When Breath Becomes Air by Paul Kalanithi: Bearing witness

Cover imageSo much has been said about Paul Kalanithi’s account of the twenty-two months from his diagnosis with lung cancer to his death at the age of thirty-six that I’m not sure what I can add of any value except to tell you emphatically to read it. This week sees its paperback publication in the UK. There will be piles displayed on tables in every bookshop you’re likely to enter. Don’t shy away from it because it’s winter, because you think it might be depressing and or because it feels like the world’s going to hell in a handcart: read it and be uplifted by Kalanithi’s eloquence, courage and the beauty of his writing.

Kalanithi’s account begins with his diagnosis then takes us back to his teenage years when he was convinced that he’d turn his back on the medicine much of his family practices and become a writer. Kalanithi was one of those rare people – equally at home studying the arts or sciences, only coming to medicine after taking a Master’s in literature. An epiphany led him to realise that only through medicine would he be able to come to an understanding of life and its meaning: he saw it as a calling not a job. He takes us through his training – the bone-deep exhaustion, the struggle between empathy and self-preservation and the difficulty of maintaining relationships while engaged in such emotionally, mentally and physically draining work. He and his wife, also a surgeon, are both open about the strains on their marriage. Half-way through the book, the doctor becomes a patient. Kalanithi describes the path his illness takes, the difficulty of being a patient and his wise oncologist’s insistence that he turn away from prognosis statistics and decide what meaning he wants to give to the life remaining to him. He and Lucy decide to go ahead with having a child – something they had planned to do in a few years – a decision which brings them both great joy. Kalanithi died on March 9th, 2015 when his beloved daughter Cady was just eight months old.

It’s not possible to write about Kalanithi’s book without remarking on the beauty and clarity of his writing, both in sentiment and description. When recounting dissecting his first cadaver he talks about the difficulty of separating its humanity from what he’s about to do then describes his first cut: ‘the scalpel is so sharp it doesn’t so much cut the skin as unzip it’. That struggle with empathy and the mechanics of what a surgeon must do is a dilemma Kalanithi returns to constantly, eventually electing to gently lead patients and their families towards the treatment that suits them, a world away from the scalpel-at-the-ready surgeons we see in TV hospital dramas. His priority is to find a meaning in life, to try to understand what that might be for each patient, then for himself when his own time comes. All this is amplified through anecdote, often expressed in lyrically beautiful prose: premature twins are born looking more like ‘preparatory sketches of children than children themselves’. Kalanithi’s humanity, compassion and courage shine out from every page, his concern for his patients palpable and his deeply probing thoughts about life and its quality enlightening. He was unable to finish the book he spent his last year writing but his wife has added an epilogue of equal thought and eloquence, tender yet clear-eyed. In it she says that Kalanithi was utterly determined to write a book which would engage his readers in understanding death and facing their mortality. That he has done, and done it with an admirable grace. Please read it.

20 thoughts on “When Breath Becomes Air by Paul Kalanithi: Bearing witness

  1. Annabel (gaskella)

    I am minded to break my TBR Dare to read this book after your wonderful review. For some reason I didn’t buy the hardback despite wanting to read it very much, but will definitely buy the paperback – to read after the TBR Dare.

    Reply
    1. Susan Osborne Post author

      Thank you, Annabel. It’s one of those books that, like Atul Gawande’s Being Mortal, I think everyone should read: a beautifully expressed object lesson in how to live, and how to die.

      Reply
    1. Susan Osborne Post author

      I do know what you mean, Marina, although I felt a powerful need to write about it. It’s one of those books I’d like everyone to read.

      Reply
  2. travellinpenguin

    I have put a hold on this from the library. It is always so sad when such brilliant, productive people die so young and so many dregs live forever. A theme that seems to be repeated over and over. A bit harsh as I’m sure if I knew some of who I call dregs I would probably like them. But I am referring to people who cause so much grief to others. I look forward to acknowledging his story.

    Reply
    1. Susan Osborne Post author

      Hard not to see it in those terms when faced with such a premature death of such a fine man. I hope you can read it soon.

      Reply
  3. Susie | Novel Visits

    Wonderful review! This book has been on my TBR list for awhile already, but your review makes me want to get to it as soon as possible! Thank you.

    Reply
    1. Susan Osborne Post author

      And thank you, Susie! It’s a very fine book written with such grace and courage. One that everyone should read.

      Reply
  4. bookbii

    This is one of those books which has been tugging at the edge of my consciousness for some time, and I suspect I will get around to reading it at some point this year though not quite yet. The slight inarticulateness of your review (not a criticism, it is charming) suggests that this is one of those books which connects with some innate, inexpressible part of ourselves which elevates the reading experience whilst making it impossible to explain why. Emotionally connective, uplifting but elusively so. I love those kind of books. I can’t imagine a stronger recommendation. Lovely review Susan 🙂

    Reply
    1. Susan Osborne Post author

      Thank you, Belinda. Impossible not to read this and remain untouched by it. I think it taps into those universal feelings about loss and death but it’s tremendously uplifting. There’s also the sadness of what this man – admirable in so many ways – might have achieved had he lived although another way to look at it is that this book is a continuation of that achievement.

      Reply
  5. Kate W

    You may think you have nothing to add in reviewing this book but GREAT REVIEW. I downloaded a sample of this a while ago but unfortunately the sample was the foreword, written by someone else! Think I need to revisit.

    Reply
    1. Susan Osborne Post author

      Ah, the forward is by Atul Gawande who wrote Being Mortal, another book that I’d categorise as essential reading. Thanks for your kind words, Kate. It almost felt like a redundant act to blog about it so much has already been written about it already.

      Reply
    1. Susan Osborne Post author

      I know what you mean: it’s such a powerful, beautifully expressed testament, isn’t it. I knew I wouldn’t be able to do it justice but felt I wanted to urge people to read it. Essential reading, I think.

      Reply
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