Book Review: When Breath Becomes Air
When Breath Becomes Air is a book about death—a subject we'll all face, yet one that remains profoundly mysterious. Death and life are the two poles we exist between. Human experiences tend to converge at these extremes. Birth is a growing consciousness: starting from one cell, becoming many, entering the world, grasping at new things, developing awareness. Death is consciousness coming to terms with the idea that it will no longer exist.
Not all death is equal. Sometimes it comes suddenly. Sometimes we're too unaware to register it. And there's another extreme: becoming aware of death even when it's not immediately imminent. We either transcend the concrete fear of nearby death, or we develop abstract ways to cope with the fact that eventually, we will meet our demise.
Paul Kalanithi's situation was a unique blend of these extremes. After his cancer diagnosis, he had a prognosis—roughly a year to live. Chemotherapy and other treatments could prolong his life, but they wouldn't eliminate the cancer. Death was certain for him. Yet he was also given time: time to come to terms with his suffering, to reflect on his life as a whole, to reconcile it.
Kalanithi had this opportunity right in front of him. While most people might waste it—clinging to false hope of recovery, losing all purpose, or refusing to engage fully with their mortality—Kalanithi accepted his fate. But he accepted it with grace, courage, and wisdom.
The first thing he accepted was the uncertainty inherent in his prognosis. Even before his own diagnosis, he had reflected on how doctors often give definite timelines to terminal patients: "You have six months to live. You have twelve months." He questioned whether this was honest, given that survival could be many more months, or many fewer. These doctors didn't grasp statistics. More importantly, they didn't grasp the importance of giving accurate information to patients. Death isn't something you can quantify so cleanly. It's inherently uncertain.
Kalanithi experienced this uncertainty throughout his journey. Various drugs could prolong his life. The cancer could flare up almost unprovoked. At each turn, he didn't necessarily value his life because living was uncertain. He certainly had the instinct for self-preservation. But he had already accepted his fate. What concerned him most was staying lucid and conscious enough to articulate the experience of traveling into the unknown, into destruction, into untimely demise.
What I find remarkable about this book is that it's a true culmination. The very urgency of knowing he would die soon accelerated his mind. Obviously, it would have been better if he had lived—he would have been a great neurosurgeon, caring and philosophical. But the acceleration of his mortality pushed him to access insights he might never have reached had he lived a full lifespan.
Kalanithi's story is one of someone who accepted the hand fate dealt him and played it to the fullest. He was caring, compassionate, thoughtful about his legacy. He thought about people who didn't yet exist in his life—his unborn daughter, who was later born but would have no conscious memory of him. It would be as if he was never there. He wanted to create letters for her, something for her to remember him by, but he never got the time.
I know this is supposed to be a book review, but I can't bring myself to critique anything about it. When someone takes up the challenge of writing about death—no matter what they produce—it's inherently inspiring. What Kalanithi's outlook shows above all is that he was always striving toward something. Whether toward a tangible goal or toward higher understanding of the human condition, he never took any hardship as an excuse to resign. He kept moving forward, striving not just in an external sense, but also in an internal one: discovering how to create meaning in his life, even as it ended.
That's the gift of this book.