When Breath Becomes Air- reflections from Dr. Lucy Kalanithi


When Breath Becomes Air,

by Paul Kalanithi, M.D.,

a memoir




( This is an update of a previous post. This post contains an affiliate,commission paying link)

Dr. Paul Kalanithi was a 36-year-old resident physician who had, as he wrote, “reached the mountaintop” of anticipating a promising career as a neurosurgeon and neuroscientist. He had a loving wife, a supportive family and professors who respected his knowledge and skill. He seemed destined to be sought after, well paid, productive, successful, and  famous.

(note: a neurosurgeon treats  brain, spinal cord and nerve  diseases such as brain tumors that can be cured or improved with surgery,)

Unfortunately, “the culmination of decades of striving evaporated” when he was diagnosed with an aggressive form of lung cancer for which the prognosis was bleak, even with treatment. He was admitted to the very hospital where he trained as a neurosurgery resident, now  to learn what it is like to be a patient with a potentially terminal illness.

When Breath Becomes Air by Paul Kalanithi




Dr. Kalanithi faced his diagnosis with the same resolve, fortitude, and determination that served him well through medical school and a grueling neurosurgery residency. After his first round of treatment he was able to return to the operating room as a doctor, not a patient.

Prior to entering medicine, Dr. Kalanithi had studied literature, earning degrees in English literature as well as human biology. He also completed a doctorate in history and philosophy of science and medicine at Cambridge. Thus, when he realized he was facing his own death, he turned to his first love of writing to chronicle his experience and to explore “what makes human life meaningful?” And as he explored the meaning of what life is all about, he also explored the inevitability of death.

“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 acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. But there is no other way to live.”

Dr. Kalanithi passed away without completing his book, although his wife writes in the epilogue, “When Breath Becomes Air is complete, just as it is.” She and his parents kept their promise to have his book published after his death. She writes, “Paul was proud of this book, which was a culmination of his love for literature.”

Even before I finished reading this book, I felt as if I knew Paul and his wife Lucy. As someone who also enjoys writing, I can understand and appreciate his desire to preserve and share this experience.

This memoir is not so much a diary of what happened to Dr. Kalanithi as what happened within him as he confronted his own mortality and chose not to let it define the remainder of his life.

On the copyright page, “Death and Dying” is included in the list of categories for this book. However, you will not find “how to die” instructions here. Instead, you will learn how one man and his family chose to live despite knowing that he would  soon die.


His wife, Dr.Lucy Kalanithi, has recently spoken publicly about her husband, his illness, his death, and the memories he left her and us through his book. Listen as she reflects on his legacy in this interview .







“In the end, it cannot be doubted that each of us can see only a part of the picture….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 Truth comes somewhere above all of them, where, as at the end of that Sunday’s (scripture) reading,

“The sowers and reapers can rejoice together. For here the saying is verified that ‘One sows and another reaps.’ I sent you to reap what you have not worked for; others have done the work, and you are sharing the fruits of their work.”

(note: the referenced scripture is from the Bible, John chapter 4, verses 36-38, precise version unidentified)


I am glad I read this book and think you will be also.

When Breath Becomes Air  was published by Random House.




Other reviews of his life and writing


I regularly review and recommend medical and health related books. I hope you will follow .

Weekend Words from C.S. Lewis

Weekend Words from C.S. Lewis



quote about love from C.S. Lewis
graphic from Lightstock

CLIVE STAPLES LEWIS (1898–1963) was one of the intellectual giants of the twentieth century and arguably one of the most influential writers of his day.” 

He is perhaps best known for his book “The Lion, the Witch and the Wardrobe” and the others in the Chronicles of Narnia series.

His book Mere Christianity is considered  one of the most powerful apologetics of the Christian faith.


Lewis wrote A Grief Observed after his wife died of cancer just a few years after their marriage.

In it he reflects on life, death and faith .


“This is a beautiful and unflinchingly honest record of how even a stalwart believer

can lose all sense of meaning in the universe, and how he can gradually regain his bearings.”

(quoted from Amazon review- these are all  affiliate links which pay a commission if used from this blog. )





Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to consider words of faith, hope and love from the Bible and other carefully selected writings.

