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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On Rounds | 3.24.15

In recent months, as I’ve transitioned from senioritis to sleep deprivation, I’ve come to appreciate the value of brevity. Goodbye, RSS; hello, Twitter, Circa, and BriefMe.

It’s with this perspective that I’m launching ‘On Rounds,’ a (hopefully!) weekly curation of big ideas, reflections, and byte-sized foods for thought. If you’re finding it tough to keep up with the world beyond the lecture hall or clinic, outsource that task to me.

On sitting with patients | New York Times
We often discuss empathy decline in medical training, and why it occurs; in this insightful, incisive piece, Dhruv Khullar absolutely nails it. Pre-meds don’t aspire to treat medical records and lab values, but people. But in medical school, knowing the patient takes a back-seat to knowing the pathophysiology, creating a rift between expectation and reality.

On MOOCs and medical training | Slate
While the MOOC is no longer a novelty, it’s still an enigma: what’s the place of online education in the knowledge market of the 21st century? This month, Yale raised the stakes by announcing its new online physician’s assistant program. In light of an imminent physician shortage and the ever-rising costs of higher education, one has to wonder: is there a place for online, or hybrid, education in medical training?

On re-designing deathCalifornia Sunday
Ideo, the legendary design firm, has built its brand on challenging assumptions and breaking the barriers of, “Well, we’ve always done it this way.” What happens when the strategies that have driven the design of products are instead applied to processes—say, death? And more crucially, how do we inspire and train clinicians to apply the design framework to the act of doctoring, itself?

On UX designMedium
What are the skills and roles that effective design requires? Irene Au breaks it down here, and spoiler alert—the parallels to patient care are remarkable. If we envision the bedside encounter as a co-design collaboration between a patient and provider, the implications and applications in this piece for clinical medicine are fascinating.

On health tech and how bad it isNew York Times
In most fields, the technologies work for the people; in healthcare, the people work for the technologies. Here, Bob Wachter explains why the transition to electronic health records has been a rough one, then lays a roadmap to realizing the value and potential of digital medicine. It’s a daunting task, but an essential one if we eventually hope to treat patients, rather than “iPatients.”