Book Reviews

Unmissable. Unforgettable. When Breath Becomes Air by Paul Kalanithi

When Breath Becomes Air by Paul Kalanithi

When Breath Becomes Air is an unflinching account of what happens when a man with expertise that can save lives, is powerless to save his own life.

At the age of 36, on the verge of completing a decade’s training as a neurosurgeon, Paul Kalanithi was diagnosed with inoperable lung cancer. Overnight he underwent a transformation in his identity. One day he was a doctor in control of his patients’ destinies. The next he became the patient, forced to relinquish control over his treatment and to put his future into the hands of fellow professionals. Having aspired to be “the pastoral figure … I found myself the sheep, lost and confused”.

When Breath Becomes Air traces his life and the path he took to become a neurosurgeon fascinated by the most complex organ in the human body. The organ that not only controls all other organs it operates in the very core of human identity.

From Literature to Neurosurgery

He never set out to become a doctor. At university he studied English literature, gaining a postgraduate degree with a thesis on Walt Whitman. But he became increasingly interested in the metaphysical questions raised in literature but found books couldn’t provide him with answers. So he enrolled at medical school.

He chose to specialise in neurosurgery because of its “unforgiving call to perfection”. A two millimetre variation in the size of an incision would mark the difference between life for his patient or a living hell of “locked in syndrome.” His quest for excellence combined with the pressure of his job (100 hour weeks were not uncommon) almost cost him his marriage. He even persevered with his punishing surgical duties (including 36 hour stints in theatre) through excruciating back pain and severe fatigue.

What kind of surgeon would he have become if those pains and rapid weight loss hadn’t turned out to be a sign of lung cancer so rampant it had deformed his spine and obliterated one lobe of his liver? When Breath Becomes Air gives us a strong feeling that he would have become one of the foremost specialists in his field, an expert much sought after by university medical departments across the United States.

Questions of Mortality

But it was not to be.

Instead of contemplating that glittering career Paul Kalanithi instead turned to contemplating questions of life and death. They are questions his medical training has not equipped him to answer. The statistics of survival rates and probability of treatment effectiveness that are part and parcel of a medical practitioner’s world are meaningless to a patient he discovers. He comes to the conclusion that the question is not “how long will I live, but how well will I live”?

Not an easy question to answer when his sense of himself has been turned upside down. Robbed of his role as a surgeon he no longer knows who he is or what he wants. How important is it that his treatment plan preserves his manual dexterity, so leaving the door open for him to return to work? Should he and his wife have a child as they had always planned? Should he stay in Stanford and take up a much coveted post or go for a different job that would require a move to Wisconsin?

When Breath Becomes Air was written in the 22 months that elapsed between his diagnosis and his death. But though he wrote at every opportunity and with great determination, he died before he could finish the book. It lends the text added poignancy particularly since the last words he wrote were in the form of a direct address to his baby daughter, the child whose first birthday he would never see. I confess that listening to this passage in my car I was so overcome with emotion I had to pull over and stop.

There is of course a huge amount of emotion invested in this narrative. How could it not be, given the topic. But it’s never sentimentalised or gratuitous. Paul Kalanithi tells his story with delicacy and beauty. It makes the result a book that is inspiring and unforgettable.


What do you need to know about me? 1. I'm from Wales which is one of the countries in the UK and must never be confused with England. 2. My life has always revolved around the written and spoken word. I worked as a journalist for nine years then in international corporate communications 3. My tastes in books are eclectic. I love realism and hate science fiction and science fantasy. 4. I am trying to broaden my reading horizons geographically by reading more books in translation

15 thoughts on “Unmissable. Unforgettable. When Breath Becomes Air by Paul Kalanithi

  • Sheree @ Keeping Up With The Penguins

    Oh, I’ve had this one on my shelf forever (I bought it as a gift for a loved one who was just about to finish medical school, but then thought it sounded too good and kept it for myself, whoops) – thank you for the reminder! I’ll stock up on tissues!

    • I didn’t need tissues as such but did get to the end of Kalanithi’s own section of the book with a big lump in my throat

  • This, along with Being Mortal, is such an important book. Both made me think of death, but to look at it realistically.

    • I know I have a copy of Being Mortal somewhere – shall . have to go and find it now you’ve described it as an important book

  • My goodness, this sounds like an emotional book. I think I would definitely need to be in a strong frame of mind to read it….

    • There’s a lovely postscript by his wife – I don’t think I would be as coherent as she is in the circumstances

  • Having been the one who recommended it for you I am pleased – though not in the least surprised – you were so touched by it. And what a lovely review.

    • Thank you so much for this recommendation Frank. I know it sounds a bit odd to say I enjoyed the book – maybe ‘appreciated’ would be more appropriate. It’s one that I will remember for a long time

  • Lovely review, Karen. You’re absolutely right about the absence of sentimentality. It’s an extraordinary book made all the more so by Kalanithi’s beautiful writing which gives it a quiet dignity.

    • Absolutely the writing is top notch. Theres a passage early on where he looks at the result of his scan and knows exactly what it means. It’s so simply related and thus doubly effective

  • This book is just heart wrenching. I still think about him and I read this a couple of years ago. All of that training and such a wonderful, productive person who dies so young and the young vandal that torched the stolen car in our neighbourhood this week will probably live to be 100 in prison. It really is true that the good die young.

  • buriedinprint

    I admire the kind of restraint that is necessary to polish the prose in this kind of story, to avoid the sentimentalism and overwriting which could so easily take over. This is a book I often pick up at the library – and vaguely consider – before I replace it on the shelf. Someday, maybe…

    • I’ll just say that next time you pick it up, do take it home with you. I don’t think you will regret it!


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