When Breath Becomes Air Hardcover – 4 Feb. 2016

A book I shall read again and again, truly inspiring, deeply considered and emotionally liberating. Stunning book, thought provoking, inspirational. Thank you,

This was such a good read. Very touching & really enjoyable even though the outcome was inevitable.

For a book about death and dying, Paul Kalanithi is neither morose nor morbid about the whole enterprise, which is in itself a magnificent feat, considering it is about his own journey towards death.A bright and promising neurosurgeon, close to completing his residency, Paul is struck down by a diagnosis of metastatic lung cancer. He quickly finds himself straddling the role of doctor and patient and his recalibrated sense about the future as he braces against the fact that “death may be a one-time event, but living with terminal illness is a process.”It comes as no surprise that the book is so lyrically written when the reader learns of Kalanithi’s literary background growing up, and that he is so articulate in his meditations about life and death. He is never preachy when he touches on faith and science as he reasons: “to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning - to consider a world that is self-evidently not the world we live in.”Neither does he shy away from his struggles with accepting his illness, and the rollercoaster of emotions he experiences with each new development during his treatment.Already an empathetic doctor who is well aware of the importance of good bedside manners with his patients, Kalanithi develops a heightened empathy with them because of his own illness, and this is most aptly described on his encounter with a resident attending to him. He queries about a drug that was taken out of his prescription and was met with hostility when they had just chatted as fellow doctors earlier: “I could see in Brad’s eyes I was not a patient. I was a problem: a box to be checked off.” That incident stoked Kalanithi’s memories about a patient who had told him that she wore her most expensive socks to the doctor’s office just so she could be seen as “a person of substance, to be treated with respect” when she was uniformed and “identity-less” in a hospital gown.Kalanithi’s account is no easy read even though it is short and crisp, and I had to pause read something else to disengage with such a sobering subject matter. But the message it conveys is enduring and I would argue, essential to what it is to live a meaningful life.

