When Breath Becomes Air Book By Paul Kalanithi (PDF-Quotes-Summary-Review-Online Reading-Download)

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When Breath Becomes Air is an autobiographical nonfiction book written by the American neurosurgeon Dr. Paul Kalanithi. It is a memory of his life and disease, fighting against stage IV metastatic lung cancer. It was published posthumously by Random House on January 12, 2016.

In his final year of neurosurgical residency at Stanford University, Paul Kalanithi experiences negative changes in his health. Rapid weight loss and severe back and chest pain start to worry him and his wife, Lucy Kalanithi. Kalanithi fears that cancer may have caused his symptoms and his deterioration in health, which is unlikely for people in their thirties. However, when the results of x-rays at a routine checkup are normal, he and his primary care physician attribute the symptoms to aging and work overload.

Determined to finish the last months of his residency, he ignores the symptoms that have not disappeared. A few weeks later, the symptoms return, stronger than before. Around this time, Kalanithi and his wife experienced a conflict in their relationship when Lucy feels that he is not communicating with her. When he visits friends in New York, Kalanithi is almost certain that he has cancer and tells his friend Mike out loud for the first time. Upon returning home, upon landing in San Francisco, Kalanithi receives a call from his doctor that his lungs "look fuzzy." When he gets home with Lucy, they both know what's going on. The next day, Kalanithi checks into the hospital, and the room where he examined his patients, delivering good and bad news, becomes his.

Book Summary:
At the age of thirty-six, about to complete a decade of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor who treated the dying, and the next he was a patient who struggled to live. And so the future he and his wife had envisioned evaporated. When Breath Becomes Air recounts Kalanithi's transformation from a naive "possessed" medical student, as he wrote, "to the question of what, given that all organisms die, he makes a virtuous and meaningful life" in a neurosurgeon at Stanford working on the brain, the most critical place for human identity, and finally in a patient and new father who faces his own mortality.

What makes life worth living in the face of death? What do you do when the future, which is no longer a ladder to your life goals, flattens into a perpetual present? What does it mean to have a child, nurture a new life as another fades away? These are some of the questions Kalanithi struggles within this deeply moving and exquisitely observed memory.

Paul Kalanithi died in March 2015 while working on this book, but his words remain a guide and a gift to us all. "I began to realize that coping with my own mortality, in a sense, had not changed anything and everything," he wrote. "Seven words from Samuel Beckett began to repeat themselves in my head:" I can't go on. I will continue. "When Breath Becomes Air is an unforgettable life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, by a brilliant writer who became both.

Book Review:
When Breath Becomes Air is a powerful look at a diagnosis of stage IV lung cancer through the eyes of a neurosurgeon. When Paul Kalanithi receives his diagnosis, he is forced to see this disease and the process of getting sick, as a patient rather than a doctor: the result of his experience is not just a look at what life is and how a scientific perspective works, but the ins and outs of what makes life matter. This heartbreaking book will capture you from page one and still have you thinking long after the closing sentence.

Book Club Questions

When Breath Becomes Air Quotes:

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

  • “Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still, it is never complete.”
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  • “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.”

  • “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.”
  • “Don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness. Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”
  • “I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.”
  • “The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with a terminal illness is a process.”
  • “Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving.”
  • “The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”
  • “even if I’m dying until I actually die, I am still living.”
  • “Life wasn’t about avoiding suffering.”
  • “What makes life meaningful enough to go on living?”
  • “Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death -- it's something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of life. We had assumed an onerous yoke, that of mortal responsibility. Our patients' lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn't. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
  • “Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die—but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?”
  • “Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.”
  • “I will share your joy and sorrow / Till we’ve seen this journey through.”
  • “Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.”
  • “All the idylls of youth: beauty manifest in lakes, mountains, people; richness in experience, conversation, friendships. Nights during a full moon, the light-flooded the wilderness, so it was possible to hike without a headlamp. We would hit the trail at two A.M., summiting the nearest peak, Mount Tallac, just before sunrise, the clear, starry night reflected in the flat, still lakes spread below us. Snuggled together in sleeping bags at the peak, nearly ten thousand feet up, we weathered frigid blasts of wind with coffee someone had been thoughtful enough to bring. And then we would sit and watch as the first hint of sunlight, a light tinge of day blue, would leak out of the eastern horizon, slowly erasing the stars. The day sky would spread wide and high, until the first ray of the sun made an appearance. The morning commuters began to animate the distant South Lake Tahoe roads. But craning your head back, you could see the day’s blue darken halfway across the sky, and to the west, the night remained yet unconquered—pitch-black, stars in full glimmer, the full moon still pinned in the sky. To the east, the full light of day beamed toward you; to the west, night reigned with no hint of surrender. No philosopher can explain the sublime better than this, standing between day and night. It was as if this were the moment God said, “Let there be light!” You could not help but feel your specklike existence against the immensity of the mountain, the earth, the universe, and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur.”

About The Author Paul Kalanithi:
Paul Kalanithi, M.D., was a neurosurgeon and writer. Paul grew up in Kingman, Arizona, before attending Stanford University, from which he graduated in 2000 with a B.A. and M.A. in English Literature and a B.A. in Human Biology. He earned an M.Phil in History and Philosophy of Science and Medicine from the University of Cambridge before attending medical school. In 2007, Paul graduated cum-laude from the Yale School of Medicine, winning the Lewis H. Nahum Prize for outstanding research and membership in the Alpha Omega Alpha medical honor society. He returned to Stanford for residency training in Neurological Surgery and a postdoctoral fellowship in neuroscience, during which he authored over twenty scientific publications and received the American Academy of Neurological Surgery’s highest award for research.

Paul’s reflections on doctoring and illness – he was diagnosed with stage IV lung cancer in 2013, though he never smoked – have been published in The New York Times, The Washington Post and The Paris Review Daily, in addition to interviews in academic settings and media outlets such as MSNBC. Paul completed a neurosurgery residency in 2014. Paul died in March 2015, while working on When Breath Becomes Air, an unforgettable, life-affirming reflection on the challenge of facing mortality and on the relationship between doctor and patient, from a gifted writer who became both. He is survived by his wife Lucy and their daughter Cady.

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