When Breath Becomes Air

Throughout the book, Kalanithi peppers specific references to authors and books. Books fuel Paul’s life. They illustrate, for example, pivotal moments (the book from his early girlfriend Abigail), lifelong obsessions (T.S. Eliot’s The Wasteland), and brief tools for argumentation (Samuel Beckett’s Waiting for Godot).

The idea of literature seems to Paul, at a young age, to be antithetical to experience. Although he loves reading, he questions whether “knowledge alone” can “be enough, with life and death hanging in the balance” (66). During his medical practice, he comes to understand that the experiences of life are given shape by literature, by the critical thinking it provokes and the meaning it creates. In the early throes of his illness, when he “finds no traction in the reams of scientific studies,” reading becomes a way for him to learn how to express himself (148). Solzhenitsyn, Woolf, Kafka, Tolstoy, Nagel, Greville: these writers are more than just teachers. They are companions, individuals who shared the conviction that reading is central to the exploration of existence. This book stands as a testament to that.

The classic roles of doctor and patient are outlined early on in the book. Paul worries he is becoming Tolstoy’s “stereotype of a doctor; preoccupied with empty formalism, focused on the rote treatment of disease—and utterly missing the larger human significance” (85). The repetition of any new experience begins to wear one down, as operations that once required focus become second-nature. However, Paul avoids slipping into static behaviors.

Understanding the patients featured in the book extends beyond knowing the names and effects of a given illness. Paul wants to make sense of what their lives mean, once they’ve been altered by the inability to speak or express language. The specific stories we hear about give us a full picture of patient-hood: pregnant women, alcoholics, the elderly, 8-year-olds with brain tumors, and friends cut from the prime of life through accident or suicide. These people do not simply sit and wait for instruction consider the demanding patient who maintains an “unceasing monologue” throughout his brain surgery (111). Paul confronts the doctor’s duty to a patient, and how a patient’s experience is mediated by a doctor.

The border between patient and doctor disintegrates once Paul crosses from being the latter to playing both roles, often simultaneously. He is literally in pain as he performs in the OR. The rest of the book is a struggle to reconcile the two positions of doctor and patient. And, although he finally gives complete domain to Emma, in order to give himself over to living the final days of his life, his expertise and modes of thinking are reflected on every page of the book. His doctorhood is undone. This leaves us wondering what kinds of insights Paul might have unearthed had he lived long enough to continue his career as neurosurgeon-neuroscientist.