When Breath Becomes Air author, Dr. Paul Kalanithi

When Breath Becomes Air author, Dr. Paul Kalanithi

Paul Kalanithi's voice still carries an indelible weight through both his memoir, When Breath Becomes Air, and through his wife Lucy's involvement in both end-of-life care and cancer advocacy, despite his death from complications of lung cancer in 2015.

A few years into his residency at Stanford, Kalanithi dropped weight unexpectedly and experienced debilitating back pain. Suspicious, he scheduled an appointment with his doctor. His chest x-rays showed that his lungs were mottled with black patches, and he was diagnosed with stage IV lung cancer. Paul shifted from his role as a doctor and had become a patient.

Armed with the knowledge that his life had a more definitive and imminent end, he learned to reframe the views and beliefs he held about his own life and humanity. He did all of this while balancing his role as husband, father, and surgeon, maintaining his responsibilities of completing his neurosurgery residency, working on his book, and seeking appropriate medical treatment.

Kalanithi articulates his diagnosis and the innumerable ways in which it affected his life, particularly philosophically, in When Breath Becomes Air. It takes an incredible level of self-awareness and humility to be able to reflect on life in the way that Kalanithi does in this book, and related interviews. In one passage Kalanithi discusses his ability to find meaning in both science and religion. He opens with a definition of Occam’s razor: “There is no proof of God; therefore, it is unreasonable to believe in God.” Through his twenties he touted atheism, favoring scientific objectivity to religious subjectivity. Kalanithi came to realize the great paradox, however: “that scientific methodology is the product of human hands and thus cannot reach some permanent truth.” Furthermore, science, in its “reproducibility and manufactured objectivity” is, ultimately, “inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable.”

It’s fascinating to reflect on Kalanithi’s insights. While scientific truths can help us make sense of the world we live in and provide structure to and explain patterns in seemingly chaotic phenomenon, it is still an invention of the human mind. Furthermore, “no system of thought can contain the fullness of human experience.” Both science and religion attempt to help us make sense of the world we live in and why we’re here. Both fall short, however, in defining “the capital-T Truth” of all worldly phenomena. Recognizing their limitations, Kalanithi concludes “that if a correct answer is possible, verification is certainly impossible” because we’re only ever seeing parts of the whole. Rather than searching for an objective understanding of the world we must recognize that “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.” And, from human connectedness, truth arises.

When Breath Becomes Air should be required reading for all clinicians. People working in hospice, home health, and skilled nursing will especially appreciate the perspectives and reflections Kalanithi writes about. Even though this is a very personal account of Kalanithi’s life after his cancer diagnosis, there’s something profoundly universal about the conclusions he draws about time, the life/death relationship, and human spirituality. Even though he died two years ago, Kalanithi’s words will surely continue to live on, presenting challenges and comfort to his readers.

Life, death, and everything in between in Paul's own words:

"Being human doesn't happen despite suffering -- it happens within it." A poignant reflection courtesy of Lucy Kalanithi: