Review of "When Breath Becomes Air"

“When Breath Becomes Air” – it is fair to say that I have not read a book like it in my life. There are multiple reasons that the book resonates so strongly with me, not the least because the protagonist (also the author) was of my present age when he was diagnosed with terminal lung cancer. He was a Neuro-surgeon, just completing his residency at Stanford and like his accomplishments speak for themselves, he was all set to be a very, very good one. Paul Kalanithi’s insights into life as a neuro-surgeon and his ability to talk candidly about everything, starting from his childhood, to his medical studies, to his realization of terminal cancer, is simply stunning and though provoking.

The parallels in his story line were simply too much for me to take. This was a book that made me stop reading many a time, if only to contemplate what Paul had written and ruminate over it for a bit. He talks of patients suffering from neurological diseases and throws up a multitude of questions that strike a chord as my own father had Parkinson’s Disease. This was the first book where I felt compelled to “Highlight” phrases. Reading novels or books usually means that a lot of what is read is forgotten in a few hours or days. What remains in my mind, is an impression or summary. I remember the storyline very well for a few days, but I cannot remember the exact phrases that were used that may have had such a profound effect on me. This book threw up phrases, provoked thought and really, brought death bang in the center of all thoughts. It is pure coincidence that I picked up this book only a couple of months after my own father’s demise as a result of Parkinson’s disease. He suffered for 26 years and I have often wondered how I would deal with a situation such as that. This book does not answer that question for me, but does give me a fresh perspective of how this person, Paul Kalanithi, chose to confront it and work towards the inevitable end. To think that he chose to spend hours and days of the final few that he had, in writing and writing so eloquently and beautifully – it is heart wrenching stuff. I confess that I was moved to tears while reading this book. The funny and compelling thing about this book is that I could have simply chosen to stop reading it if it were dark and sorrowful. While he talks about death repeatedly, either with patients about theirs or about his own, it is never morbid.

Amid all the gloom, the love for his wife and their courage in having a baby after the diagnosis is exemplary and speaks volumes for the kind of person that he was and the relationship that he shared with his family. His wife, Lucy Kalanithi, takes over the story-telling activities after his death and writes in the most loving way about his last few moments spent at the hospital. These were moments that moved me to tears, not just reminding me of my own father, but of how fleeting and short life is!

What we plan for and what eventually happens, is completely out of our control. The selfish purpose of study of medicine, is for the future. Invariably, Doctors are expected to live long enough to put all their study to use, with their experience and knowledge honed over the years. To have such a life cut short with a disease that afflicts 0.012 percent of all humans in their 30s, reeks of injustice, so to speak. Like Paul says, when a patient would question, “Why me?”, the answer is always, “Why not me?”.

Paul begins the story in Stanford and takes us through the symptoms leading up to the diagnosis. He suffers from excruciating back pain and ends up doing a few scans. His training as a Doctor ensures that he knows, before anyone else does, that he has cancer. Over the course of the book, we learn that he was a runner, having completed a few half marathons, avid biker along with his wife who is also a Doctor. We learn that he is nearing the end of his 7 years of residency at Stanford and he is likely to be hired full time at the same college with an opening that appears tailor made for his skills and expertise. Over the course of the book, he has devoted a bulk of the time to his impressions formed with literature and later, with medicine.

Some of the stories from his internship are moving. I learnt that neuro-surgery is the pinnacle of medicine. The Neurosurgeon is expected to be familiar with all other fields and he spends his internship in various departments. His first experience as an intern as an obstetrician also turns into his first experience with death. Tellingly, when asked about what prompted the resident to take a decision to perform a C-Section operation on a lady pregnant with twins in just the 24^th week of their full term, she responds “Judgement call”. It leaves an ever-lasting impression, not just on the author, but also on the reader. Ultimately, the life and death of patients (and he draws upon multiple definitions of a patient, one of which is “one who suffers silently”), is in the hands of the Doctor who is treating them. Another Doctor may have made a different judgement call in that very situation. As it were, the twins were born pre-mature, the size of the hand of the Doctor that helped bring them out. They were placed in Neo-natal ICU, where they passed away within 24 hours, unable to breathe even with all the support systems in place around them.

Another story springs to mind and the line “Was I making moral slides or strides?” resonates with so many situations that I have seen in and around India. The author is having his breakfast consisting of an ice-cream sandwich in between the never-ending hours of internship. He is called into an emergency with a man who has just suffered an accident on a motorbike. His skull is crushed and all attempts to revive him fail. This happens in a matter of a few 10s of minutes. While his friends and family are dealing with the shock of the loss of a life, Paul is reminded of his ice-cream sandwich. He rescues it and devours it. While doing this, he wonders about the morality of it all. He has just witnessed a death of a human at close quarters and is immediately concerned about his own sandwich. This is a scene that acts itself out countless number of times in every hospital across the world. I think it is worse here in India, that’s all.