When Breath Becomes Air


There have been 3 books in my life that have absolutely wrecked me.

And this is one.

Paul Kalanithi is a neurosurgeon and writer, with an interest in putting words to the things that make up a meaningful life. The combination of his intelligence and his ability to write weave together to create a truly powerful book about his life.

Towards the end of Paul’s med school residency, he learns that he has stage IV lung cancer. Braced with the fact of his impending death, he resolves to face what future he has with courage, honesty and openness. While also writing about it.

Spoiler alert

For most of the telling of his story, I was able to emotionally stay with him, hold it together, and just process the black and whiteness of his upcoming death, but also the shades of grey in the other areas of his life. He talks about med school, his relationship with his wife, trips he loves to take. Seeing his perspective on the cruelty of cancer, but the value he places on living out his last days in truly meaningful ways. But as the cancer wages war on his body, he and his wife find themselves pregnant with a baby girl.

The crux of the book that made me start to unravel was a scene where Paul goes into the hospital because he has pneumonia (on top of metastasizing lung cancer), is rapidly losing weight at about 15 pounds a week, and becomes gravely ill. He gets hooked up to machines, has lots of fluids, oxygen, antibiotics, you name it. And as he’s being thrown into this awful whirlwind of infection and illness, his wife goes into labor. In the same hospital. And the doctors wheel him into the delivery room, in which he is too frail and cold and sick to do anything but lie beside her as she labors. He smiles, he touches her hand, and supports her in all the ways he possibly can. Watching her belly rise and fall with each contraction, listening to the nurse as she coaches Lucy through the birth.

And my heart was just breaking. Splitting into a million pieces, scattering on the floor, tears flowing uncontrollably down my face. Thinking of being in his position, the most wonderful and sweet and powerful moment of his existence up until that point, and unable to really be there. And his wife, Lucy, being strong and having a baby on her own, while also caring for a dying husband. Walking this thin line between life and death in every single moment.

And thats when the book got hard. Paul spending his last and dying days with his newborn daughter. Writing the things he wants to tell her while having chemo or procedures or lying in a hospital bed in the ICU. Lucy knowing the end is near and giving the baby her last few minutes with her dad before he passes on. Too little to understand the gravity of the situation, and that she’ll never have her daddy hold her and kiss her tears and teach her to ride a bike or read books. He won’t be there to hug her after a hard day or remind her of who she is.

And then Lucy, Paul’s wife, picks up the torch and continues the story after his death. Recounting those last days and hours and minutes. The sacred tension that existed in their home as he prepared to leave this earth. Saying his last goodbyes, hearing from friends and family, and slowly choosing to just have his closest family by his side as he passes. His wife lying on his chest, asking if she’s making it too hard for him to breathe. His response “This is the only way I know how to breathe.”

I sat reading these last pages on an airplane, furiously wiping tears away from my eyes so I could read the words on the page. My heart was aching and grieving for this family. For this man who is so kind and gentle and brave. And the fact that he has left such a remarkable legacy behind him on facing death with an open heart and an open mind. Honestly taking each step and allowing the reader to come alongside him in this grueling process. I grieve for his daughter and his wife, and those students that will no longer be able to learn from the tremendous doctor that he was. I grieve the loss of life at such an early age, but see the joyful moments that existed in tandem with the brutal ones as he found the meaning with which to live each day.

I was reminded of the beauty and shortness of life, the simplicity mingling with the complex.

Our world, both bitter and sweet.



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