When Breath Becomes Air

Before writing When Breath Becomes Air, Paul Kalanithi was in residency in neurological surgery and a postdoctoral fellowship in neuroscience. In May 2013, Kalanithi was diagnosed with stage-4 non-small-cell EGFR-positive lung cancer.[3]

As Kalanithi underwent cancer treatment, he shared his reflections on illness and medicine, authoring essays in The New York Times,[4] The Paris Review,[5] and Stanford Medicine,[6] and participating in interviews for media outlets and public forums.[7] He also began work on an autobiographical book of his experiences as a doctor and a patient facing a terminal illness.[3]

Kalanithi died in March 2015 at the age of 37. His memoir was published posthumously 10 months later.[8] The book included a foreword by Abraham Verghese and an epilogue by Kalanithi's widow, Lucy Goddard Kalanithi.

Following the prospect of a better life, Kalanithi's father moves the family from Bronxville, New York to Kingman, Arizona when Kalanithi is ten. A doctor himself, Kalanithi's father dedicates most of his time to medicine and is notably absent from the house. Believing that to be a doctor, he would have to be away from the family like his father, Kalanithi becomes disenchanted with medicine. Although Kalanithi and his two brothers enjoy the newfound liberty of their desert town, their mother constantly worries for their academic future in a town that the U.S. census has declared “the least educated district in America.”[2] Unwilling to let anything halt their learning, she acquires college reading lists and instills in her sons a love for literature. The summer before heading to Stanford University for school, Kalanithi reads Satan, His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S., by Jeremy Leven. The book's idea that the mind is the result of the brain doing its work awakes a curiosity in Kalanithi for neuroscience.

After completing degrees in English literature and human biology, Kalanithi feels there is still much to learn. He is accepted to a master's program in English literature at Stanford, and one afternoon—pushed by his desire to understand the meaning of life— discovers the calling to practice medicine for the first time. Preparing to apply to medical school, Kalanithi uses the time off to study the history and philosophy of science and medicine at Cambridge. He later starts medical school at Yale. During his time at Yale, Kalanithi meets his wife, Lucy, and sees the patient-doctor relationship as an example of life, death, and morality coming together. After two years of classroom learning, Kalanithi experiences his first birth and death in his OB-GYN clinical rotation, when a set of twins could not be carried to term. It is then that Kalanithi understands that intelligence is not enough in the practice of medicine, and that morality is also needed. After medical school, Lucy Kalanithi starts internal medicine residency at UCSF and Paul Kalanithi begins a neurosurgical residency at Stanford. Though he finds it hard at first, Kalanithi grows used to the rigor of neurosurgery and, in his fourth year, joins the neuroscience lab of a professor affectionately called “V.” In the sixth year of residency, Kalanithi returns to his hospital duties and having reached professional recognition, he feels he has finally found his place in the world.[2]

Kalanithi's life takes an unexpected turn when, after weeks of health problems, it is confirmed that he has lung cancer. Images obtained from a CT scan show organ systems compromised by the cancer, causing him and his wife great sadness. Searching for the best experts in the field of oncology, Kalanithi begins treatment with a doctor named Emma Hayward. Because of his status, rather than stepping back and letting Hayward offer her professional opinion, Kalanithi expects to be treated as a consultant, even if it is his own case. Hayward suggests to find the root of his cancer before determining treatment options. In the meantime, Kalanithi's family helps him through his transition from doctor to patient, and together with Lucy, he decides to explore reproductive options before he dies. They visit a sperm bank and make the decision to have a child. Test results arrive and Kalanithi discovers that his cancer is derived from a mutation in the epidermal growth factor receptor (EGFR). This fact gives him a bit of relief because it means that he can be treated with Tarceva, which typically results in less-severe side effects compared to traditional chemotherapy.[2]

Symptoms subside with the treatment and, in Dr. Hayward's office, Kalanithi feels like himself again. After weeks of using the medication, CT scans show a reduced number of tumors in Kalanithi's lungs and he becomes determined to return to the operating room. Back in the OR, he cannot finish his first surgery because of his health. However, his strength and technique improve over time. With both graduation and a baby due in June, he takes another CT scan after months since the last. He discovers a big tumor in his right lung and without getting scared, he and Lucy research what other options are available. Kalanithi retires from surgery indefinitely and begins chemotherapy. His response to chemotherapy is adverse and his health worsens, forcing him to skip graduation. With the failure of chemotherapy, other treatment options do not provide him much hope. His condition becomes so severe that even Dr. Hayward gives an approximation of how much time he has left – something she had strongly refused to do before. On July 4, 2014, their daughter is born and Kalanithi is filled with joy.[2] Eventually, Kalanithi dies in the intensive care unit of his hospital.

The epilogue is written by his wife Lucy Kalanthi, after his death. It shows her point of view of the experience with her husband Paul Kalanthi's lung cancer. It is an in-depth personal explanation of her experience.

When Breath Becomes Air is a New York Times bestseller, spending 68 weeks on the non-fiction bestseller list.[9]

Matt McCarthy of USA Today gave it 4 out of 4 stars and said, "It's a story so remarkable, so stunning, and so affecting that I had to take dozens of breaks just to compose myself enough to get through it."[10] Nick Romeo of The Boston Globe wrote that it, "possesses the gravity and wisdom of an ancient Greek tragedy."[11] Melissa Maerz of Entertainment Weekly stated that the book was "so original—and so devastating. . . . Its only fault is that the book, like his life, ends much too early."[12]