanithi | Sister Review


This review is a combined effort between me and my sister. Every month we will read a book that is outside our comfort zone and review it by asking each other questions related to the title we are reviewing. The idea is to provide you with two different perspectives: that of an English student and a medicine student.

This review might contain spoilers, as we may discuss any part of the story (sometimes the questions we ask each other might be general, while other times they might touch upon something specific about the ending, etc). If you have not read the book and do not wish to be spoiled you might want to avoid this post.

When Breath Becomes Air by Paul Kalanithi | Sister ReviewWhen Breath Becomes Air Published by Random House on January 19th 2016
Genres: Non-fiction
Pages: 208
Format: Hardcover
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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.

The English student to the med student:

What did you think about the medical jargon of When Breath Becomes Air? To me, a non-med student, the medical terms appeared to be very easy to understand. Was the explanation too oversimplified in your opinion?

I think Paul Kalanithi wrote his book in a perfect way. It was easy to read because of the beautifully written prose he used and I think it was approachable for both medically and non-medically schooled people. Personally, I don’t think that he oversimplified anything. Of course, he explained some terms, and his personal course of his disease was written in a more simplistic way, but I think that that’s what made the book so strong. His story wasn’t just a case he saw passing by, he had to live it, and therefore he wrote the book in such a personal and less medical manner. There were quite a few terms that he didn’t explain further, but even when he did it wasn’t something that stood out or I was bothered by. At the end of the day, it is impossible to know the exact definition of every diagnosis and having something explained only proves helpful.

Did the situation Paul finds himself in, and his narrative of all he endures, scare you? You study so long to work in this field, only to perish from something that you study to treat. 

I think in a way, everyone is afraid to die and, more specifically, everybody is afraid to die a long painful death. So, in that way, yes. When Breath Becomes Air, Paul’s story, is so beautiful and raw that you feel everything and the thought that this might happen to me, or to someone close to me that I love is something I don’t even want to think about.

As a med school student, you get trained to recognize what they call ‘alarming symptoms’, and they drill it in that you always have to check for these complaints. I think that doctors feel like they will be able to catch such a disease before it can have a fatal impact, but at the end of the day we are all people, and when things get scary we try to make them less scary. Not to mention that it is almost impossible to catch this kind of disease before it has wrecked havoc on your body.

I think When Breath Becomes Air did open my eyes in some ways. Med school is a long trajectory and when I look back at the past years I notice that I postpone certain things because I am busy. Med school takes so much of your time, but at the end of the day you only have one life to live and as Paul’s story showed you don’t know how long you get to live it. I made the decision to stop postponing social events and meetings with friends for when I have more time. I love med school, but it shouldn’t define me like it almost did Paul at certain moments. So now I do try to meet up more with friends more often and do the things I want to do without pushing them back for ‘when I have the time’.

Paul describes and approaches parts as med school very lightly. It almost feels like he brushes over them whereas he mentions small things, small events in his study, that have a big impact on him as a person. It seems like those small moments are the ones that almost seem to break him at times. Can you relate to this?

I think this is something that every medical student can relate to. By learning about all kinds of disorders, a lot of them deadly, you somehow learn to tune out the part where you realize that a lot of people suffer from a particular disease. However, sometimes it does hit you… I remember a particular case about a woman that had a pregnancy wish and even though we had discussed these kinds of cases a million times, this one hit me hard, and I sat in class to thoroughly saddened and wishing that there was something that I could do for her (this was a paper case; I had never even met the patient). I think this is a way of coping with everything you see as a med student. Sometimes this mechanism shuts off the small things, the things that seem insignificant, and then that small thing ends up being the straw that breaks the camel’s back. Then, 15 minutes later you’re ready to go at it again.

The med student to the English student:

Even though When Breath Becomes Air was about Paul’s last months and his transition from a doctor, to a patient, to a dying man, he always had the dream to write and publish his own works later in life. As an English literature student, how did you perceive Paul Kalanithi’s writing?

His writing, to me, was incredibly memorable. It was fast-paced, which was evidence of how fast his time was running out, yet incredibly poetic with a beautiful flow to it. The way he spoke, or more accurately wrote, conveyed that he was an intelligent man. At the same time the subjects he touched upon somehow felt easy to understand through his literary explanations. I always have trouble with medical jargon. It feels distant and I always find myself unable to follow, but Paul Kalanithi combined his passion for medicine and literature and turned it into beautiful prose. It is perhaps one of the most memorable pieces of writing I’ve ever encountered for that very reason. He uses literature to describe certain medical issues and I found myself completely engrossed.

In the beginning of When Breath Becomes Air, Paul describes his youth and how his mother tried so hard to keep them on the straight and narrow, all to give them the best chance to get into some great colleges. While doing this she made him read certain books. He says that this was the most dangerous thing that she could have done, for his love for literature started there. Can you relate to this?

I can always relate to a fellow bookworm. Although, my parents never truly had to make me read books, really, I did that all on my own. My parents never really pushed for great colleges. They encouraged us to learn, but they never forced us. They encouraged by taking trips to the library (and taking home way more books than the limit that was set beforehand) or by giving us a small allowance and taking us to the bookstore when we saved up enough money to buy the next Harry Potter installment. While I have always loved to read, I never was the kind of child that read ‘classic’ literature.

I finally fell in love with the classics during high school when I discovered a fondness for Jane Austen’s wit and sarcasm. This opened the way for me to explore the classics and fall into the world of poetry and led me to discover the wonders (and hardship) of Shakespeare, Dickens, T.S. Elliot, and more. I always loved to read, but I learned to love literature at a later age and I have been obsessed ever since. I think I can most definitely relate to what Paul Kalanithi calls the dangers of literature. If there’s one thing I’ve learned is that it’s a love that’s never truly satisfied. There are always more books, more words, and sentences to be read and enjoyed. You’re never truly done.

Unfortunately, Paul couldn’t finish his autobiography. His wife did this for him by writing the epilogue and telling us readers how his final days were spent, the following funeral, and how she managed to move on. To me, this was very touching as you could read the love she still felt for her late husband. How did you perceive the epilogue? Was it structurally as good as the rest of the book written by Paul himself? Or did you have some difficulties with her way of writing?

The way this book ended, with the epilogue this way, is what makes the ending so powerful. Her writing is incredibly powerful and emotional. Her words are what broke me down. When you start reading When Breath Becomes Air you know the way it is going to end. There’s this sense of impending doom throughout the entire book and Lucy brought a measure of peace with her words. I felt quite hopeless near the end of the novel and, although her unflinchingly honesty was sometimes hard to take, the grief in every word, Lucy brings a spark of hope to the story as well. That, to me, was beautiful. Her prose, too, was beautiful and I think you’ll find her touch upon Paul’s work infused throughout the entire novel as Lucy was the one to bring When Breath Becomes Air to completion.

While reading Paul’s last chapter I had a certain moment thinking ‘this would be the perfect ending.’ It’s a sad and terrible ending, but it’s almost like he’s concluding his story here, without knowing that this was actually the last chapter that he would ever write. Did you feel the same way?

Definitely, I think part of what makes this book so powerful is its ending. Paul had his life taken away at such a young age, but When Breath Becomes Air isn’t a story about dying, it’s a story about living. Paul Kalanithi was an incredibly talented and inspiring individual who had some incredibly important things to say about life and about living life. I think the ending of When Breath Becomes Air conveys this view: even in that last chapter Paul Kalanithi wasn’t focused on death, he was focused on living and that’s what makes the ending so powerful.