When Breath Becomes Air: A Tryst With Life

41jFVZL72YL._SX336_BO1,204,203,200_I read Paul Kalanithi’s essay in The New Yorker in January, and pre-ordered When Breath Becomes Air. The book arrived last month, but I couldn’t muster the courage to read it. Although I was reading a lot of books that affected me deeply, I still shuddered at the mere thought of reading Kalanithi’s memoir, only because it’s a dying man’s reflection on mortality, and life’s meaning.

Many Goodread’s reviews contained warnings — the reader would shed torrential tears, the reader would be depressed, the reader would empty numerous boxes of tissue papers. I admit. I am a crier. A heavy crier. However, this poignant book didn’t depress me. At the end, I had the satisfaction that usually envelops me after having a profound conversation with an intelligent friend, and I was moved by Kalanithi’s tenacity to face death, the very thing that retained a sense of wonder in him all his life.

Kalanithi read George Orwell’s 1984, when he was 10. His mother ensured that her children were exposed to great minds, as they lived in Arizona, which didn’t have great schools. His father practised medicine there, and Kalanathi spent many afternoons, sprawled in the desert contemplating life, and its meaning. When his mother became suspicious of his frequent escapades with his friends, Kalanathi observed that nothing else intoxicated him besides the poetry that he had read the previous day.

I wasn’t surprised when he chose to pursue literature. Although he completed his BA, and MA in literature, he realised that his answer to the most baffling question — what is life’s meaning? — was not offered by literature. He noticed that literature was far removed from science. However, a lowbrow novel that his friend shoved on him, when he was in Arizona, planted an unassuming seed in him, which later blossomed as his love for the most beautiful human organ — brain.

Kalanithi deemed that if one had to understand life, and if literature didn’t quench the thirst, then the next natural option was to understand human brain, the instrument that enables one to define identify, and the confounding aspects of humanity. He joined Stanford again, as a resident neurosurgeon, and he toiled hard for about six years, before he was diagnosed with terminal lung cancer. All his hard work became futile, and boiled to this moment, when he had to confront his own mortality. He might have been fascinated about death all his life, and observed death at close quarters through his patients, but that didn’t prepare him for this ill-fated moment, when death appeared in front him with its horns, and fangs. He told his wife, “I don’t want to die.”

He was a bright, esteemed neurosurgeon, and neuroscientist one day, and he was a terminally ill patient the next day. The Stanford campus — where he employed his adept hands to operate on petrified patients’s brains, where he comforted grieving families, and friends — became the hospital, where he underwent multiple levels of treatment, and finally inhaled his last breath.

Paul Kalanithi-jacket photo - Norbert von der Groeben- Stanford Health CareKalanithi was a man of principles, and appreciated the moral responsibilities of a doctor. To Kalanithi, his patients were not problems. They were not discharge papers, nor X-Ray, and MRI results. They were people with values, ideologies, dreams, and fears. They were people who could love, who were filled with hope, who were terrified by the sharp turns their lives took. He didn’t reduce them to mere statistics. Even when asked about the prognosis of his patients, he refrained from saying, “You have got six more months.” Instead, he said, “You will live for many months to a couple of years.” The sentences, despite sounding similar, carry a chasm of difference between them. He was a doctor with a big heart.

In his memoir, Kalanithi wrote mostly about his ambitions, grand dreams that evaporated, a life well-lived, and his philosophical views about life, and death. On one hand, he offered little information about his strained relationship with his wife, and how his illness saved their marriage. Before I could reach the afterword written by his wife Lucy Kalanithi, I wanted to know more about the Kalanithi, who might have also been vulnerable, and who at some point in time harboured regrets.

