When Breath Becomes Air

It is hard to accept that death is not only inevitable but unpredictable. As a child, I believed that death came slowly, with a soft knock on the door, asking for permission to enter. As I’ve grown up, I’ve had to accept that death can come loudly, without permission, and take down the whole house. For Paul Kalinithi, author of When Breath Becomes Air, death came suddenly and swiftly at age thirty-six.

I don’t like to read memoirs. I’ve found that they’re inherently catered to readers, meaning they can’t just tell a story; everything has to be tied to an awakening or a lesson. And they all seem to come to the same conclusions: hardships are necessary, close bonds are essential, and life is a gift. I don’t disagree with these lessons, but I don’t like learning about ‘life's meaning’ in that way. Don’t tell me how you changed your life; tell me a story that will allow me to figure it out.

When Breath Becomes Air was the first memoir I truly enjoyed. I’d heard about its brilliance for years but discarded it into my mental category of ‘counterproductive memoirs’-- until my mother suggested I give it a chance.

‘It’s really that good,’ she told me on the phone last summer.

I don’t take book recommendations seriously unless they’re from my mother, so I moved the book into my mental category of ‘books I’ll eventually read.’ Later that week, however, during my daily peruse through Daunt Books in Marylebone, London, a copy of When Breath Becomes Air was laid on an entry-way table. Its light blue cover stood out amongst the surrounding beige and black. Who knows why this book was displayed last June, but I took it as a sign and bought it.

When Breath Becomes Air is split into three parts: a Prologue, Part I, and Part II. The Prologue is 20 pages long and catches you up to speed: Paul was a thirty-six-year-old award-winning neurosurgeon when an intense bout of back pain revealed inoperable lung cancer. As readers, we’re left with this devastating information and then shot back into time with Part I, titled ‘In Perfect Health I Begin.’

Some could argue that Part II is the heart of the story, to which I would agree. Part II is titled ‘Cease Not Till Death’ and walks us through Paul’s journey fighting cancer and his ultimate death. Amidst the chemotherapy, Paul contemplates his neurosurgical work, his passion for writing, and his and his wife’s desire to conceive a child. Rather than dwell on the ups and downs of treatment, Paul surges towards his heart’s desires. His optimism, bravery, and tenacity are pungent until the end. Part II is stunningly heartbreaking, and the final section, written by his wife, left me blubbering. If Part II is the heart of the story, then Part I is the brain, and that part, honestly, impacted me more.

Maybe it’s because of my age or because I’ve studied English literature for most of my adult life, but Paul’s description of his childhood and the start of his search for the meaning of life through novels and poems left an impression on me only a few texts have been able to do.

Part I introduces us to Paul pre-cancer and pre-neuroscience. As an undergraduate student at Stanford, Paul studied literature and philosophy ‘to understand what makes life meaningful’ (pg. 35). He delves into authors like T.S. Eliot, Vladimir Nabokov, and Joseph Conrad, and he revels in their understandings of the human mind. Paul’s descriptions of literature and his takeaways from philosophers perfectly capture what I’d describe as why some of us are so pulled to language. Reading is not just a form of entertainment, but a search for knowledge. Fiction or non-fiction, stories are condensed versions of life that explore our wildest ‘what-if’ questions.

Paul’s desire to understand the human mind resonated with me and my research. Last summer, I spent four months writing a forty-page dissertation to complete my MA. My research began in Afrofuturism, specifically African folklore and myth. What drew me to these myths was how their creativity and symbolism were used to process real-life circumstances. Because of this, I wondered if I should tie the myths to real-life theories by theorists like Saidiya Hartman and Dionne Brand. At the time, this bridge felt monumental and borderline unreasonable; even my dissertation advisor was hesitant. I was stuck at a crossroads.

Towards the end of his undergraduate degree, Paul considers the overlap between literature and science. He explains:

‘There must be a way, I thought, that the language of life as experience– of passion, of hunger, of love– bore some relationship, however, convoluted, to the language of neurons, digestive tracts, and heartbeats’ (pg. 39).

This quote resonated with my research deeply. It was fate-like that while I was writing my dissertation and considering whether I should bring theory into my creative paper, I happened upon When Breath Becomes Air. Paul’s words validated my desire to connect the creative with the scientific. I wanted to know how and why African myth-making connected to enslaved individuals. In other words, how did what they were physically encountering influence the stories they created? That question was not so different from Paul’s quest to understand the human body and the human mind. After finishing When Breath Becomes Air, I decided to take the leap and add Hartman and Brand to my paper. It raised the stakes in my research and added a critical dimension to my dissertation. I can’t imagine what my paper would have become without them. This is just one example of my immense gratitude for Paul and his memoir.

Early in the story, Paul weighs whether he should study or experience the meaning of life. I believe in pursuing both. Creative explorations of the mind can/should inform scientific explorations of the brain– and vice versa.

Another reason Paul’s memoir is successful is because he asks questions. He doesn’t try to sway the reader to a conclusion or even to agree with his questions; he simply articulates the queries his brain wrestles with. This method of writing is influential because it welcomes the reader’s personal experiences. When Breath Becomes Air is about Paul and his life, but if you’ve read it, you know it leads to many questions about the self.

One of my favorite quotes is the following:

‘The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving’ (pg. 115).

This quote is about surgery, but it’s really a metaphor for life. We’ve all heard the phrases ‘nobody’s perfect’ and ‘all you can do is your best.’ They’re cliched at this point, yet Paul manages to revamp the conception of perfection. He’s not telling you to dismantle the idea of perfection but urges us to recognize that being unable to reach perfection shouldn’t dismount trying. Losing is unavoidable, but recovery is non-negotiable. Don’t lower your expectations or change your goals; keep going and aim to land higher than before.

It’s ironic that Paul deduces that perfection is impossible when I think many readers of his story would agree that how he lived his life was pretty perfect. This memoir is phenomenal because it allows you to reconsider what’s important in your life alongside Paul. And the greatest gift of all is that, unlike Paul, you leave the story alive and can implement all that you’ve learned.

Although Part I resonated with me more, Part II was equally successful in pushing me to reconsider my values and how I spend my time. He doesn’t say these things explicitly, but here are some of the lessons I learned from the memoir:

• Death is inevitable and unpredictable.
• Live intentionally.
• Find your calling and make it your job.
• Help others, and help often.
• Build close friendships and commit to those friendships.
• Don’t hold grudges.
• Take the scary leap and trust your legs.
• Hold your loved ones close and your younger self even closer.
• Life (and literature) is a gift.

Alongside the title, the motif of breath and air carries on throughout the memoir. It's a flawless image that, like Paul, addresses both science and literature. We need air to breathe and we need stories to live—the two interchange from personal to public.

I advise readers to inhale this book like a deep breath, and turn its contents into your own air. Whether it’s literature, science, or something entirely different, find your calling and pursue it until your last breath.

Thank you, Paul, for spending the last of your days writing a memoir and guide that has and will continue to impact many.