New Review: When Breath Becomes Air

In Western, English as first language culture, we do not talk about death. Perhaps you and your family or friends are the exceptions to this, but on the whole- we do not have good culture habits about discussing death, dying, and desire. Our cultural practices center around avoiding death, despite the fact that our present conversations around healthcare, immigration, and which lives matter are very much death-based conversations.

When Breath Becomes Air by Paul Kalanithi has become a best-seller precisely because we do not talk about death. We rarely, outside of movies, sit with the idea that someone is dying, what they may want in their last weeks or days, and what it means to know that no further treatment will work. When Kalanithi writes in beautiful, philosophical prose about these very things, people flock to the words because they are thirty for this kind of conversation.

Right as Kalanithi was about to embark on a busy, profitable, and altruistic career as a neurosurgeon, he is diagnosed with lung cancer. Not from smoking, but simply because shit and malignant metastasis happen. As he ponders what it means to be moving from doctor to patient, he writes like he is running out of time. Because he is.

In his study of medicine, Kalanithi had a deep and organized sense of ethical forbearance. In addition to his study of the scientific whys and hows, he was also drawn to the moral dilemmas of patients and doctors- in truth-seeking and truth-speaking. He found himself weighing these issues even more carefully as he pondered his own future.

It occurred to me that my relationship with statistics change as soon as I became [a patient]… The angst of facing mortality has no remedy in probability. (134f)

Kalanithi’s journey toward death has a specified endpoint. Do we envy the knowledge of how much or how little time is left? Or do we dread the pressure that we might place on our still human, still fallible selves to “make every moment count”? When time becomes finite, is it excusable to waste it? What actually constitutes wasted time?

I believe that people are buying this book, in part, because it is a bestseller. I am curious about the other side of that purchase, what the majority of reactions are in reading it. Are people holding it in their laps, like I did, overwhelmed by the nuances of the writing and the deep contemplation of what it means to acknowledge that one is dying? The truth this small volume forces the reader to confront is that we are all always the patient, always dying, always on the way- even while our other identities are flourishing and strong.

In reading this book, I hope that people will push past the culture barriers. In book clubs, lunches, and bedtime conversations, mention this book. Mention your thoughts and feelings. Then lean into talking about your own fears and desires. Be willing to say, since I am dying (perhaps years from now, God willing), I would like to do this thing or write that or see the other.

Kalanithi writes in beautiful prose, which makes his book a pleasure to read. It also causes the reader to lament his death because the other writings from this mind are lost to us in this corporeal form. We cannot forget, also, that there are people presently alive because of his skill in surgery. His legacy is beyond these words- spreading into the future through lives that were saved and lengthened through his skills. May the same be said for each of us when we die.