Book Review: A Young Doctor Faces Death in When Breath Becomes Air

When Breath Becomes Air

By Anne Fox, President of Massachusetts Citizens for Life

The following article originally appeared in the Spring 2018 issue of the MCFL News magazine, a perk of membership mailed out quarterly to all members.

Paul Kalanithi’s memoir, When Breath Becomes Air, written as he faced a terminal cancer diagnosis, is the story of a young doctor, and his family, who lives well until he dies. He is a very different person, but he faces terminal cancer as J. J. Hanson did, with courage and conviction. (See Editor’s Note at end of the review.) 

In 2013, Kalanithi, a 36-year-old neurosurgeon, realized he had lung cancer, which involved serious pain. As he looked at the scan he thought, “The future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated. Who would I be, going forward, and for how long?” he wondered.

Kalanithi’s fatal diagnosis leads to the kind of introspection that never seems possible unless forced by tragedy. 

He was an extremely well-read, thoughtful, contemplative, kind, and gifted person. He earned two B.A.s and an M.A. in literature at Stanford, then a Master of Philosophy at Cambridge, before graduating cum laude from the Yale School of Medicine. His decision to go to medical school, he writes, was an effort “to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” 

book-review-When-Breath-Becomes-Air.jpgHe returned to Stanford for a residency in neurological surgery and a postdoctoral fellowship in neuroscience. He excelled at every level. His training was almost complete when he fell ill. 

In the first half of the book, Dr. Kalanithi provides a good set of anecdotes about how he goes from medical resident to seasoned doctor: first cadaver, first births and deaths on the same day. From the start, workaholic though he is, he understands patients’ needs better than most young doctors do. 

His words are bracing for their honesty. He also writes beautifully about the philosophical aspect of medicine, neurosurgery in particular: “Every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact.” 

On telling patients how much time they have left, Kalanithi says, “I came to believe that it is irresponsible to be more precise than you can be accurate.” Also, “Science may provide the most useful way to organize empirical reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” 

Kalanithi’s health improved for a while, allowing him to go back to work and to write more. He persevered through chemotherapy treatments. In 2015 though, things took a turn for the worse, and Kalanithi died before he completed this work. His wife, Lucy, with the book’s editor, finished the manuscript. 

When a friend heard I was reading the book, she exclaimed, “How could someone have a child when he knows he is going to die?” Let him answer for himself. 

“What are you most afraid or sad about she his wife, Lucy asked me one night as we were lying in bed. ‘Leaving you’, I told her. I knew a child would bring joy to the whole family and I couldn’t picture Lucy husbandless and childless after I died. 

“Will having a newborn distract from the time we have together?” she asked. ‘Don’t you think saying goodbye to your child will make your death more painful?’ ‘Wouldn’t it be great if it did’, I said. Lucy and I both felt that life wasn’t about avoiding suffering. After many years of living with death, I’d come to understand that the easiest death wasn’t necessarily the best.” 

In one of the book’s most poignant moments, Kalanithi lies on a cot in the same hospital room where his wife is giving birth to their daughter, Cady. Holding his child for the first time, he writes, “The possibilities of life emanated before us.” A few pages later, however, he is confronting yet again the certainty of death. “Everyone succumbs to finitude,” he writes. “I suspect I am not the only one who reaches this pluperfect state.” Only memory and words — in his case, those in this very book — “have a longevity I do not.”

Editor’s Note: Marine Corps veteran J.J. Hanson was president of the Patient’s Rights Action Fund (PRAF). Hanson was married and a father when he was diagnosed with stage 4 glioblastoma, the deadliest form of brain cancer. This was at the same time that glioblastoma patient Brittany Maynard was being lionized in the mainstream press for traveling to Oregon in order to take lethal drugs to end her life. 

Despite being given a prognosis of only four months to live, Hanson chose to fight. He not only endured grueling cancer treatments but worked tirelessly with PRAF, traveling to states to help defeat laws promoting doctor-prescribed suicide. Hanson outlived his prognosis by three years and he and his wife became parents again to a second son, Lucas, who was six months old at his father’s passing. 

J.J. was keynote speaker at the MCFL Mother’s Day Dinner in 2016. We respect his courage and honor his memory with gratitude.


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