Reflections on “When Breath Becomes air” by Paul Kalanithi

By Bob Steele

December 25, 2016

I have read many books in my lifetime, likely several thousand, but this is one of the rare ones. It is a profound, beautifully written book that reached out and touched me on many levels. It triggered deep reflection about health and disease, living and dying, wisdom and folly.

This is a sad story, a memoir written by a brilliant, young neurosurgeon who loses his fight with lung cancer. And yet I am so glad I read it and hope that my family and friends will do so. Paul Kalanithi deals with death, looking at its many facets, but never in a morbid or clinical way.

Paul spent a third of his life in his quest to become a neurosurgeon. The book reflects some of the many lessons learned in that journey. It includes a helpful treatise on doctor-patient relationships that should be required reading for doctors, nurses, and caretakers for people who face terminal cancer/illness diagnosis.

There are literally dozens of quotations that I want to share from this remarkable journey of self-growth as he transitioned from doctor to patient. However, I am resigned to citing these few.

I began to realize that coming in such close contact with my own mortality had changed both nothing and everything.

       I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death.

       Amid the tragedies and failures, I feared I was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient. Technical excellence was not enough…. When there’s no place for the scalpel, words are the surgeon’s only tool.

       In those moments, I acted not, as I most often did, as death’s enemy, but as its ambassador.

       A tureen of tragedy was best allotted by the spoonful.

       How little do doctors understand the hells through which we put patients.

       You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

      Doctors, it turns out, need hope, too.

 For his infant daughter, Cady:

      When you come to one of the many moments in life where you must give an account for 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. In this time, right now, that is an enormous thing.


More poignant words, I have yet to read. A sense of sadness fell over me as I reread the book to collect my thoughts and considered how many more lives he could have saved, how many more he could have touched with his new-found sense of empathy and wisdom. But then I realized that through this book he can reach out and touch the lives of so many more than he could have done as one of the best doctors. He has yet much to share and teach.

Thank you, Paul.

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