Book Review: When Breath Becomes Air


When Breath Becomes Air, by Paul Kalanithi, is a memoir put together from an unfinished manuscript left on the author’s computer after his death from cancer. The book opens with a forward by Abraham Verghese and contains two parts written by Paul and then an epilogue by his wife, which brings closure to a story that he did not have time to complete. It is incredibly moving but so much more. It is a profound exploration of what it means to live.

“even if I’m dying, until I actually die, I am still living.”

Paul’s prose is coruscating, devastating, illuminating. The words reach down deep. I felt a sense of loss, of tears, of a desire to grab this life and appreciate everything in it.

Paul was obviously born to privilege. He first studied as an English major, completing a Masters in Literature before changing direction and preparing for medical training, first at Cambridge and then at Stanford where he rose to become Chief Resident with a glittering career promised, just ahead. He was always questioning his choices and seeking wisdom.

“I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.”

The sections relating to the author’s residency should be required reading for all with contacts to the medical profession, including patients. He ponders what it means to be a doctor, how it is so much more than saving a life. He offers thoughts on those occasions when this may not be in the patient’s best interests, how illness afflicts not just the individual but also family and friends. Few survive major trauma unchanged.

The second part of the book relates to his months after diagnosis, a time when he had expected to graduate and realise the dreams he had been working so hard and for so long to achieve.

“I knew I was going to die – but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell.”

I found this section acutely moving. Paul had such potential yet he did not indulge in asking “why me?” Instead he accepted, “why not me?” He had support from his family, he made plans with his wife to have a child, he wrote this book.

“Death may be a one-time event, but living with terminal illness is a process.”

Paul struggled at times to hand over his care to others. He learned how difficult some of the treatments he had routinely recommended were to bear. When improvements occurred he questioned how he wanted to spend his time, if his career was as important as it had seemed. His musings on why he had become a doctor should be read by all who complain about those entrusted with their medical care.

The epilogue is written by his wife and is in a very different style. Rather than considering the bigger questions of life and death and how to deal with these, she rounds off Paul’s story with facts wrapped around love and grief.

A beautiful, emotive book that is more than just a memoir. The author is a thoughful and skilled writer making this an inspiring, considerate read. Any death brings sadness to loved ones. It is hard not to think of the death of this man, whose work could have led to the saving of so many other’s lives, as a loss to the world. I am grateful that he left us these words.

My copy of this book was provided gratis by the publisher, The Bodley Head.



I am not a blogger who plans and prepares ahead. I tend to just type in whatever I am thinking at the time and hit publish. Sometimes I get an idea and want to write about it but don’t have time. I might set up a few prompt lines in a draft and try to come back later to flesh it out. More often than not these unfinished posts end up in trash.

One thing I would like to do more often is write about light hearted things. I don’t think of myself as negative and do not wish to be considered so. Today, however, I am going to cover a topic that is making me feel annoyed, frustrated and despondent. I am going to write about student work experience.

My daughter would very much like to be a doctor, which does of course require that she gain a place at medical school. When she first started talking about this aspiration I thought that the big challenges would be producing a noteworthy personal statement, impressing the university at interview, and gaining outstanding exam results. Whilst all of this is still necessary, and a tough enough challenge for any aspiring medic, it seems that she also needs to have proof of regular work experience in a variety of medical settings prior to applying.

Having obtained good enough GCSE results to keep her dream alive, in September of this year she started writing to local hospitals and doctor’s surgeries about the possibility of them accepting a work experience student. It seems that our home county has very strict data protection rules that preclude such schemes. As most of the recipients of her letters and emails failed to respond it took her some time to find this out.

In October she started writing to hospitals outside of our home county. She was comfortable with the idea of travelling by public transport and staying over in a cheap hotel or B&B for the week or fortnight that she would be working. Between fifty and a hundred missives later she finally got an explanation as to why nobody would take her; she lived out of county. If she could find someone to personally accept her for shadowing then that would be acceptable, but the Trusts would not take on a student from out of county except on this basis.

November has been spent writing to everyone we have ever known who has some link, however tenuous, with the health service. With one exception, who we have still to hear back from, these people do not work directly enough with hospitals to feel able to help. We are running out of ideas. It seems that to become a doctor you need to personally know a doctor. Or not live in Wiltshire.

I have family and friends whose children have won places at medical school. Their kids worked hard to get the exam results, impressed at the tough interviews, and got work experience through family friends or school contacts. They also went to fee paying schools, the sort of schools that doctors send their children to. My daughter attends a state school.

This is why I am annoyed. Nepotism is alive and well and it appears that I do not know the right people; I feel as if I am letting my daughter down. If she failed to gain a place because she didn’t get good enough grades in her exams, or bombed her interview, that would be unfortunate but her call. It seems that getting work experience is down to the parents. Either they somehow find the money to pay for a school that will help with such pupil aspirations, or they make sure they befriend the right people. I have managed neither so it seems that my daughter will struggle to fulfil her dream.

Even our local care home for the elderly has ignored her. I would have thought that a care home would welcome a regular, volunteer helper. I have read so many times about how the elderly are supposedly lonely in these places, yet my daughter’s requests to meet with someone to discuss the possibility of volunteering go unanswered. There are other care home options to explore but I am now wondering if we need an inside contact for that as well.

I have a Facebook friend who is vocal in her belief that writers and other creative types should not work for free. With the proliferation of internet news sites and amateur bloggers who welcome exposure she is finding that, as an experienced journalist, there are outlets who are unwilling to pay her fees. If too many people are willing to work for free then this trend will increase. She believes that content quality will deteriorate and talented, creative people will be exploited.

Last week I noticed that she was raising this issue with a sixteen year old aspiring journalist. The young lad was writing for, what I understand to be, a respected publication. He was working for free and trying to recruit other young people to do the same. Whilst I can sympathise with her argument, I think that in this particular case the young lad was to be applauded. He had managed to get his foot in the door of a competitive industry and was gaining experience. That experience is worth more to him than any pittance that young people can earn. I mean, have you seen the level of the minimum wage for a 16-18 year old?

A lack of work experience may prevent my daughter from even being considered for medical school. No matter how good a doctor she may make, because her parents don’t have the contacts, she may not be able to get that all important proof of interest in her chosen field of study. Sometimes it is not about the money; experience and contacts now seem to be the vital ingredients if a competitive industry is to be entered.

There are way more people wanting to get into medical school than there are places available. No matter how good my daughter may be she will not be missed (although if she ended up in the field of medical research who knows what she may achieve).

At an individual level though, through no fault of her own, she will miss out on attempting to achieve her dream. As her parent, I think this system sucks.

School-of-Clinical-Medicine-University-of-Cambridge    ‘The world needs dreamers and the world needs doers. But above all, the world needs dreamers who do.’