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BOOK REVIEW

When Breath Becomes Air

By. Paul Kalanithi, MD
Reviewed by Rajam Ramamurthy, MD

You that seek what life is in death,
Now find it in air that was once breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! Then make time, while you be,
But steps to your eternity.

-Baron Brooke Fulke Greville. “Caelica 83”

Randomly browsing through the shelves — could have been at our conscience the topic of death that we physicians avoid. What
the airport — I picked up a book titled ‘When Breath Becomes Air.’ makes life meaningful enough to go on living? It is a question each
Recently my eyes seem to focus on topics that deal with ‘end of life,’ one of us gracefully donning our senior citizen cloak have to give
like a magnet wand that snaps on metal objects at the beach as the some serious thought to. There is one prognosis in life that is so
sweeper scans the sand. We do choose our reading very often to easy to pronounce yet we never do. Most of all we in the medical
feed our intimate thoughts. Thoughts I could not or would not profession don’t. That is the eventuality of death. Everyone dies.
share as I stood at my husband’s bedside day after day that fateful The physician’s knowledge and experience should place them in the
month, April 2016. best possible position to guide each patient through their illness and
recovery or sometimes through illness and death with as much com-
Breath Becomes Air, a New York Times Best Seller, was written passion and guidance. As per Paul “when there is no place for the
by Dr. Paul Kalanithi, a surgeon who was in his final year of training scalpel, words are the surgeons only tool.”
in neurosurgery when he was diagnosed with lung cancer. Paul’s
richness of language surprised me for we in medicine generally Oh! There is so much more that Paul expounds that I read and
chuckle when we speak of notes surgeons write. The depth of his reread. This passage about god really answered some questions that
thoughts reflect his vast reading of serious writings. There is almost arise and nag my scientific thinking. “Science may provide the most
a cadence to his style like this one I quote; “I lay there in the dirt, useful way to organize empirical, reproducible data, but its power
awash in sunlight and memory, feeling the shrinking size of this to do so is predicated on its inability to grasp the most central aspect
town of fifteen thousand, six hundred miles from my new college of human life: hope, fear, hate, beauty, envy, honor, weakness, striv-
dormitory at Stanford and all its promise.” I almost felt ashamed ing, suffering, virtue.” His writing touches upon so many aspects of
and kept apologizing to Paul for deriving this vicarious pleasure of humanity as though he, in his death, has comforted many.
reading his beautiful writing when he was laying his life open as the
ravaging lung cancer was greedily robbing him of life and all that There are aspects of Paul’s story that I do not comprehend, I never
could have been. have. It has always troubled me when terminally ill patients begot
children. Who am I to judge a soul standing at the edge of life. I so
The book throbs in your hands as though Paul has infused his life want to move away from such thoughts and leave those of you dar-
into its pages. Paul goes to visit a close friend in New York City. ing enough to pick up and read a book such as this that will awaken
Lucy, his wife, refuses to go. She has to sort out many things about your feelings in so many spheres of life.
how their relationship is moving; Paul not sharing with her his con-
cerns about the diagnosis of what is happening with his health is Rajam Ramamurthy, MD, Professor Emeritus. Pediatrics/
one of them. Tears welled up in my eyes as I read the part where Neonatology, UTHSCSA.
Paul was going to talk to Lucy about the X-ray report. “Lucy picked
me up from the airport, but I waited until we were home to tell her. The late Dr. Paul Kalanithi’s widow, Dr. Lucy Kalanithi, will be
We sat on the couch and when I told her, she knew. She leaned her speaking at an event hosted by UT Medicine San Antonio’s Center
head on my shoulder and the distance between us vanished.” for Medical Humanities and Ethics in March 2017. For details,
please visit texashumanities.org.
The book is the third in a row of books that I read that bring to

30 San Antonio Medicine • December 2016