I don’t remember the last time I finished reading a book and then immediately re-read it but that is exactly what I did with what I think is a life-changing, ‘must read’ book,


‘When Breath Becomes Air [What Makes Life Worth Living In The Face Of Death]’


by a very special human being (as I sit typing this blog, I feel tears welling up), Paul Kalanithi.






Lucy Kalanithi (Paul’s doting wife):


“He (Paul) spent much of his life wrestling with the question of how to live a meaningful life, and his book explores that essential territory”.


In essence, besides being a beautiful love story, that is, indeed, what this book is about, examining what is meant by the ‘meaning of life’.



Paul was a brilliant neurological surgeon – but he was so much more!



He was a cultured intellectual, an academic, a man who knew so much about so much, a Stanford, Harvard and Cambridge University-educated man who read widely, who could put his medicine and life into context, BUT he wasn’t aloof, he didn’t live in an ivory tower, he was an empathetic, kind, caring, good man, a man, believe it or not, who I felt I really came to know thanks to his book (long sentence but a great man!) – plus he loved the music of Stan Getz and Joao Gilberto so we’d definitely have got on famously!


Paul, from a medical family, didn’t grow up envisaging himself, as an adult, being a doctor. He immersed himself in the arts, principally in literature, and saw himself becoming a writer. Paul’s style of writing, as seen in this book, is so beautiful, exquisite at times, it’s almost musical.



At the start of Paul’s University life, he read a book, ‘Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S.’ by Jeremy Levin.


Paul observed:


“…it did make the throwaway assumption that the mind was simply the operation of the brain, an idea that struck me with force; it startled my naïve understanding of the world. Of course, it was true – what were our brains doing otherwise? Though we had free will, we were also biological organisms – the brain was an organ, subject to all the laws of physics, too! Literature provided a rich account of human meaning; the brain, then, was the machinery that somehow enabled it. It seemed like magic. That night, in my room, I opened up my red Stanford course catalog, which I had read through dozens of times, and grabbed a highlighter. In addition to all the literature classes I had marked, I began looking in biology and neuroscience as well”.



Paul’s focus, in his reading, his literary studies, in his medical/surgery career, I guess his quest, was to understand the concept of the meaning of life.



You can see in the above observation that it suddenly dawned on him that he wouldn’t be able to get close enough to the forces at play, that he wouldn’t be able to touch it, to get there, to help others find it, the meaning of life, as a literary scholar, that the vehicle would be medicine.




“A few years later, I hadn’t thought much about a career but had nearly completed degrees in English literature and human biology. I was driven less by achievement than by trying to understand, in earnest:




I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain….”


…and Paul goes on to quote T.S. Eliot, Nabokov and Conrad on the subject(s) of ‘meaning’, human relationships and moral values.



(years 3 and 4, Stanford University):


“…I kept at it, seeking a deeper understanding of the life of the mind. I studied literature and philosophy to understand what makes life meaningful, studied neuroscience and worked in an fMRI lab to understand how the brain could give rise to an organism capable of finding meaning in the world…”



Through a thinking process, as detailed in Paul’s book, he arrived at a conclusion that,


“…There must be a way, I thought, that the language of life as experienced – of passion, of hunger, of love – bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats.”



After graduation from Stanford, Paul’s friends headed out into the workplace, many into the arts in New York but,


(Paul) “ I couldn’t quite let go of the question:


Where did biology, morality, literature, and philosophy intersect?”


It now dawned on Paul that Medical School was beckoning:



“…It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action.



So, off to Yale Med School (Paul enrolled on a programme, ‘The History and Philosophy of Science and Medicine, aka ‘HPS’, at Cambridge University between finishing at Stanford and starting at Yale):


Paul: “Medical school sharpened my understanding of the relationship between meaning, life, and death. I saw the human relationality I had written about as an undergraduate realized in the doctor-patient relationship. As medical students, we were confronted by death, suffering, and the work entailed in patient care, while being simultaneously shielded from the real brunt of responsibility, though we could spot its specter.”



(Paul, further to more reading….):


“…I was pursuing medicine to bear witness to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal.”



All the aforementioned considered, you won’t be surprised that Paul chose neurosurgery:


“While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of ourselves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living…….Because the brain mediates our experience of the world, any neurological problem forces a patient and family, ideally with a doctor as a guide, to answer this question:


What makes life meaningful enough to go on living?”



Paul says a lot more about his draw to neurology, how he saw it, neurology, as the result of his ‘joining the dots’ which are the questions relating to the meaning of life, to the mind and the part played by the brain. Paul also saw God as being part of the mix – he didn’t see the brain as being in complete control of the mind/emotions.



