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.