Follow this blog for more Weekend Words and words that explore the “heart of health”.



Watercress Words on Facebook


Watercress Words is on Facebook where I post additional content to explore the heart of health just like I do here- posts to inform, instruct and inspire you . If you haven’t visited me there, please do.

Here are a few of my recent Facebook posts.



Do you qualify to donate blood?

This article from the New York Times health blog explains who can and can’t donate blood.  If you meet the qualifications, consider donating in your community. You may help save a life.

Too Old to Donate Blood? Maybe not.


person donating blood
photo compliments of Pixabay




Wednesday Word is where I define and discuss a medical term , like this one.


endemic- natural to or characteristic of a particular people or place

Medically speaking, an endemic disease occurs in a particular place or a particular population; for example, malaria is endemic to tropical areas; malnutrition is endemic to people suffering from famine.

Related words are

epidemic– a sudden severe outbreak of a disease in a particular location or group , such as influenza epidemics.

pandemic– an epidemic becomes wide spread, across countries and continents


Are you looking for a new doctor?

This article offers sound advice on finding and choosing a physician, and  how to prepare for your first visit.

Thanks to Nurse Beth at her blog Boomer Highway.

You’re A Candidate For

Good Health & A Good Doc

Dr. Oglesby nametag
How much do you know about your doctor’s training and experience? Make sure you choose a doctor for the right reasons.




I share humorous medical cartoons on  Friday Funny.

I am particularly fond of the antics of the organ characters from The Awkward Yeti.

( note this is an affiliate link)





And  inspiration from some fun-loving, dancing nurses.

Shared from InspireMore.


Weekend Words from Jude

Weekend Words from Jude

Jude 1:2, Good News Translation

May mercy, peace, and love be yours in full measure.


Kawaiaha'o Church in Hawaii
an old photo taken by Dr. Aletha on a visit to Hawaii



Honolulu, O’ahu, Hawaii 

the “Westminster Abbey of the Pacific”

“Kawaiaha‘o stands as the first Christian church to be built on O‘ahu, and today is respected as the Mother Church of Hawai‘i, where God’s work continues and the Hawaiian culture and language is perpetuated.”

(from the website )


I also wrote about Hawaii at this link-

finding the rainbow and a volcano 

How your vote for president will affect your health care

How your vote for president will affect your health care


The Presidential election is a month away. The Republican and Democratic candidates debated last week, and the political commentators  have been debating over which of them “won” the debate.

Health care was not covered in that debate so I hope it will be included in the two remaining debates.

I am re-posting this review of the candidates’ health care positions so you can compare what they may say in the debates. This time I am also including information about the two other  political parties that have presidential candidates, although they are not in the debates.

Health care was a major issue in the last election and proved to be momentous. In his campaign, the Democratic candidate, Barack Obama, promised health care reform and as President he delivered with the passage of the Affordable Care Act, the first time Americans have had universal health care. This election’s candidates also make promises about health care.

The White House
The White House, home of the President (photo from the Lightstock website )






This is a summary of  what each candidate proposes and plans according to information on their official websites. I’ll give you the links and encourage you to read them for yourself. In sharing this formation, I am not endorsing any of these candidates or their party.




Republican- Donald J. Trump, Chairman and President,

The Trump Organization

 “Healthcare Reform to Make America Great Again”


Mr. Trump believes the Affordable Care Act, which he refers to as Obamacare, is an “economic burden” to the country. He says it has caused

  • Runaway costs,
  • Websites that don’t work,
  • Greater rationing of care
  • Higher premiums
  • Less competition
  • Fewer choices

He recommends a

“series of reforms that follow free market principles and restore economic freedom and certainty” , which will

“broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.”


As President, Mr. Trump will request Congress to

  1. Completely repeat Obamacare, eliminate the individual mandate to buy health insurance.
  2. Modify existing law that inhibits the sale of health insurance across state lines.
  3. Allow individuals to fully deduct health insurance premium payments from their tax returns.
  4. Allow individuals to use Health Savings Accounts (HSAs), which should be tax free, allowed to accumulate, and become part of one’s estate at death.
  5. Require price transparency from all healthcare providers.
  6. Block-grant Medicaid to the states.
  7. Remove barriers to entry into free markets for drug providers, allowing consumers access to imported, safe and dependable drugs from overseas.



