When Breath Becomes Air

As I write this, I’m wiping away the tears in my eyes stirred by Dr. Paul Kalanithi’s When Breath Becomes Air. Richly reflective and powerfully evocative, it’s the touching narrative of a doctor’s attempts to confront death—as a student of literature, as a neurosurgeon, and as a patient—and, through the lens of terminal illness, examine how dying gives meaning to living.

With When Breath Becomes Air, Dr. Kalanithi allows us to, in his words, “Get into these shoes, walk a bit, and say, ‘So that’s what it looks like from here … sooner or later I’ll be back here in my own shoes.'” It’s a walk that resonates particularly strongly for me as a fledgling physician.

As he reflects on his medical training, Dr. Kalanithi looks back with the perspectives of both patient and provider to offer valuable insights on what it means to be a physician: someone who translates statistics and survival curves into a patient-oriented language of values, identities, and capabilities; someone who is relentless in the pursuit of operative excellence, but understands that a surgeon is more than an expert technician; someone who aspires to perfection, but ultimately accepts his fallibility.

For any avid reader of medical non-fiction, these reflections will sound familiar, the stuff of Better and Being Mortal. And yet, When Breath Becomes Air feels different, because it explores medicine’s virtues, values, and flaws from the perspective of a patient, someone who is both an insider and outsider to medicine. As Dr. Kalanithi writes, “As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know.” His perspectives on what makes a good doctor are informed by an intimate understanding of what patients feel, what patients think, and what patients want that most of us, as providers, can only infer and intuit from our interactions with illness in the third person.

At its heart, When Breath Becomes Air is about more than how we ought to provide care; it’s a contemplation of how we ought to live. The life of a physician-in-training often feels like a life of anticipation, of potential, of surviving the present to reach the rewards of the future. We spend a third of our lives studying, sacrificing sleep, accumulating loans, and watching our friends build lives that are less exhaustive and more lucrative, all of which we accept for the eventual promise of a career that offers an unparalleled balance of intellectual engagement, moral fulfillment, and socioeconomic comfort.

I ask myself, then: if faced with a terminal illness tomorrow, would I feel that I’d achieved anything more in 23 years besides a pursuit of a life still yet to come? For Dr. Kalanithi, the prospect of dying gives the present an immensely deeper significance, a more imminent urgency. As I read his detailed recollection of his last day as a physician, a heartfelt recall of each interaction, each sensation, each incision, I felt uncomfortably reminded of what I’ve seen and done over the last week, and how it felt so unremarkably routine. I’d been present, but I hadn’t been truly present.

Reading When Breath Becomes Air, I felt called to attention, awoken from autopilot to embrace the quiet miracles and subtle wonders that transpire around us each day in the hospital. If we practiced medicine each day as if it were our last, what might that look like? What could it do for our connections with patients, for our interactions with our colleagues, for our thirst for meaning and fulfillment in our daily lives? This, I think, is Dr. Kalanithi’s strongest parting advice for us. And as cliche as “live as each day is the last” sounds, that we so rarely do it makes it advice worth hearing.

When Breath Becomes Air is an easy read that raises difficult questions, a short book that invites lengthy pauses for thought. Whether you’re in medicine or not, you’ll invariably someday find yourself pondering the matter of mortality and the meaning it imparts to the closing days of life—and therefore, you’ll invariably find this book to be both moving and meaningful.

Thanks, Dr. Kalanithi.

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4 thoughts on “When Breath Becomes Air

  1. Amol, this was a beautifully written review and discussion of what Dr. Kalinithi addresses and touches on in his book. I have not yet read it myself because I am anxious about how emotional it will make me feel. I have come home after many a shift and cried in my wife’s arms because of the things I have seen. I have known that I need to read it because it addresses my deepest fears. You’ve made it clear however that it is a book that all doctors everywhere should read and would benefit from. My wife read the book already and encouraged me to do so as well. I’ll share my experiences once I do as well. Again, thanks for sharing your feelings and reflections!

    1. Sumit,

      Appreciate the feedback, and thanks for sharing on Twitter as well. I definitely, definitely recommend When Breath Becomes Air, and look forward to hearing your thoughts when you read it!

  2. This post suites you well. It really brings out the narcissistic nature of many doctors. You are not even to that point and you talk of all these miracles happening around you. Learn to be a little more humble in your presentation. Some of what you write has meaning to it but you will lose many readers with your overall self riteous attitude. Nobody likes it especially in the hospital. I’m an attending at Vanderbilt and this is a word of advice. One of your fellow students told me to take a look at this post.

    1. Dr. W,

      Thanks for weighing in. I’m not certain where in this piece you found a tone of narcissism and self-righteousness; if anything, the intention was quite the opposite—to prompt thinking about how the words of the dying were humbling to read as a budding provider. I’m also reassured by the fact that your advice is not consistent with the feedback I’ve received both as a writer and a learner to date, though I’m always happy to get advice from more experienced health professionals and will take it into consideration.

      I would also suggest that someone who feels confident enough to make such sharply-worded critiques about my narcissism or lack of humility from a single blog post should also be willing to identify him- or herself. After all, it’s far easier to criticize the work of others from a position of anonymity.

      I hope we’ll have the chance to work together in the hospital in my time at Vanderbilt. If we cross paths in the future, hopefully you’ll actually be able to know my character enough to know what “suits me well,” and hopefully that will prompt a reassessment of your opinions. Thanks,

      Amol Utrankar, VMS II

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