Page 26 - Delaware Medical Journal - June 2016
P. 26
BOOK REVIEW
186 Del Med J | June 2016 | Vol. 88 | No. 6
When Breath Becomes Air
Paul Kalanithi - Random House, 2016, 256 pages, $15
J ames F. Lally, MD
I Nuland published in The Paris Review, Paul Kalanithi,
then a neurosurgery resident at Stanford University Medical Center, noted that it was exactly 20 years after
the publication of Nuland’s How We Die that Kalanithi was diagnosed with advanced metastatic cancer at the age of 36. Ironically, Kalanithi knew Nuland while
profoundly impressed with his book as
it appreciated the “twinned mysteries of
death....at once deeply personal and utterly
impersonal.” While an impersonal and
dispassionate aloofness may well serve the
emerging career of an academic neurosurgeon
such as Kalanithi, a forewarning of death
compresses time and punctuates thoughts of
mortality with urgency. Paul Kalanithi, as a
physician who dealt frequently with end-of-
life decisions, realized this more than most.
time left compelled him to face the agonizing
paradox of “the pain of knowing and not
knowing the future.” With his skills as a physician and as
a very gifted essayist on full display, he graciously lets us enter his abbreviated life with his poignant coming-of-age-in- medicine memoir: When Breath Becomes Air.
Paul Kalanithi had two callings, two passions in life: English literature and writing and later in his short life, medicine. While Arizona, Kalanithi’s parents instilled in him a love of learning and books. As a teenager he had already read books by Dickens, Stanford University with dual degrees in English literature
and biology. An MA degree in English literature at Stanford followed. Before medical school he earned a master’s in the history and philosophy of science and medicine from the career as a teacher of English literature and as a writer waned
as he thought, “moral speculation was puny compared to
would give him a sense of greater involvement. The action and
Photo by Norbert von der Groeben
vocation in a neurosurgery residency at Stanford, an arduous six-year program that brought the challenges he had been seeking. Kalanithi viewed medicine as the intersection of life and death and neurosurgery in particular as a “crucible of identity: every operation on the brain is, by necessity, a manipulation of ourselves.”
of weight loss, back pain, and cough, he brushed aside his entrenched denial and sought consultation with a fellow physician. Subsequent CT scans of the chest and abdomen revealed multiple sites of metastasis. All that he had envisioned in his career as a surgeon and later as a writer, “the culmination of decades of striving, evaporated.”
in his cancer memoir, Mortality, referred to as the bargaining