In relation to emotions, such as love and hate, Paul saw a ‘gap’ between


  1. a) what the brain does, and can, do, between science




  1. b) our understanding, what we can see and feel.


It seems that Paul bridges that gap with God but that plays right into Dawkins’ ‘God Gap’ theory (which, sorry, Kalathini’s, I subscribe to), ie if science can’t explain a phenomenon, can’t answer a question, the answer must be ‘God’ but, as Dawkins says, the mere fact that we don’t understand something, that, in and of itself, is not evidence of ‘God’.



Of course, Paul’s thinking was not only guided by his reading but was more and more informed by his ‘on the job’ work, his experiences ‘at the coal face’, throughout his residency in hospital (at Stanford) and it all makes for fascinating reading.



So, all’s going well on the career front….Paul still has questions but he seems to be in the right place, exposed to patients with heartrending neurological condition, patients whose identity, whose lives, hang in the balance, patients who are having to examine what ‘the meaning of life’ means to them and he, Paul, has a pivotal role in guiding the patients through the thought process and the journey through illness towards the next stages of their lives…. As Paul says towards the end of the book:


“…I had learned something, something not found in Hippocrates, Maimonides, or Osler: 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 back up and face, and make sense of, their own existence…”


…….and then…..


Paul is diagnosed with what turns out to be Stage IV lung cancer.


Paul: “…One chapter of my life seemed to have ended; perhaps the whole book was closing. Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering……I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced…”


I don’t know what’s worse, to be a non-medic/oncological nurse being diagnosed with a life-threatening illness and not knowing the answers or being medically qualified and knowing them!



Paul: “…Death, so familiar to me in my work, was now paying a personal visit….”



Paul now had to confront the question, what did he understand by the term, the concept of, ‘the meaning of life’, what did he think was the meaning of his life and he had to get on top of the question quickly because the issue as to what course of treatment to follow was dependent on how he wanted to LIVE during the next stage of his life.


The issue here was not one of dying but of living.


Paul must have been in a spin – he’d spent so many years face to face with people living in the eye of a life-threatening storm, so close to it and yet so far from it. He’d always been able to – physically – walk away (though the emotions surely weighed him down):


“As a doctor, I had had some sense of what patients with life-changing illnesses faced – and it was exactly these moments I had wanted to explore with them. Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle…..


Lost in a featureless wasteland of my own mortality, and finding no traction in the reams of scientific studies, intracellular molecular pathways, and endless curves of survival statistics, I began reading literature again: Solzhenitsyn’s ‘Cancer Ward’, B.S. Johnson’s ‘The Unfortunates’, Tolstoy’s ‘Ivan Ilyich’, Nagel’s ‘Mind and Cosmos’, Woolf, Kafka, Montaigne, Frost, Greville, memoirs of cancer patients – anything by anyone who had ever written about mortality….”


As Paul’s illness progressed, as he went into remission and the cancer returned, he focused constantly on living, on the – on his – meaning of life, he enjoyed many highs and, of course, there were lows….I don’t want to say more than that – read the book but I shall say this, that not only has my ‘meeting’ Paul through his book benefitted me hugely, not only am I determined to take his lessons on board but he has definitely calmed/relaxed me vis a vis my thoughts about death, and beyond, however and whenever that may be….Paul’s mental approach during his illness, his courage and his stoicism, and the beautiful words and thoughts of his darling wife, Lucy, although their story is heartbreaking, it is all inspiring, uplifting, calming and I thank them – and I thank all of the people mentioned in the book who added value to the Kalanithis’ lives and brought them peace of mind on the journey.


Lucy’s words in the book’s epilogue are beautiful and heartrending and reflect love, friendship, kindness, empathy, commitment and respect, even awe and incredulity.


Lucy: “Although these last few years have been wrenching and difficult – sometimes almost impossible – they have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love.


That, Lucy, is 100% apparent in the book! The aforementioned emotions are, to the reader, palpable, even tangible.


As Lucy touches upon in her epilogue, Paul – and their marriage and partnership as parents – continues, thanks to the inspiring, beautiful and loving legacy of his thoughts, lessons, philosophies and indelible footprint in this world. Paul still has a lot to give and many, many people will continue to benefit from the fact that Paul was here and their lives will be all the better for it.


I wish all the family well, that they know no more heartbreak and that they only know the best of health and happy times….


I shall forever be one of, I’m sure, the many ‘When Breath Becomes Air’ and Paul Kalanithi ambassadors throughout the world. Paul put so much effort, often during painful, difficult times, into writing his book and the least I can do is do my little bit to help keep his legacy alive and (continue to) raise awareness, not just of lung and brain cancer but all cancers.


Paul, RIP…

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