When Breath Becomes Air- review of the memoir

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.

 

When Breath Becomes Air

by Paul Kalanithi, M.D.,

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.

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, 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 .

from the book

“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)

When Breath Becomes Air  was published by Random House.

Other reviews of his life and writing

exploring the HEART of life and death

Dr. Aletha

Pandemic- a book review

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.

update July 25, 2020

When I read and reviewed this book almost 4 years ago, I thought it was only for historical interest. I never imagined you and I would live during and hopefully through a pandemic. I now know that assumption was false; this COVID-19 pandemic is not over, and even when it is, it likely will not be the last.

The world has now spent the majority of this year dealing with a COVID-19 pandemic producing grim statistics.

  • Almost 16 million confirmed cases world wide
  • 640,000 deaths worldwide
  • 4 million cases in the United States
  • Close to 150,000 deaths in the United States
source: Johns Hopkins Coronavirus Resource Center

Pandemic by Sonia Shah

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.”

What is a pandemic?

Let me back up and define some terms. (And tell you this post uses affiliate links for your convenience and to fund this blog’s mission)

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, physicians and patients 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.

Cholera- a historic pandemic

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
How pandemics spread

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.

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 and animated by Patrick Blower 
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)

Dr. Larry Brilliant talks pandemics

Lawrence “Larry” Brilliant is an American epidemiologist, technologist, philanthropist, and author, notable for his 1973 – 1976 work with the World Health Organization, helping to successfully eradicate smallpox.

In this recent TED interview, he discusses COVID-19 , how we’re doing so far, where we’re going, and what we should do to get there

a book by Dr. Brilliant

Sometimes Brilliant: The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History

Exploring the HEART of pandemics

Dr. Aletha
before you leave, take a look at this post

Why COVID-19 and other infections are not “just a virus”

Unless you haven’t listened to any news for the past 8 weeks, you are well aware of the “challenge” the whole world has been confronting over what some do call “just a virus”; and you know that it has caused much critical illness and death, leading to “public” and private anxiety.