Kalanithi’s voice was steady, and his thoughts were pristine through out the book. However, I couldn’t dismiss the sense of urgency his words carried. Of course, he raced against time to finish the book in a year. As the end approached, as Kalanithi’s health deteriorated further, maybe he had to hurry, and the book had to end abruptly. He had no time to soften the edges. So, in her afterword, Lucy Kalanithi assumed the responsibility of opening a window to her husband’s world that he didn’t have much time to reveal. She showed a Kalanithi, who was always surrounded by his family, as he went closer to death, and she showed a Kalanithi, who was a doting father to their daughter Cady, whom they decided to have after his cancer surfaced. She was a pillar of support to him during his battle, and ensured that his book was published, as he wished. After his death, his distant dream came true — he became a writer.

With little to distinguish one day from the next, time has begun to feel static. In English, we use the word time in different ways: “The time is two forty-five” versus “I’m going through a tough time.” These days, time feels less like the ticking clock and more like a state of being. Languor settles in. There’s a feeling of openness. As a surgeon, focused on a patient in the OR, I might have found the position of the clock’s hands arbitrary, but I never thought them meaningless. Now the time of day means nothing, the day of the week scarcely more. Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line. But now I don’t know what I’ll be doing five years down the line. I may be dead. I may not be. I may be healthy. I may be writing. I don’t know. And so it’s not all that useful to spend time thinking about the future — that is, beyond lunch.

(To his daughter:)
When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.

Memoirs inspire me. I haven’t read a lot, but a couple of ones like Cheryl Strayed’s Wild, and Monica Holloway’s Cowboy and Wills, changed me a bit. Kalanithi’s too has hurled a stone in my pond, creating enormous ripples. In his wake, Kalanithi has left some questions, and heartbreaking meditations on the pointlessness of planning, the irony of hope, and the fantasy of survival. However his views were not cynical; they were powerfully pragmatic.

When Breath Becomes Air is not about Kalanithi’s rendezvous with death, but his tryst with life. That’s how I want to see it.


44 thoughts on “When Breath Becomes Air: A Tryst With Life

  1. I don’t have the guts to read this one. I know I’ll be a blubbering mess but that’s not it, I guess. The one thing that haunts me about Kalanithi’s story is the fact that he had a daughter. I read the interview where his wife talks about their decision to have a baby and as beautiful as her explanation is, it also made me very sad. I guess I’ll come to this one once my baby is a lot older. Then again, maybe I will read it sometime soon. Who knows. But it’s definitely on my list.

    Liked by 2 people

  2. I also want to read this, and your review makes me even more sure of it. It sounds like the world lost a good man, but luckily for us, he left something of himself behind. Once again, a beautiful review!

    Liked by 1 person

  3. I got teary-eyed just reading your excerpt…

    I am positive that this book will make me bawl and feel everything. But that’s OK. I allow myself to be emotional and don’t shy away from books that are heart-wrenching and difficult to read.

    Deepika, this was one of the best reviews I have read in a while. Wow. I genuinely want to read this book just because of your review. You’ve sold me with your absolutely beautiful writing.

    Liked by 1 person

  4. What a lovely tribute you gave to this man and his life. I love his ironic humor when he says it’s not useful to think much about the future, at least beyond lunch. I also like the way he dissects the word time.

    I haven’t read many memoirs either though I enjoyed Abigail Thomas’s Safekeeping. At some point I will read Joan Didion. Too many books, too little time. Oh, there goes that word again…

    Liked by 1 person

  5. I am not frightened by death. What does death mean? To an agnostic, it is the cessation of all activities that characterise life. Death is a natural thing which happens to every living being, so too would death come to me. It is simply “The End”. I am not afraid to die.

    Yes, that is what my rational brain tells me. But then, my other parts, those that control my emotions don’t let me be. I’m simply terrified of death. So when I read of people with terminal diseases, where their end is imminent, I can only wonder at their ability to face the situation.

    Sometimes, calamities bring us together. I marvel at Dr Lucy, for deciding to have a baby, after Paul was diagnosed with cancer. Having a daughter seems to have had a profound impact on Paul, in his acceptance of the inevitable.

