Book review: ‘When Breath Becomes Air’ by Paul Kalanithi

By LARRY BALLWAHN | Wilton

What are you willing to give up to continue living? Your right arm? Your memory? Your mobility? What about your ability to speak? These are the kind of questions faced by the neurosurgeon, especially those who specialize in the brain. Virtually anything done there affects a basic function. No matter how well the surgery goes, life will never be the same for the patient.

Paul Kalanthi was 35. He was just finishing his neurosurgery residency. At first, he thought his symptoms were the result of the long hours required. Fatigue in such a situation was to be expected, but serious back pain and weight loss, too? The CT scan revealed stage-four lung cancer. With medical school nearly completed, the life plan that he and his wife had made was suddenly in disarray. “When Breath Becomes Air” is the book that Kalanithi wrote to tell his story and to record as much as possible of what he had learned about living and dying.

When you are the one in control, the doctor, stage-four cancer appears quite different from when you are the patient. A diagnosis of cancer is a life-changing experience for anyone. It’s one thing to know that everyone is going to die, and quite another to realize that you may well be face to face with the cause of yours. Stage four yet. Dr. Kalanithi knew intellectually what a blow this was to the patient; he knew what the doctor’s role needed to be with such trauma. But, unbelievably, he was the patient, and what he knew as a doctor did nothing to change the facts.

The reader is taken along as Kalanithi draws on every medical advance in his fight to regain his former life. He is fortunate to have Dr. Emma Hayward, one of the best lung cancer oncologists, to guide his progress. Right from the start, she urged him to decide what he really wanted to do, perhaps return to surgery, research, teaching of writing? If he identified a goal, he would likely be able to accomplish it as the cancer was held in check. The question, of course, was for how long and in what physical condition?

While the cancer challenge and Dr. Kalanithi’s family make up the heart of the story, some of the most informative aspects are Kalanithi’s reflections on medicine, death and religion. Is there such a thing as a good death? When is the cost of staying alive too high? How do you want to live your final days? What does that imply medically?

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