Review: When Breath Becomes Air by Paul Kalanathi

When Breath Becomes Air is the story of a supremely high-achieving brain surgeon's life and untimely death in his 30s from lung cancer, exploring his journey from superstar doctor with the world in his hands to terminal cancer patient. It's the kind of story that, once existing, has to be told, because that kind of insight is exceedingly rare. It's a book that inspired me, unsettled me and made me cry.

I could relate to a lot of his early career as well, especially his love for words and his transition to health as a calling. He loved words and always used them to figure out where to go, but after doing his degree in English Literature realized his vocation to help people and entered medical school to become a neurosurgeon. I always wanted to be a writer before realizing after a couple of science fairs that science was the best way for me to improve the world. 

So then he starts talking about his medical training and it became a real page-turner. I remember sitting in bed with Leon (I think he was reading Temeraire beside me) and being struck by this sense of awe when he described the medical students' anatomy classes with cadavers and the sacredness of it all, how these were real people just being used as teaching materials. I was also extremely impressed with the beauty of his writing -- I kept coming across sentences I had to tell Leon about. 

There was just so much gravity about it, the story of this ancient, sacred profession, sacred in the sense of our shared humanity -- the wonder of consciousness and the sadness of its extinction.

His obvious passion for helping people and his stories of times he'd failed, times he'd saved a life but had made a millimetre's error and turned a sweet child into a monster or a sick patient into a vegetative one, and his death from lung cancer, renewed my drive to save people with science because our current medicine isn't enough. There was also that sense of wonder at the intricacy and mystery of the brain, how a human life is squeezed into the small space of a skull, how there are so many ways it can go wrong and yet so often it doesn't. 

He told stories of the extreme pressure in medical school and residency, of leaving for work at 6 am and going home at 2 am, of colleagues who committed suicide, and of the additional pressure he put on himself to do every surgery perfectly and swiftly because of the enormous power he held in his hands to heal or maim. 

Paul had almost made it. He'd very nearly finished his residency and was fielding prestigious job offers, winning top awards, even having a position created specifically for him at a university. Then he started experiencing debilitating back pain and was diagnosed with lung cancer. It was an interesting diagnosis story because he was a doctor as well so the diagnostician couldn't soften the blow for him because he could see how poor the prognosis was from the scans.

And suddenly, he was in the hospital bed instead of standing over it.

He was treated and went into remission, then went back to work as a neurosurgeon despite his exhaustion. But then the cancer came back, and this time it was terminal. 

The really unsettling bit here was how Paul spent his whole life in preparation. School, college, Masters, med school, residency, cancer diagnosis in the last year of residency. His fingertips were just touching the pinnacle of his field when he was cut down. He'd been working 18-hour days, not making time for his family, not making time for rest or reflection or relaxation, because he thought he had time for that later. This book, which he wrote while dying, was the book he wanted to write at the end of a long life. It's scary because so much of what I do is future-focused, always trying to create things and work for the future rather than living in the present. 

Paul's last few weeks, his death and its aftermath are written in an epilogue by his wife who promised him she'd get his story published. It's a beautiful afterword, one that really drives the poignancy of the word home -- in many novels, an afterword is just something that happens after the arbitrary point the author has decided to end the story, but here it's the story after his death, after that point of finality he cannot come back from. His wife described their love and his life and legacy, and the child he had with her just months before his death. She described visiting his grave and ruffling the grass as if it's his hair, and I thought of how I liked to do that with Leon.

The only criticisms I have are (a) it's short (well, what can you do) (b) I didn't appreciate how he says everyone, even rationally-minded people, will become religious facing death. 

It's the second book I've read on the recommendation of Bill Gates (Superintelligence by Nick Bostrom was the first, review here) -- he seems to have good taste. I'd previously loved another poignant and far-reaching book by a doctor-writer called Siddhartha Mukherjee, Emperor of All Maladies: A Biography of Cancer (seems I didn't actually review this -- I'll have to soon, it was incredible) and have since bought another neurosurgeon's autobiography, Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh.

Really an excellent book -- it fascinated and inspired me with his work, and moved me with his illness.