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“When Breath Becomes Air” by Paul Kalanithi

“…I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.”

When Breath Becomes Air, Paul Kalanithi

Paul Kalanithi was working as a neurosurgery resident, when at the peak of his career, he received a devastating diagnosis. After years of reading CT scan images (which provide detailed images of the body), it was his own CT scans that were being analyzed, to the conclusion that he had stage IV metastatic lung cancer.

Although this autobiography centers on Kalanithi’s own battle against cancer and his personal experiences that accompany it, When Breath Becomes Air is remarkable in that every sentence has been written with intention, and Kalanithi’s style of writing and tone conveys a charisma that enraptures readers and makes each page profound. Although Kalanithi’s journey is deeply personal and specific to his own life, the experiences he has, as well as the book’s themes and morals, can resonate with people from all walks of life. 

Doctors can learn from his insight about life and death, and about respect for lives beyond merely centering on disease and symptoms. College students can relate to his journey in trying to find a life trajectory and calling. And with respect to the HD community, anyone suffering from a terminal illness that rips at your fundamental being and robs you of the life you’d dreamed of can relate to Kalanithi’s experiences, as he grapples with the experience of watching himself die, attempts to restructure his goals and life plans, and decisions about having children and building a family.

The book begins with a poem called “Caelica 83,” which describes souls as eternal and says life changes form after death, like breath when it turns into air. The poem not only explains the title’s origins, but gives readers insight on some of the book’s themes: time, life and its various forms, and death.

After a foreword comes the prologue, which describes the beginning of Kalanithi’s symptoms, when he didn’t yet know what was going on and dealt with all sorts of questions and doubts. He also tells readers about the worry that gnawed at him and his wife, and how their lack of communication put a strain on their relationship. This part of the prologue can apply to HD: different but parallel to pre-diagnosis uncertainty and the struggle to reconcile the personal experience of coping with marital sharing. Later he also describes a dissonance between feeling and knowing that your body is dying, but at the same time being surrounded by vibrant life, which is relatable for anyone with a terminal illness.

The rest of Kalanithi’s story is divided into parts, with the first one describing his complex love-hate relationship with medicine, his journey from high school to medical school, and the plethora of moral and ethical concerns he experienced through medical school and the beginning of his residency. Part II becomes more relevant to the HD community, as he switches perspective back to the present, post-diagnosis. In this section, he navigates concerns about what to do with his life, his family, and his career. He decides to continue working as a neurosurgeon and to have a child with his wife, so he and his wife “would carry on living, instead of dying.”

With that, Kalanithi chronicles the ways in which he carries on living through the birth of his child, until his treatments stop working and his cancer forces him to carry on dying. His words conclude with a message to his daughter, and his life abruptly ends before he can finish telling his story, conveying the sudden nature of death itself.

Kalanithi’s story, although not specifically written about or for the HD community, offers perspective on hardships many individuals and families with HD must also face. His attitude towards living without knowing how long he has left, him and his wife’s thought process before having their child, and his final moments watching himself decline are all pertinent to those who have HD. Reading When Breath Becomes Air will not only take readers through Kalanithi’s personal journey, but will leave readers with insights that make them consider their own journeys through life.