The difference between breath and air is life, and all of life is a quest for meaning– a quest whose essence is found in the journey and not necessarily the destination.

– Unknown

When Breath Becomes Air is a neurosurgeon’s account of his quest to find the meaning of life. From his days in college throughout his residency, he takes us with him as he seeks to answer the question of the meaning of life; the meaning of life in the face of death– the death of his patients and eventually his own death. He openly shares with us his struggles to determine what really mattered to him and his battle to live a meaningful life.

Paul Kalanithi

Paul Kalanithi begins his memoirs with the argument that the quest for the meaning of life is not in finding happiness, but in cultivating and valuing human relationships. These relationships, he asserts, are made possible through language. His book in fact highlights his belief in the power of language.

“…yet now to understand my own direct experiences, I would have to translate them back into language.” p 149

Language is a product of the mind and the mind is fundamentally controlled by the brain. So after studying English, literature, philosophy, biology and the history of medicine at Yale, Stanford and Cambridge, he settled on medicine, more precisely neurosurgery, as a way to find these answers he sought. His practice as a surgeon, performing the most life-altering surgeries, offered him the opportunity to not only learn the value of life but help his patients ascertain theirs when it mattered most– when they were on the verge of losing it. And when he was finally face to face with his own death, he found what made his own life worth it. He fathered two children: Cady and this book.

Probably what I like most about this book is the personal journey it took me on. There were those parts I could totally relate with: Just as he was inspired by his dad’s way with patients (p 89), I’m literally moved to tears as I watch my mother hug a worried patient or high five a frightened kid. Even when she’s tired, she makes sure to not only ease their physical pain, but to touch them where it hurts most– the soul. In special moments like that, I bow my head and whisper a heart-felt prayer, “Lord, if I could be half the doctor she is…” There were those parts that also made me critically analyse the kind of doctor I’m becoming. I perfectly understood what he meant when he talked about human beings becoming piles of tissue not only in the dissecting room, but also in our minds. How often do we even refer to patients by names? It’s usually “The guy in bed 1” or the “CCF on PS4”. Paul brings us back to the fundamental principle of medicine: the treatment of the human BEING. Then there are those parts that made my heart swell with inspired ambition. Mehn, he pushed himself! Almost-professor of neurosurgery at 36, he had won countless national awards for his research and yet still made time to connect with his patients– eacho one of them. Come on, what’s my excuse again? Then there were those parts that touched the raw nerves of my heart and left me broken with tears racing down my cheeks; like Lucy’s (his wife) epilogue and his last words to his daughter, Cady (p 199). I couldn’t help but tear up (ok, that’s putting it lightly; I literally wept!) at the thought of Elizabeth Acadia reading her dad’s words almost a decade from now, knowing she would never get the opportunity to know the man behind those words; the man who could only be with her for the first 8 months of her life (p 194 – 195).

So what are the lessons I learnt from this book?


In death is life. Only the brave learn that. We each need to face the reality of death and mortality and try to understand what makes life worth living for us. (p 139) It’s only when we learn how to die/ walk through death that we can truly live. When we all, like V (p 101), dare to face the question of morality in the face of mortality (hopefully a long way before we actually face her physically) then maybe can we find meaning and clarity of purpose to forge on. Like V, we all probably need to stop and ask “Does my life have meaning?” “Am I making the right choices?”


Paul Kalanithi, and wife Lucy

When life slips away before our eyes, we learn to slow down and savour each moment as it passes; to live each day meaningfully. After being diagnosed with stage IV lung cancer, Kalanithi writes:

“My life had been building potential; potential that would now go unrealised. I had planned to do so much, and I had come so close.” (p 120)

Darn. I don’t want to face my death only to realise I hadn’t even begun to live. I won’t stop building my dream future but not at the expense of my present. I need to learn to live in today. Slow down and listen to the birds sing. Smile as the rays of the sun kiss your cheeks each morning. Spend time with loved ones. Clichés are so because they represent the overlooked realities that dot life’s journey over and over and over. Take walks; connect with nature; with God, who gives life ultimate meaning.

If I died tomorrow, what would make me die with the satisfaction of having lived a full life? I’m not sure yet. One thing I do know is that what I studied this evening won’t matter; getting this piece published would.


When we are at our lowest, we gravitate towards the people closest– usually family. In his last days and even at the moment of his death, this was all he had and it was indeed all he needed. He came to agree with the Teacher in Ecclesiastes that all is vanity – a chasing after the wind indeed. (p 198 -199) The only thing he excluded from that conclusion was his daughter. On his dying bed, her presence alone made the hospital room home. He was leaving, but his existence didn’t have to end– through her, a part of him, his legacy lives on. If you ever must choose, choose family. I know I will.

Again, on love relationships, Lucy summed up my dream in these words:

“His journey thereafter was one of transformation – from one passionate vocation to another, from husband to father, and finally, of course, from life to death, the ultimate transformation that awaits us all. I am proud to have been his partner throughout, including while he wrote this book…” (p 221)

I want to be that partner– partner to a man living out purpose through all the changing scenes of life. So help me God.


One of the main issues Paul addresses in When Breath Becomes Air is that of the doctor-patient relationship. Throughout the book, we see him go from the stereotypical hardened doctor, to the doctor who cared about and treated each of his patients with love and respect and finally, to the point he becomes a patient himself. The basic question this book leaves the reader with is essentially the one it answers. “What kind of doctor should I be? The kind I would want to take care of me. Sometimes I don’t blame us; after repeated exposure to death and suffering from the DR to the wards and finally the morgue, we become inured to the indignities of infirmity. Yet life has a way of bringing us face to face with our frailties (maybe the second law of thermodynamics applies here?). How now shall we live? (which by the way happens to be the title of another good book we must endeavour to read, ?) In humility, serve patients reverently; overcome with an increasing sense of our littleness and the limitations of the reach of our knowledge. We must strive for excellence in practice appreciating the meaning of life as it applies to each patient. Technical excellence is a moral requirement (p 105).

We all need to be taken care of at one point or the other. We are frail and the journey is long and hard. We are meant to give each other strength and comfort along the way and the doctor has both the privilege and burden of extending this arm of grace to the many that come to him at their weakest and lowest in life. It is ours to give hope and where necessary guidance with respect to the issues of life, death and identity, and how these interact in the face of disease and death. We never know if or when the roles will flip.


Few things have the power to force our minds to face those questions we passively evade: questions of existence, identity, purpose and the place of death; questions that expose the limitations and inadequacies of human knowledge; questions that leave man in a state he abhors– vulnerability. This book is one of such.

Atul Gawande:

“Dr Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.”

Paul Kalanithi was 38 when he died in 2015. I may not be a good judge of this, but I feel this book ties in greatly to his whole purpose on earth. Dare I reduce all his life to the mere essence of this book? But is it a reduction, or this book a “mere essence”? No. No, its not. It’s a life-changer. Few books do that these days. I bless God, then, for the life– and death– of Paul Kalanithi. He may have felt like he couldn’t complete his writing, but what needed to be told has been. When Breath Becomes Air, I believe, is complete in its incompleteness.


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