When Breath Becomes Air By Paul Kalanithi

By

Leonard Zwelling

         A physician dying. On the surface, that’s what this book is
about. A young (thirties) chief resident in neurosurgery is diagnosed with
terminal lung cancer. This is what he left behind—a wife, a baby daughter and
this book.

         By modern standards, Dr. Kalanithi led a short life.
Measured by this book, he was a giant.

         The book jacket tells the details and has the picture of a
young surgeon in the prime of his life, finishing up the grueling training
needed to become an academic neurosurgeon only to be felled by a fatal illness.
It sounds like a tragedy. I guess it is, but the testament Paul left behind is
that of a man of literature as well as a man of medicine.

         He was a Stanford graduate who was heading for a career in
writing when he got the calling to medicine. He was a standout at Yale Medical
School and was on track to become one of the leaders in academic neurosurgery
and neuroscience when his diagnosis was made. The ups and downs of his clinical
course are well documented in his manuscript, which was just that at the time
of his death, sitting on a computer screen waiting for the page. He left his
wife, Lucy, also a physician, to get the book into print where it is currently
a New York Times best seller, as it
should be.

         How a literate physician analyzes his life, living, dying
and death makes for engrossing reading and tears. Paul was a singular force as
a surgeon and as a writer. His command of literature and poetry is
breathtaking, even as his own breath is being taken from him. He has considered
every aspect of being both a healer and a patient and gives voice to so many of
the anxieties that we doctors feel at various times of day or night—mostly
night. And I can assure you from my own experience, not quite as dire as his,
that he gets the part of being a patient exactly right.

         This book is a chronicle of his relationships, with his
family and his crafts—writing and neurosurgery. The beauty of his words mixes
with the depth of his grief at losing his skill and his joy at regaining it,
even if for just a brief time. I get this. Fortunately for me, I did not need
death to bring me to the point of both cherishing and missing my diversions and professions as
I sought new ones—running as a medical student, being a house officer, working in the lab, studying in business school, struggling in administration and steeping myself in
health policy. Each conversion felt like a big loss and only a small gain,
until the gain became realized, only to be lost again with yet another change.

         I find myself there again, not really knowing yet whether I
can make a go at this writing thing. Once again I know that it is the
perception of others that will determine my perception of me to some extent. I
hate that, but I know it.

         Dr. Kalanithi has left a small, precious legacy for
everyone, but especially for us doctors. 

         Read this book. You will be both humbled and glad that you
did.

Leonard Zwelling