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When Breath Becomes Air, by Paul Kalanithi

Yale Medicine Magazine, 2015 - Autumn


The catastrophe in When Breath Becomes Air reveals itself immediately. In the opening paragraph, Paul Kalanithi, M.A., M.Phil., M.D. ’07, in his sixth year of a neurosurgery residency at Stanford, sits before a hospital computer looking at CT scans. He sees lungs “matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I’d examined scores of such scans. But this scan was different. It was my own.”

“And with that,” he writes, “the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.” It is spring 2013, he is 36, and Stanford has been courting him for a faculty job.

After describing that terrible day, Kalanithi explains how he has reached that moment. Growing up in Kingman, Ariz., he feels no inclination to emulate his cardiologist father, who leaves home at dawn and returns in the dark. What interests Kalanithi is how to formulate a philosophy of life at the intersection of biology, philosophy, and literature. He studies all three, first at Stanford, then at Cambridge.

His search leads him to medicine after all. Caring for patients, he decides, offers the best way of exploring “what makes human life meaningful, even in the face of death and decay.” In gross anatomy class at medical school, he and his fellow students learn to repress the thought that they are slicing open real people. He writes that “we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.” Among those classmates, Kalanithi meets his wife-to-be, Lucy Goddard, M.D. ’07.

In the memoir’s second half, Kalanithi describes his attempts to find meaning in his prognosis. Terminal illness, he tells himself, should be “the perfect gift to that young man who had wanted to understand death.” But the hoped-for epiphany eludes him. Instead, he feels as if “someone had just firebombed the path forward.” He has forsaken literature to practice medicine, but now his illness compels him to seek it out again. Reading revives him, and he and Lucy decide to have a child.

In the epilogue, Lucy Goddard Kalanithi recounts her husband’s final months. During the treatments that prolonged his life for a year, the two became as inseparable as they had been as medical students, when they’d held hands during lectures. One night she asked her husband if he could breathe comfortably with her head on his chest. “It’s the only way I know how to breathe,” he replied.

Their daughter, Cady, was eight months old when Paul Kalanithi died in March 2015.

Early in the book, Kalanithi writes about the first time he assists a woman in childbirth. Her twins, born prematurely, die. Their deaths remind Kalanithi of a passage from Samuel Beckett’s Waiting for Godot: “One day we were born, one day we shall die … Birth astride of a grave, the light gleams an instant, then it’s night once more.” In the parting gift that is this book, Kalanithi tenderly reminds his readers of our common fate.

Lucy Godddard Kalanithi recently published in The New York Times an essay about her life after her husband’s death. And her husband’s book received a glowing review in the newspaper.