Also under his health care plan, Mr. Trump includes

  • Enforcing immigration laws
  • Eliminating fraud and waste
  • Energizing our economy
  • Reform our mental health programs and institutions



Oval Office replica
replica of the Oval Office at the Reagan Presidential Library






Next, the  Democratic Party convened and nominated its candidate-


Democrat-Hillary Rodham Clinton, lawyer;

former First Lady, Senator, and Secretary of State

“Universal, quality, affordable health care for everyone in America”

  1. Maintain and expand the Affordable Care Act
  2. Bring down out-of-pocket costs for copays, deductibles and prescription drugs
  3. Expand access to care for low income groups, immigrants and rural populations.
  4. Defend access to reproductive health care.



As President, Mrs. Clinton will work with Congress to

Fight addiction and substance abuse with prevention, treatment and recovery programs and reforming the criminal justice system handling of offenders.

Set a goal to prevent, treat and cure Alzheimer’s Disease by 2025. Help those affected and their families get the care they need.

Create an AIDS/HIV policy to increase research, expand treatment options, increase health care financial options for those affected, and eliminate discriminatory laws.

Develop an “autism initiative” to expand insurance coverage, increase funding for research, early identification and intervention, employment opportunities, and school safety.

Commit to fully implement the Americans with Disabilities Act, and increase support for persons with disabilities and their families.

Under the heading of health Mrs. Clinton includes her positions and proposals for

  • Climate change
  • Women’s rights and opportunity
  • Support for veterans, the military and their families
  • Paid family and medical leave


couches in room with Presidential seal on the floor
another view of the Oval Office

Green Party – Jill Stein, M.D., physician, activist

Dr. Stein favors

“Medicare for all”, single payer health care system for everyone, with no premiums, co-pays or  deductibles.

Eliminate private health insurance.

Decrease prescription drug costs

Full access to contraceptive and reproductive care, including morning after contraception

Invest in community health infrastructure- organic food, renewable energy

Prioritize prevention by encouraging physical activity, improving nutrition and minimizing environmental pollution


Libertarian- Gary Johnson, businessman, former Governor of New Mexico

Mr. Johnson’s website had little information about his health care proposals, so I am also including items from the Libertarian party’s website.

 The party supports

a free-market healthcare system where the individual is free to choose everything related to health care- insurance, doctors, treatments, medication, end-of-life care

the ability to purchase health insurance across state lines

abortion as a private decision up to the individual’s conscience and not regulated by the government

Mr. Johnson

opposes mandatory vaccination

supports the legalization and regulation of marijuana.


Weekend Words -a wedding update


2 Corinthians chapter 4 


16 So we do not lose heart. Though our outer self  is wasting away, our inner self is being renewed day by day. 17 For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, 18 as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal. (English Standard Version) 







If you read this blog regularly or even occasionally, you know that I like to write updates on topics I’ve covered. This is one update I would rather not need to share with you.

This past week, Swift, the groom in this video, died from the cancer that he has so bravely endured for several years. Abbi, above a bride, is now a young widow.

Please keep her and their families in your thoughts and prayers.


Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to read words of faith, hope and love from the Bible and other carefully selected sources.


This blog gains no financial benefit from  any charitable organization mentioned here. I recommend you investigate before donating anywhere. Affiliate links will be identified.

Pandemic- a book review

Pandemic- a book review

Pandemic by Sonia Shah

a review


Genre-non-fiction, science, medical, history, politics, geography, sociology, international relations


Sonia Shah is a science journalist, not a scientist or physician, who has built a career  writing about medical science. She explains the “what”  of her book in the subtitle-


Tracking contagions from cholera, to Ebola, and beyond


And she answers the “why” in the introduction-


“By telling the stories of new pathogens through the lens of a historical pandemic, I could show both how new pathogens emerge and spread, and how a pathogen that had used the same pathways had already caused a pandemic.”


Pandemic by Sonia Shah




Let me back up and define some terms.


Pathogen– any disease producing agent, but especially referring to a living  microscopic organism, such as a virus, bacteria, or  parasite; this includes the organisms that cause Lyme disease, Ebola, West Nile, HIV, bird flu, even the common cold


Pandemic– a disease outbreak that spreads throughout a country, continent, or the world, as opposed to an epidemic, which is localized.


map of the world
In a pandemic, an infectious disease may spread all around the world.




With current focus on chronic diseases like heart disease, diabetes, cancer, and dementia, even I as a physician can get lulled into thinking that infectious disease has been conquered and no long a serious medical threat. This book reminded me that is not the case.


Ms. Shah recounts the history of cholera, which has caused epidemics on every continent except Antarctica, focussing on the epidemics which devastated London, New York City, and more recently Haiti.


Cholera is little known in the United States now, but in the past it has been deadly both here and throughout the world. Cholera, an infection due to a bacteria Vibrio cholerae causes severe uncontrollable diarrhea which quickly renders its victims helpless, dehydrated and critically ill. The bacteria lives in and is spread by contaminated water, but for many years physicians did not know this; and even when some doctors proposed this as the method of spread, others refused to believe it. Thus the opportunity to control it and prevent thousands of deaths was delayed .

bacteria under the microscope
photo of the Vibrio cholera bacteria under a microscope; used courtesy of CDC/ Dr. William A. Clark


The author explains how cholera and other infectious diseases cause so much human suffering by detailing “How disease spreads” in these  chapter titles


Locomotion– Humans and pathogens travelling from place to place spreads disease.

Filth-Waste management and in some cases mis-management, leads to contamination of drinking water by human waste.

Crowds-People living in crowded slums creates perfect conditions to spread disease person to person.

Corruption– Public officials and business people who place profit and power above public health.

Blame No one willing to take responsibility for making hard choices, and too willing to blame someone else.


Ms. Shah uses examples from her personal life, like her annual family trips to India to visit relatives who lived in less than clean and sanitary neighborhoods. She also shares her and her sons’ battle with skin infections due to  MRSA, a form of staph (staphylococcal) that is resistant to many antibiotics and can be difficult to eradicate.


Pandemic includes extensive footnotes and a glossary of terms used in the book.


If you like history, current events, medical science, or just want to be more knowledgeable about why we should be concerned about infections , antibiotic resistance and vaccine phobia, you should read this book.


Here are other resources that address  the risk of global spread of infections.


For a visual lesson on how pandemics occur, watch this video.Warning: it is rather graphic. 


“How Pandemics Spread”

created by Mark Honigsbaum (http://www.markhonigsbaum.co.uk) and animated by Patrick Blower (http://www.patrickblower.com)


When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed

by Howard Markel

“Medical historian and pediatrician Howard Markel, author of Quarantine! tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.”  (quote from Goodreads)


In this article from the New York Times, Gina Kolata reports  how scientists use genetics to discover and track bacteria and viruses .


The New Generation of Microbe Hunters


In this  TED talk Dr. Larry Brilliant explains how new pandemics may be prevented.





Weekend Words- The Lord’s Prayer

give us this day our daily bread

Matthew 6:9-13, NIV 

This, then, is how you should pray:

“‘Our Father in heaven,
hallowed be your name,
10 your kingdom come,
your will be done,
    on earth as it is in heaven.
11 Give us today our daily bread.
12 And forgive us our debts,
    as we also have forgiven our debtors.
13 And lead us not into temptation,[a]
    but deliver us from the evil one.[b

Weekend words is a regular feature of watercress words. At the end of the work week we pause exploring strictly medical topics to consider words of faith, hope and love from the Bible and other carefully selected writings.

6 things you need to know to get through the flu season

This week autumn begins in the northern hemisphere. Where I live, fall brings brilliant orange,yellow and red to our trees and shrubs,  the start of the school term and football season. Unfortunately,  fall also brings the cold and flu season.


This is usually the busiest time of the year in physician offices, urgent care clinics, emergency rooms and hospitals. This information may make this season easier for you and for your doctor.



1. If you think you have the “flu”, you probably don’t. 

To many people “the flu” is any respiratory illness characterized by  fever, cough, congestion, fatigue and aches. That term has become so nonspecific even we doctors use it that way. But flu refers to influenza,  one of many viruses that cause illness. The other viral illnesses  are “colds”, upper respiratory infections, aka URIs, bronchitis, pharyngitis, sinusitis and pneumonia.

