Book of the Week

When Breath Becomes Air by Paul Kalanithi
Recommended by Isaac Wighton

On the verge of completing a decade’s worth of neurological training, Paul Kalanithi had examined hundreds of CT scans. This one was especially bad: 'the lungs were matted with innumerable tumours, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated.' What made it worse was that this was not a patient’s scan. It was his own.

At 36, Kalanithi had led a glittering academic career. Holding degrees in English literature, human biology and history and philosophy of medicine, graduating from Yale School of Medicine, winning the coveted American Academy of Neurological Surgery's highest award for research and very nearly completing years of training in Neurosurgery, the future was most definitely bright for Paul. This made the discovery that he had type IV inoperable lung cancer even more painful.

Kalanithi draws on his career as a neurosurgeon, his deep interest in philosophy and his insatiable appetite for literature to help grapple with some of the greatest existential questions, all with the knowledge that his time is dwindling away. Written with the eloquence of the authors he held in such high regard, Kalanithi’s posthumous autobiography proves to be a book of the calibre of Atul Gawande and even Oliver Sacks himself.

Terminal illness is by no means uncharted literary territory; many accounts have been written about personal battles with cancer. Few are as poignant and penetrating as Kalanithi’s, but what sets his aside is the transition from doctor to patient. Having spent years working with and preventing death as a doctor, but also years craving to understand meaning through literature and philosophy, he was no longer forced to understand death through the experiences of his patients, statistics and prognoses. He was forced to experience it himself, and quickly realised his bank of medical knowledge did not aid his situation as a patient, that it did not help him answer the greater questions he had. This switch in perspective is striking but exhilarating, providing an intense account that delves into what it really means to live a fulfilling life when faced with death.

Separating Kalanithi’s book from novels about terminal illness is its abrupt realism. Despite its completion it still feels like an unfinished account, cut short by death. And is above all, painfully truthful, free of the hyperbole or romanticisms sometimes found in fiction: Kalanithi’s account is raw and the dialogue is brilliantly recalled.  At times, the book can get congested with medical terminology and turns of phrase. Whilst this can seem overwhelming and is alarmingly easy to get bogged down in, most of it is easily remedied by a google search if need be. For the most part however, the medical intricacies are not central to the story and the book is just as readable to a non-neurosurgeon.

One of the most powerful questions Kalanithi is forced to ask himself, is ultimately the most moving. Should he bring life into the world, as he is about to leave it? Is a fatherless child worth having? When asked by his wife whether he thought 'saying goodbye to your child will make your death more painful?' Kalanithi replied with 'wouldn’t it be great if it did?', adamant to carrying on living, instead of dying. The book concludes with an address to his nine-month-old child that is enough to move most to tears: 'when you come to one of the many moments in life when 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.'

Overall Kalanithi’s insightful and moving account beautifully encapsulates a life well lived, a man whose yearning for knowledge and understanding inspired many, including his many patients. He powerfully grapples with some of the great existential questions, and provides new perspectives on mortality and life but also provides an unapologetically haunting account of cancer and its destruction. Kalanithi’s dry wit provides a refreshing break from his otherwise morbid situation, and his account is written with the grace and fluidity of the authors that gave him such a powerful outlook on the world. As novelist Ann Patchett put it, 'this is one of a handful of books I consider to be a universal donor - I would recommend it to anyone, everyone.'