Book Review When Breath Becomes Air

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When Breath Becomes Air

by Paul Kalanithi

Forward by Abraham Verghese

ISBN 9780812988405 Random House, New York 228 pp

This author takes the reader with him through the terrible transition between his very ambitious and successful early life to his death as a 36 year old man– who gets lung cancer in the last years of his neurosurgery residency at Stanford. He had originally wanted to be a writer, but chose medicine instead. Yet he is still also a writer. As physician readers and reviewers, george meyer and I walked his walk not wanting to put the book down until the last word. Though Paul was unable to actually finish his book, he takes the reader to the point where he loses the ability to go on. His wife, Lucy, an internist whom he first met in medical school, provides closure in a touching epilogue.

The story begins at the ending…in the prologue. The author, previously treated for cancer, has recovered enough to nearly complete his 6th and last year of neurosurgery residency, when he develops extreme exhaustion and ominous symptoms. He pulls up and views his own CT scan with

‘lungs matted,… spine deformed, a lobe of the liver obliterated.’

Part I, 100 pages, could be of most interest to the non medically savvy reader. It tells of Paul’s life, from childhood through his years in medical school. Most interesting is that even while young he is concerned about life and death. That interest is sharpened later by patient care and by the death of his best friend. His writing is filled with pithy literary quotes, reflecting his extensive reading as a child and young man; and perhaps, great intimacy with his browser.

His portrayal of medical school and his experiences with patient care will be familiar territory to most physicians, and informative to others. He nicely portrays many of the challenges and contradictions medical students deal with as they progress through their training. Paul talks about the difficulty all of us (most of us) had with our cadavers and of the depersonalization we may develop so we are not too emotionally involved with the bodies we dissect. He describes the struggle of first-year residents who are fighting just to keep their heads above water. He worries that he was on “the way to becoming Tolstoy’s stereotype of a doctor”, dealing with the demands of residency, then practice, filled with the taste and smell of life and death while dealing with the ‘drama’ of the hospital, and administrators. It seems, though, that Paul develops a sense of who he is and what he stands for sooner than many of us do. He professes great sensitivity to patients and their families in the most trying of circumstances. He gets involved…intimately and actively, with patients, something often considered bad form or dangerous.

Part II, titled Cease Not Til Death, will likely be most meaningful to physicians, our friends, families, and other medical professionals. It is headed by this quote from Montaigne:

..to study philosophy is to Learn to Die”.

Paul, the physician, becomes the patient. He describes his years long struggle, both mentally and physically, fighting his malignancy. During a tenuous remission he is able to complete all the demanding requirements of his neurosurgery residency. He writes of the experience during diagnosis, chemo, recovery, mental rigors, and recurrence. Both he and his wife are high powered high pressure professionals, and the marriage is stressful and long distance; yet the cancer changes that, bringing them more together. Paul’s long drawn out dying also intimately involves his oncologist, who helps him consider and make crucial decisions. All their intertwined lives are changed.

This book– short by comparison with so many that are far less informative– is well worth reading both by medical professionals, and by the general public. The former often look into the eyes of death, and the latter will at some time… It seems likely neither will escape life without that encounter.

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