January 22, 2016

When Breath Becomes Air by Paul Kalanithi

This memoir about facing death by a 36 year old doctor diagnosed with terminal lung cancer is so amazing. One of the best books I've read in years.
There’s nothing quite like reading on a crowded airplane while trying not to let your seatmate see tears running down your face.

When Breath Becomes Air is a memoir of a Paul, a neurosurgeon at Stanford. He was diagnosed with terminal lung cancer at age 36 and wrote an op-ed in the New York Times called How Long Do I Have Left? that went viral. I heard about both the article and the book from his sister-in-law, Joanna Godard, the blogger behind Cup of Jo, who mentioned them both as they were published.

Paul wrote this book about facing his own death and it was published last week, ten months after he died.

From his early years, he was interested in death and mortality, the meaning of life, human morality, and how those play out for people through the ages and all over the world. He did an undergrad degree at Stanford with degrees in English and Biology, as two different ways to think about life and went on to get a master’s in English. And then, as he was finishing up that degree, he decided to go into medicine where he could see first-hand life and death and their intersection.

He went to med school at Yale, where he met his wife Lucy, and then together they went back to Stanford for residency. He worked his way to the top of neurosurgery – one of the most demanding fields of medicine – and then, in his last of seven years of residency, was diagnosed with terminal lung cancer. “Death,” he says, “so familiar to me in my work, was now paying a personal visit.”

Suddenly, he’s on the other side of the doctor-patient relationship and he has to confront the realities of mortality. Of course, one of the terrible truths about cancer (and most terminal diseases) is that while you know death is on the horizon, you don’t know how far away it is. Do you have months? A year? Five years? Ten? And what are you going to do with that time? Of course, all of us know what we’re eventually going to die, but we don’t really live with that knowledge in a tangible way as we make decisions. We all assume we’re going to live to be 80 or 90. He describes it, “my state of knowledge was the same, but my ability to make lunch plans had been shot to hell.”

Paul had planned to become a surgeon-scientist but he doesn’t have enough time left to really do the kind of scientific research he was interested in – the timelines are just too long for the years he has left. He’d always wanted to write a book, but planned to do that after his medical career was over. At first he goes back to surgery but as his cancer progresses, he decides that’s not how he wants to spend his remaining time and instead dedicates the last year of his life to writing this book about facing his own death.

He and Lucy also decide they want to have a child together before he dies, and their daughter, Cady, is born eight months before Paul dies. At the end of the book, he writes directly to her, the most important thing he wants her to know about their briefly overlapping lives:
When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied.
While this book is basically going to break your heart right in half, it’s also surprisingly funny. Talking about his first experience in labor and delivery he says, “An Anne Geddes photo this was not.” Listening to a doctor describe making the tough decision about delivering twin babies at 23 weeks and 6 days: “What a call to make. In my life, had I ever made a decision harder than choosing between a French dip and a Reuben?” After his diagnosis, he wrote a friend, “The good news is that I’ve already outlived two Brontes, Keats, and Stephen Crane. The bad news is that I haven’t written anything.”

Paul died last March, with this book not quite completed – the book deal came through only three months before he passed away – and his wife Lucy writes the epilogue and fulfilled his wish to have it published.

I tend to be a little hesitant about books that are described as having beautiful writing (doesn’t that sometimes seem to be code for, “no plot and also very long and wordy?” I know; I’m a weak reader) but there seems to be no other words to describe this book.

There’s no doubt that this was written by someone who loved literature and had spent much of his life engaging with the best writers in the English language. He references many books, poetry, and great authors, and it adds an extra layer to his own really extraordinary writing. But it never feels forced or heavy-handed or like he’s trying to be the next great American author. It’s a completely engaging story of his life and experiences, that happens to be beautifully written. It’d be a perfect book to pair with Being Mortal and would make a phenomenal book club choice.

Check back in December, and I’m almost positive that this book will be in my top 10 for 2016 – it’s hard to imagine that I’ll read ten books that are better than this one. Frankly, there might not be any.

Advance copy provided by publisher


  1. I have a question: Where do you hear about all the books you read? You said where you heard about this one, but in general? I'm realizing that I find out about a lot of books through you but I want in on your secrets! :)

    1. I get tons of book emails, I read Book Page (that little free newspaper at the library), people suggest books to me, NetGalley, browsing the bookstores. Good luck!

  2. I recently added this to my To Read list so I'm so glad to hear that you think it's so good! Very glad to have found your blog. It's my go-to before library visits with my 2.5 year old son.

  3. I'm not sure I should read this since my own father's death from cancer is still difficult, but I'm not sure I can't. It sounds truly beautiful.

  4. I can already tell you I will never read this. Is be a hot mess. It sounds beautiful though!

  5. I too read about this book on A Cup of Jo. Later, I saw it again on Dinner A Love Story. I want to read it... and I'm afraid.

  6. This book really sounds amazing. This is probably going to be my Audible purchase for next month.

  7. Wow. Just reading your review made me cry. This book sounds wonderful though.

  8. I can't wait to read this! I'm an RN, and soon to be FNP coming this May! As a medical provider I know the hard decisions that need to be made and the heartbreak and anguish we feel over them. With graduate school, work, and two little girls (3 and 1) I don't get much time to read so I listen to books on my commutes. I can only hope listening to it will be as good as reading it. I'm currently listening to And they were not ashamed, it has parts that I'm screaming yes! And other parts that make me go... eh, I don't agree with that at all. It reads more like a textbook for husbands on how to be better in the sack.

  9. Your review of this book is also beautiful. I know that can sound cliche, but it is true. Thank you for the recommendation.

  10. I just got this in the mail! Can't wait to read it.

  11. I'm always hesitant to read books that touch the subject of death so closely. It is something that hits me too deeply and personally. But I read your review, and I clicked on the link of the letter he wrote when he first found out. After reading it, I felt compelled to find out more about this book. Unfortunately, they don't have it at my library, yet. I'll have to see if they have it at the book store. I'm still a little bit 'scared' to read it, though.

  12. This book came into my book club this month and I snatched it before anyone else could as this review has stuck with me since January. Four days later as my husband took my toddler out for Saturday afternoon I'm a tearful mess on the couch having just finished it. Beautiful, heartbreaking. Thanks for the review.


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