When Breath Becomes Air by Paul Kalanithi
Posted Sat Jun 07 2025
For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question 'What makes a life worth living?' At the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.
I was recommended When Breath Becomes Air by a few friends. Paul Kalanithi's posthumous memoir, When Breath Becomes Air, follows his life from training to become a neurosurgeon to confronting a diagnosis of stage four lung cancer. It's a tragic and beautiful book that made me question how one should live life and when it's worth living.
The first section of the book follows Kalanithi in medical school and residency. Learning about a physician's life and the education they receive was intriguing. A family member of mine is a doctor, but I wasn't aware of the intense conditions they inhabit. Reading about dissecting cadavers, witnessing death, comforting patients, and 100+ hour work weeks gives me a profound respect for medical practitioners. Kalanithi mentions how neurosurgeons must be passionate about their jobs to endure the stressful environment.
Throughout the novel, Kalanithi attempts to understand what makes life worth living. He says that a neurosurgeon must understand a patient's reasons for living in order not to compromise these reasons when performing surgery. In addition, when a surgeon can't save a patient's life without sacrificing these core values, they must weigh whether the patient would prefer death. For instance, if a patient's life can only be saved by being put on life support, a neurosurgeon must decide if the patient would rather have life support or an easy death. They also make meticulous efforts not to damage the parts of the brain that control motor function and language, as what is life without language?
While reading When Breath Becomes Air I reflected on what makes life meaningful and when I would opt for death over living. If surgery left me unable to understand or communicate language, paralyzed in my whole body, or in severe cognitive decline, I think I would choose death. My ability to communicate, reason, and interact with the world is central to who I am, and I wouldn't want to live without it.
It's clear that writing deeply captivated Paul Kalanithi. The book's prose is beautiful, and I reread passages to appreciate them again. This is one of the first books I've annotated with definitions because I didn't recognize many words.
The second half of the book switches tone and delves into Kalanithi's life after being diagnosed with cancer. The first section taught me what it's like to be a doctor, and the second taught me about being a patient.
Throughout this time, Paul Kalanithi grapples with his priorities and how he wants to live out the remainder of his life. Without knowing how much time he has remaining, he must balance living in the present and thinking of the future. He must decide between continuing neurosurgery or pursuing writing. I'm reminded that no one knows how long they'll live for, and illnesses can befall anyone. You shouldn't assume you have limitless time. I'm now more motivated to pursue my hobbies and work towards my goals, knowing that my time can come at any moment.
Furthermore, the book made me ponder my values in life and whether my actions align with them. So often, we focus so intently on the things immediately in our vision, like making money and getting good grades, that we become blind to why we pursued these in the first place. It's hard in college, but I'm going to try to focus on what truly makes me happy, like friends and hobbies.
Kalanithi dealt with his condition with as much grace as anyone could muster. He still devoted himself to helping others as a surgeon and continued to live and enjoy life with his family. A quote of his I like is, "Even if I'm dying, until I actually die, I am still living." He didn't let a terminal illness stop him from experiencing life, and I hope to emulate his behavior if I'm ever in a similar situation.
When Breath Becomes Air is gorgeously written, taught me a lot about the medical field, and made me reevaluate my approach to life. My friends who have read the book have thought it's life-changing. However, it unfortunately didn't leave a lasting impression on me, which I understand is controversial. There weren't many concrete lessons I learned beyond not procrastinating in pursuing my goals, which I already tried to do. Additionally, the book felt less engaging than it could have been because it focused on recounting events rather than using vivid storytelling. This is understandable, given that Kalanithi wrote this book in the last months of his life and had limited time. Still, it's a great, heartbreaking novel that I recommend reading. It's only 200 pages long and gives precious insights into being a neurosurgeon, terminal illness, and the meaning of life.