When Breath Becomes Air, by Paul Kalanithi

This book was actually a recommendation from a friend over a year ago, and I had always been interested in the perspective that was offered (Paul was a doctor and a patient). Essentially, the biography is of a neurosurgical resident nearing graduation, who is then stricken by terminal late-stage lung cancer. As the roles were cruelly switched, it was evident how unusual the transition would be. One passage states that Dr. Kalanithi was given the same room for his diagnosis that he once prescribed treatments for and explained surgeries and complications in. I took away many lessons from these heartbreaking passages.

I related a lot of Dr. Kalanithi’s childhood, with the drive to read and learn, and ultimately grow. The ambition and the strength of his youth resonated with me. Which made this a tough read. A really tough read.

Man, this book was tough to read.

  1. Doctors are not immune to the maladies that plague patients. It’s always a question at the back of everyone’s mind. Why don’t doctors get sick? Well, they do. They’re people too.
  2. The choice to have a child as death is approaching is a difficult decision, but Dr. Kalanithi says that until he is dead, he is still living. That was sound rationale for having a child for them, and sound for me.
  3. This career isn’t what half my peers are anticipating. It’s too grueling to be a “job”. Indeed, the obstacles to being a doctor are not there to deter you; they’re necessary. You really really have to be committed. I still am.
  4. Perhaps the most poignant lesson: a doctor’s job shouldn’t just be about extending life, but making life worth living and having discussions about that. Dr. Kalanithi calls himself an Ambassador for Death.
  5. Have a life outside of medicine, or it will consume you, as it did Kalanithi’s friend.

I had previously read that extending life is important, while also making sure that the patient’s desires are heard. There’s a fine balance there that’s quite difficult to achieve, especially if communication is impaired (from damage to critical speech and understanding areas in the brain).

In the first book I had read, it was mentioned that being honest with the patient was ideal, but this book incorporates another layer to that mentality: it talks about subverting the key words that scare people. At one point in my life, to make some money over the summer, I sold CutCo knives (terrible decision), and what stands out to me is the fact that when selling knives, you don’t say “One-thousand, two-hundred twelve dollars”, you just say “twelve-twelve”. Almost casually. This reminded me of that. Instead of using the term “brain cancer”, you just say “a mass found in the head”. In this way, you are being honest with them. In addition, giving broad ranges for survival is important, as it is honest but also lends hope.

Another huge lesson to me was how to face death itself, and how to tell patients about it. Dr. Kalanithi says that most people say that they would confront death with bravado, or extreme sadness. Kalanithi’s way was very honest, and he tried to keep his life very normal. While it is admirable, it is not the way I would approach it. While I would never be so confident as to say that I would beat cancer, I would certainly approach it like a fight, because that’s the only way I know how. I don’t back down, and I won’t in the face of death either. People will all have very individual responses, and my lesson learned from shadowing is that it’s important to treat everyone the same so you don’t let internal biases get in the way. That’s something I will have to consider when dealing with patients, assuming that I even make it to that stage.

(Fun fact: Brave New World was referenced in this book! Heck Yes!)



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