When Breath Becomes Air, by Paul Kalinithi

When Breath Becomes AirWhen Breath Becomes Air, by Paul Kalinithi.  Foreword by Abraham Verghese.  New York: Random House, 2016. 228 p.

Paul Kalinithi was a neurosurgeon, writer, husband, father. He was diagnosed with lung cancer and died about 24 months later in March 2015. This book became his focus in the last months of his life —a rare, movingly honest, literate, and beautifully written account of facing death and living. OK, I wept when I read this, not because much of it is sad, but because all of it is so beautiful.

Paul swam in the deep end of the pool: in the incredibly exacting work of neurosurgery and neuroscience —a surgery which is meant to heal the body but unavoidably also amends the soul, a person’s very sense of self. This weighty responsibility has to be met by physicians with equal courage, tenacity, knowledge, and stamina —excellence in all things, αρετή in the true Greek sense. When Paul, such a physician, then had to become a patient, the roles shifted to courageous colleagues more than a simple reversal. His oncologist (“Emma”) was uncommonly gifted, and preserved for him an ability to choose his identity, his future, and his life at a time when too often the illness can strip those way. Paul quotes Becket, “I can’t go on. I’ll go on.” And he does.

In physical, embodied words, this book is beautiful to hold as well –beautifully produced.  The Monotype Bell font renders the text crisply and without weight.  Since the book is about having a body subject to disease and death, its physicality is important.  Reading it on a digital device would be definitely second-best, but good enough if that is the only choice (for those who are very ill or with impaired vision).  The care shown in the production of the volume perfectly corresponds to Paul's drive for excellence and humane expression in all his works.

This book is about facing death and remaining time to be alive —which is everyone’s situation, whether shorter or longer. Paul’s illness allowed him keep this in focus in a way few achieve. He really was remarkable, a force of nature in his prime, blazingly intelligent and impossibly well-read, with a keen sense of humor that only partially reveals itself. His intelligence, education, and experience as a neurosurgeon distilled into wisdom. When I come to that “someday” when life and mortality are both clearly in focus for me, I will reach for rather few books. This will be one of them.