The cover of Paul Kalanithi's When Breath Becomes Air, on a pink and grey clouded background.
The cover of Paul Kalanithi's When Breath Becomes Air, on a pink and grey clouded background.

"What," asks Paul Kalinithi early on in When Breath Becomes Air, "makes human life meaningful?"

It's a question the late neurosurgeon grapples with as both doctor and patient, a journey that includes coming to terms with death.

Kalanithi was 36 and less than a year away from completing a decade's training as a neurosurgeon. He was all but guaranteed a job at Stanford University as a surgeon-scientist. And then, after months of weight loss and back pain, he was diagnosed with inoperable lung cancer. Within 24 hours, Kalanithi went from being a doctor to being the subject of doctoring. 

When Breath Becomes Air, which was finished by his wife Lucy after his death in 2015, chronicles Kalanithi's search for meaning as he receives treatment, makes his way back to work, and then discovers his cancer has returned.

Kalanithi returned to surgical duties soon after his bout of cancer, doing one surgery a day, but it was only when he took on a full workload again and was interacting with patients that the meaning of his work returned. As he contemplated his next steps, Kalathini wrote: "The physician's duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand up and face, and make sense of, their own existence."

Over the course of the last two years or so, as the world has battled coronavirus, we've seen doctors, nurses, paramedics and other medical professionals do for patients just what Kalanithi describes.  

Medical treatment is where it begins, but it's through the extras – through taking patients into their arms – that we've truly come to understand just how deep the work of a doctor or nurse goes. We understood it as we saw the celebrations staff took part in as patients who had only days before been in ICU left their hospital. On a sadder note, we saw it in the stories of doctors and nurses who sat holding patients' hands and calling up relatives unable to see their loved ones in their final moments.

And the medical profession did all this as they themselves faced being patients. Every day, those working to fight coronavirus faced the knowledge that they could catch the illness, and yet they still went to work. And they continue to do so; although coronavirus seems to be loosening its grip on us, the pandemic is far from over. From patients who still need to be treated to people with long covid to a backlog of cases that were delayed or put on hold while doctors and nurses and support staff focused on the pandemic, the effects of Covid-19 are still being felt.

Kalanithi, of course, faced death in very different circumstances to the doctors and nurses who have faced it during the pandemic. But in When Breath Becomes Air, he perfectly describes the sacrifices made by those in the the medical profession, and provides us with an understanding of what is as much a calling as a job. 

"I don't think I ever spent a minute of any day wondering why I did this work, or whether it was worth it," he writes. "The call to protect life – and not merely life but another's identity; it is perhaps not too much to say another's soul – was obvious in its sacredness."

This article was originally published in June 2020, and updated throughout in April 2022.

Image at top: Victoria Ibbetson / Penguin

  • When Breath Becomes Air

  • **THE MILLION COPY BESTSELLER**

    'Rattling. Heartbreaking. Beautiful.' Atul Gawande, bestselling author of Being Mortal


    What makes life worth living in the face of death?

    At the age of thirty-six, on the verge of completing a decade's training as a neurosurgeon, Paul Kalanithi was diagnosed with inoperable lung cancer. One day he was a doctor treating the dying, the next he was a patient struggling to live.

    When Breath Becomes Air chronicles Kalanithi's transformation from a medical student asking what makes a virtuous and meaningful life into a neurosurgeon working in the core of human identity - the brain - and finally into a patient and a new father.

    Paul Kalanithi died while working on this profoundly moving book, yet his words live on as a guide to us all. When Breath Becomes Air is a life-affirming reflection on facing our mortality and on the relationship between doctor and patient, from a gifted writer who became both.

    'A vital book about dying. Awe-inspiring and exquisite. Obligatory reading for the living' Nigella Lawson

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