“But above all, see what it is to still live, to profoundly influence the lives of others, after you are gone, by your words.” (Abraham Verghese)

When Breath Becomes Air should come with a box of kleenex attached.  This is the memoir of Paul Kalinithi, who spent the major part of his life as a student and the last 20 months battling cancer while writing a memoir to help others through the dying process.  It is the story of strength, resilience and bravery.  It is also the story of reflection, hope and love told through a voice that had been influenced by literature, philosophy and science.

Kalanithi spent many years as a student.  He had graduated first with undergraduate degrees in English literature and human biology.  He continued with graduate degrees in the history and philosophy of science and medicine.  He graduated from the Yale School of Medicine prior to residency training in neurological surgery and a postdoctoral fellowship in neuroscience.  He spent many years learning and thinking about life, death and dying.  He experienced a gruelling residency working long hours and learning the art of being a neurosurgeon yet remained reflective of literature and philosophy.    He had a unique view and helped his patients by slowly feeding them information as they came to accept their situation and understanding what was meaningful to them, helping them make life and death decisions.

“Neurosurgery attracted me as much for its intertwining of brain and consciousness as for the intertwining of life and death.”

When he was younger, he spoke of his family’s move to Arizona.  His mother was concerned about the school system and found a college prep reading list which she used to instill a “deep love of and care for language” in her boys.  Kalanithi reports reading 1984 as a 10 year old and used Brave New World (not my personal favourite) for his college admissions essay, arguing that happiness was not the point of life.

“Literature provided a rich account of human meaning:  the brain, then, was the machinery that somehow enabled it… Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection.”

Like all of us, he learned from mistakes.  He had made mistakes in the OR and when speaking with patients.  He made mistakes in his marriage.  He learned from his mistakes, becoming a better doctor, a better husband and shared both his failure and his success, learning from these mistakes with the readers.

Towards the end of his residency he was tired, losing weight and realized that something was wrong.  He was diagnosed with lung cancer which had already progressed to stage 4 with bone metastasis. The doctor had become the patient.

Kalanithi and his wife Lucy (also a doctor) understood that the disease was serious, progressive and incurable.  They worked with an oncologist, hoping for the best possible treatment to slow the disease and provide the best quality of life.  Kalanithi started writing his book and the couple had a beautiful baby girl.  Unfortunately, one by one, the recommended treatments became ineffective and he began to lose his race against time.

Kalanithi died peacefully in the presence of his wife and parents.  He had spent time with his family that day and everyone accepted his decision to decline active treatment to lengthen his life.  He died 20 months following his diagnosis, leaving behind a wife, a beautiful baby girl, parents, brothers, friends who loved him.

Kalanithi spent his last months writing this book.  The prologue was written by Dr. and author Abraham Vereghese (Cutting for Stone) who he had met once and provided an insightful introduction.  The heart wrenching epilogue was written posthumously by his wife Lucy.  I cannot imagine how difficult it must have been to share her intimate thoughts after such a loss.

When Breath is Air has been a timely read for me in relation to my new career focus on palliative and end of life care.  Kalanithi shares his most intimate feelings in the limited time remaining.  He somehow remains positive,  fully living his life until the end.  He leaves a legacy for his baby girl in these words which will help her to know and understand her father’s strength and resilience.  Those of us who have read the book have learned from his brave acceptance of a dreadful diagnosis and his ability to live life until his untimely death in 2015.

“Books became my closest confidants, finely ground lenses providing new views of the world”