Review: When Breath Becomes Air by Paul Kalanithi

They say, Death comes for all of us, either by swift force or a gentle cradle, we all come back to the Earth. It’s a moody Saturday today, a perfect day to reflect on a book that was on a volition course to breaking my heart and putting it all back together, all at the same time.

Title/Author: Paul Kalanithi with a Foreword by Abraham Verghese

Date Started/Finished: Feb23-feb 28, 2017

Genre: Biography

Format: Hardback, US Edition

Pages: 228



This book was written by Paul Kalanithi, a neurosurgeon and neuroscientist, who at the age of 36 years old, was diagnosed with terminal lung cancer. The first part of the book tells the story of how he ended up taking up medicine after majoring in literature, his first love. The second part talks about his success as a up and coming neurosurgeon in his institution and then how he dealt with inevitable news that he had terminal cancer. His wife Lucy, also wrote the epilogue of the book, since Paul died on March 2015 before he even finished it.

What I think about it:

I am actually having a hard time putting my thoughts for this book into words. It’s because reading this book was such a personal experience for me, not just because Paul and I share the same vocation, but also because Paul’s relatable musings of death and life was such a familiar tune for those who work in the medical field. However, even if you do not work in the medical field, I think you’d still be able to relate to how Paul dealt with his illness. He is just like every human who faced death and embraced it, with too many questions, with a little bit fear and some regret.

I couldn’t say Paul is an excellent writer. I haven’t read a considerable amount of books to judge his narrative. However, just by reading his genuine words and his unpretentious personal stories, evoked a profound feeling kinship. It’s as if he has been one of your long time friend and he is telling his story over a cup of coffee or over a cigarette break after such a toxic ER rounds. His stories sometimes left me reeling, putting down the book once in a while to hold back tears because it made me think that what if that happened to me or to the one I love? It’s basically one of the most rattling thoughts that I have had since becoming a doctor.

At one point he writes:

” Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death— it’s something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel and in so doing, to confront the meaning of life. We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands,yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

This passage hit me really hard. People think that doctors become emotionally blunted by the death we encounter everyday. That it has become natural to us and that the feeling of compassion has been sucked out by the reality, leaving us hollow. We enter medical school with such high hopes and dreams of serving and saving lives, yet the grueling mental, emotional and physical demands of our training sometimes leaves us jaded. However, we are not hollow beings, the truth is, we doctors feel too much. We feel the pain of our patients and their love ones in addition to the pain we feel when we fail them, when we fail to become better healers for them. Sometimes that emotion becomes overwhelming that we compartmentalize it in order for us to have the strenght to move on to the next life that needs our help. This passage comes into full circle for me, affirming that we do what we can for those who we love, for those who loves us, and for those we will love.

What really suprised me, is how Lucy, Paul’s wife finished the book. She writes in a similar vein as that of Paul, only that she writes from the perspective of the one that is left behind. You realize that she writes with pain and honesty that is never alienating. She writes with hope and she writes with courage. She writes just as she is, someone who  has loved and will aways love her husband.

Death is easy for those who leave us, it is never easy for us who gets left behind. We can only pray and hope that it gets better in the long run.

P.S. This post is dedicated to Dr. Dreyfuss Perlas, a Doctor for the Barrios who served in marginalized Sapad , Lanao Del Norte until the day of his death, felled by a single bullet to the chest while driving home from a medical mission and to every modern hero: doctor, nurses, EMTs, etc. who dedicated their lives in selfless service to humanity and its goodness.


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