When Breath Becomes Air by Paul Kalanithi review – thoughtful and poignant

A dying surgeon contemplates his mortality and his vocation in this moving, astute farewell

Paul Kalanithi became a neurosurgeon because he felt compelled by neurosurgery and “its unforgiving call to perfection… it seemed to present the most challenging and direct confrontation with meaning, identity and death”. He was, in his own words, overwhelmed and intoxicated by neurosurgery – feelings which I certainly shared when I started my own neurosurgical training 35 years ago. He wrote his moving book When Breath Becomes Air as he approached the completion of his training as a neurosurgeon, but after he had developed metastatic lung cancer. He died at the age of 37, before he could ever practise as a fully qualified surgeon. The book, which he wrote as he was dying, is published posthumously.

It is disturbing, at first, to read an autobiographical book in which the author knows he is dying and you know that he will be dead by the end of it. But Kalanithi writes very well, in a plain and matter-of-fact way, without a trace of self-pity, and you are immediately gripped and carried along. The fact that I use the present tense in writing about him shows that the book has taken on a life of its own, as Kalanithi clearly hoped it would. It’s a remarkable book, for many reasons, especially for his description of his transition from all-powerful doctor to anxious patient, and of how he was “so authoritative in a surgeon’s coat but so meek in a patient’s gown”.

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