    Thanks for the balanced, review of the book. I need to read the book, if only to confront my fears of death.

    Liked by 1 person

  6. Great review.

    This sounds like such an important and meaningful book.

    Works like this can be gut wrenching but sometimes they can be life affirming. It seems that you got a lot of positive things from it.

    I think that it is really important that we read things like this.

    Liked by 1 person

  7. Wow, this is on my to-read list but I’ll have to get to it sooner. When I was a medical librarian I worked with neurologists and neurosurgeons, and I am fascinated with in part because of the nature of the work they have chosen. You’ve written about this memoir so beautifully.

    Liked by 1 person

  8. I received this from Book of the Month club (won a three-month subscription during last year’s Readathon!) but haven’t dared to crack it open yet. It made me think of another book I really want to read but also don’t dare (weepy sobbing mess that I would be) which is Wave by

    Liked by 1 person

  9. I’m about half way through with listening to this in the car. When I came in today from the grocery store, I felt exhausted, and when I tried to figure out why (how hard is rolling a cart?) I finally realized it was emotional exhaustion from listening to the book! It’s very, very good though!

    Liked by 1 person

  10. I’m afraid to read this one. I may need that box of tissues. It saddens me that people have to come to the end of their life to realize their dreams (I’m thinking of Kalanithi who wanted to become a writer). I wonder how many things we’d try if we knew we’ll be gone soon…. That’s something to think about.
    This is a beautiful review, Deepika, but then all your reviews are beautiful.

    Liked by 1 person

    1. I remember what Kalanithi mentioned in his book. He said if he had had three months to live, he would have spent time with his family, 1 year, he would write a book, and 10 years, he would go back to medicine. The man’s vision was astonishing. I hope you will read this book one day, Delia.

      And, thank you for all the kind words.


  11. I read this book two weeks ago. It’s a haunting book and it literally reached up and slapped me in the face hard like a tsunami. Our niece aged 29 died from lung cancer. A no smoker, she was a bright and athletic girl and when diagnosed she had just given birth to their first child. In the short year that she has with us she remained positive and embraced life in unimaginable ways. I never understood how she could remain so positive in the face of something so devestating. After reading this book I now understand. I throughly believe that she and Paul were kindred spirits put on this earth to help the rest of us come to grips with understanding the real meaning of life and of living.


  12. Great and moving review! Thank you, Deepika! I made a conscious decision not to read this book, I admit I am a coward, I am afraid of death, I don’t want to think about it, I’m not ready to read about someone who had to face it, I know we all will have to at some point. But I do admire people who were able to not only face death but also share their thoughts and emotions.

    Liked by 1 person

  13. I have stayed away from this book, because I know I will be a complete mess after this; but I am going to keep this on my TBR for someday..maybe..

    Have you read Being Mortal by Atul Gawande?

    Liked by 1 person

  14. I keep seeing this book everywhere. I almost bought it the last time I was in a Crossword – but I had only enough money for two books and a coffee, all of which I already had… you know how it is. The time quote is fabulous. As is your tribute to this brilliant man who didn’t want to die. My father was a doctor too. I lost him years ago, though with much more abruptness – which is a strange relief whenever I read something like this. Having gone through your post multiple times, I feel I ought to read this book. I know I will cry, but it just feels necessary, you know?

    Liked by 1 person

    1. Priya, thank you. I am so sorry for your loss.

      Necessary, yes. I look forward to hearing your thoughts.

      And, I know how it feels when another lovely book appears after emptying our wallet. One of the worst tragedies. 😉


  15. I put this book on hold at my library after reading some of your comments (on FB or Goodreads?) but hadn’t read this great review yet. I think it is natural for people to fantasize about what they would do if they only had a year left. I think what would actually happen might be very different than we think.

    Liked by 1 person

  16. Nice review. I like your writing … some books are stones in my pond too. I think this book sounds sad but is also life-affirming. I have it on my radar.

    Liked by 1 person

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