The human respiratory system
The respiratory tract including the nose, sinuses, mouth, throat, trachea, bronchi in blue and the lungs (pink). Infections can involve the breathing organs from the nose all the way down to the lungs. (photo complimentary from Pixabay)
  1. If your doctor thinks you have “the flu”, you probably do.

Prior to the  “rapid flu” test, we doctors diagnosed influenza by the characteristic symptoms,  exam, and knowing there was an outbreak in the community. The test is helpful for confirmation and patients have come to expect it now.


3. The best way to prevent influenza is by vaccination.

The World Health Organization (WHO), Centers for Disease Control and Prevention(CDC) , the National Foundation for Infectious Disease and  other reputable medical organizations recommend vaccination against influenza.


People refuse vaccination because they believe it is ineffective, unnecessary, dangerous, toxic, unnatural, subversive, and who knows what else.  I don’t think I or anyone else are going to change their minds.

My family and I always get vaccinations which have successfully protected us without side effects or adverse reactions. There are risks, just like there are with any medical procedure, or lots of other things we do in life. In this case we have decided the benefit outweighs the risk.

If you don’t want a “flu shot”, just say no. Your doctor doesn’t need or want to hear a speech; we’ve already heard them all.

  1. If you want to avoid getting influenza, avoid being around people who may be infected.

This means everyone, since one may be contagious 2 to 3 days before symptoms. It’s not a coincidence that influenza outbreaks coincide with the American holiday season (approximately November through January). So to protect us all,

  • Stay home if you are sick, and ask your family, co-workers and employees to do the same.
  • Cover your nose and mouth when coughing or sneezing
  • Wash your hands frequently.
  • Wash frequently touched surfaces frequently.
Hand hygiene saves lives.
a common sight now in public restrooms
  1. If you do get sick, don’t ask your doctor for an antibiotic.It will not help. 

    Antibiotics attack bacteria. Influenza and 99% of all respiratory illnesses are due to viruses.

There are 2 antiviral drugs that will “shorten the duration and severity of symptoms” by 1-2 days, if started early. The effectiveness is uncertain for an illness that will resolve within 10-14 days regardless. But if it gets you back to school or work a day earlier, it may be worth the cost-they are not cheap drugs.

Otherwise, the treatment is“symptomatic” or “supportive” care:

  • Rest; eat and drink as normally as possible; extra fluids if running a fever 
  • Non-prescription cough/congestion /pain/fever meds

Here are  general guidelines  on what to do if you get a respiratory illness.

  1. You can die from influenza, but you probably won’t.

I cringed last year when a friend wrote on her social media page, “My doctor said, ‘No one dies of the flu’.” And, technically, that is true. People die from complications of influenza, and infants, young children and the elderly have greatest risk.The most common fatal complication is bacterial pneumonia, infection in the lung. Influenza can also attack the nervous system causing brain inflammation (encephalitis and/or meningitis) and paralysis in the form of Guillain Barre syndrome .

an xray of healthy lungs with no signs of pneumonia.
Healthy lungs with no signs of pneumonia.
Persons with chronic illnesses like diabetes, lung disorders, depressed immune systems and cancer are at greater risk of complications and should always consult a physician if feeling ill. If you are not sure if you fall into that category, ask your doctor.

Influenza is a disease to take seriously; consider my suggestions, talk to your doctor, and stay healthy this season.

Here are some other posts about winter illness you may find helpful.


Get Smart About Antibiotics

6 smart facts about antibiotics

Sorting out sinusitis


Weekend Words from Amy Carmichael



you cannot love without giving. Amy Carmichael


Amy Carmichael (1867-1951) was an Irish woman who moved to India to serve God.

Her work there involved rescuing young girls  forced into prostitution, even though doing so put her  at risk of arrest and imprisonment. She established an orphanage for them.

Her health declined in her later years, and she became essentially bedridden; but she continued to direct the mission she founded and wrote prolifically.



(This is an affiliate link, this blog will earn a commission if used for a purchase. Thank you. )




Weekend words is a regular feature of watercress words. At the end of the work week we take a break from exploring strictly medical topics to read words of faith, hope and love from the Bible and other carefully selected sources.