When I first finished this book, I was ready to award it only 3 stars.I had absolutely loved Part 1. Everything Paul talked about enthralled me. His love for literature, his constant philosophical questioning as to what made life meaningful, his insights into the paradoxes of studying life to understand it vs experiencing it and building the relationships that gave it meaning, and his drive and fascination with biology and specifically neurology. He felt so alive in Part 1 as I read, his drive, his yearning to master this thing called life, his success mindset, I loved him. I felt so sad that he was dead and that I would never get to meet him. What a loss to the world. And it seemed so horribly unfair that a man who did so much to save the lives of others, should be deprived of life himself. Horribly unfair. Was that how we got rewarded in life for good deeds?I gave myself a break before Part 2. A breather because I knew it was going to get heavy. Paul hadn't survived despite the upbeat voice of Part I. He had died. Others had warned me this was a book that would leave me in torrents of tears, so I gave myself some time to prepare for the emotional upheaval and brace myself.Yet during that break, something nagged at me. A small voice at the back of my head told me something didn't sit quite right. Paul seemed too brilliant from the first part. Was that how he really was? Maybe he was saying some of things that so impressed me, because they came to light after he knew he was facing death. Maybe he was making himself sound better than he was...?I made the mistake of googling the book so I could read some more about him. It was odd, I wasn't ready to face Part 2 yet, but I still wanted to stay connected to Paul and the book, so I found myself reading about him and his wife on the internet.I discovered they'd had a baby! That shocked me. Why would he have a child when he knew he wasn't going to be around to bring it up?And I read about his wife finding new love a couple of years after his death. Ironically, with a widower whose dead wife had also written and had a memoir published about her impending death.I know it's totally wrong of me to feel this and judge, but I felt cross with her. I was still at the part in the book where Paul was alive, and here she was already with someone else. I lost love for her and my opinion of her became a little jaded. (I know, totally dumb and unfair. What can I say...)When I finally got back to Part 2 then, I was already in lower spirits, but not because I knew Paul was going to die. Because I felt lost and didn't understand the decisions that he or his wife were making. I started to feel cross with him for having a baby when we wouldn't be there for her as she grew up. And when he returned to work full gusto after the first successful treatment, I was beyond flabbergasted. How could he do that. Knowing how ill he'd been? In fact, worse, how could he ignore all the pain that was returning and just use painkillers to mask it and go on? Why? Why would he do that? Why would anyone do that?In my vanity and arrogance, I was so mad with Paul. He'd had a chance to live and he'd thrown it away in my opinion. He'd gone back to a job that had killed him. That's what it felt like for me.And that oncologist! Why did she keep pushing him back to such a stressful unhealthy job?! There was no way in the world that a personality like Paul was going to go back to it part-time. A return to it was always going to almost certainly put critical strain on his body.And emulating her question, he kept asking several times in the book, what do you value? What gives your life meaning?Except, he never explicitly answered. In my arrogance, I judged the meaning of his actions and assumed that they revealed what gave him meaning: his job, achievement, becoming a high-flying consultant who was respected and adored by all.I thought he was selfish. His marriage was on the rocks before his diagnosis, precisely because they weren't spending time together (my assumption) and there he was, having been given another chance, and he returned to the same crazy lifestyle. He valued success. He didn't value relationships or other people.That was my original opinion. Harsh, judgmental and assuming.It took a whole evening of discussion at Bookclub to really unlock this book and Paul Kalanithi's last days for me, and turn my opinion completely around. One of the members asked repeatedly, why did we think Paul wrote the book?We didn't come to a common consensus right away. I felt he had wanted to leave a legacy. For selfish reasons. But others thought that the book was a way of him coming to terms with what was happening to him.I now think that this is true, the book did give him opportunity to try to make some sense of his life and his impending early death. I think that anyone facing an early demise would find themselves trying to understand what was the point of it all.I think he did also want to leave a legacy, but not truly for selfish reasons. Literature was a passion of his and he had always wanted to write. It was a dream, an ambition and he wanted to fulfil it before he died. There's even something noble in this. To leave something of value behind for others so that they might benefit from his sorrow and suffering.When we noted that Paul never explicitly answered what he valued and what made his life meaningful, we considered that maybe he didn't actually know the answer to that question. And there was a searching for it in the book as he wrote it to some extent.Someone noted that he'd repeatedly asked and needed to know, how long did he have? Because how long he had would impact how he chose to spend his remaining time. Did he have time to finish his training and graduate? Or was it less? If it was less, he would write his book. The same dilemma appeared again and again.And he noted finally at one stage, the irony of his position. Before his diagnosis, he hadn't known how long he'd got left. And after, he hadn't known how long he'd got left.My friends helped me to realise that Paul was a man that was really struggling even though he doesn't express it in emotional terms through his writing. What a horrible position to find yourself in. You've got cancer, you're definitely going to die. What do you do with your remaining days? What would you do?For Paul, it made sense if he had more time to go back to work and complete the training he had invested virtually his whole life in. He was so close to the finish line. So close. It made sense to just go back and finish it and maybe even reclaim the future he had worked so hard and relentlessly to attain.When the returning cancer started to make itself known through the excruciating back pains he started to experience again, he dumbed it down, ignored it, buried his head in the sand a little, or more accurately perhaps, stayed laser-focused on his goal. You don't become a neurosurgeon by being swayed or distracted by obstacles when they appear. That was not his way, and I can only assume that he was helpless to change this in himself.I realised that for all the good that Paul Kalanithi did for others, how many lives he saved and how many people he redirected on the road back to health and self-care, ultimately he did not do the same for himself.Did he realise this? That he had failed in his own self-care? He makes a point midway through Part 1 how some students had rallied to try and change the Hippocratic Oath equivalent that they were to swear to in the US, caveating that they should not put their own welfare behind their patients. Of course this was meant in a different context, but the irony strikes me hard in the face. I wish fervently that Paul Kalanithi had cared more about his own health and well-being, maybe then, maybe, he might even be here still to save more lives and see his wife smile and his little girl grow up.Of course death comes to us all. It is our final master. The curtain that gives our performance meaning ultimately. And yet what I learnt from this book is that having Focus without Balance is a fatal mistake. Fatal to all projects, but in this case it feels like it may have been a key factor that claimed a life.If Paul had not been so single-mindedly driven, would he have spotted those shadows in the scans before they became irreversible? Would he have chosen to make better choices about his hours (punishing 5am starts and such late finishes it was all he could do to collapse), about the food that he ate (a quick lunch of an ice-cream sandwich and coke was never going to be conducive to promoting good health in the body), about the emotions that he felt (there was such a desperate need/requirement to perform unreasonably consistently at an exceptionally high level for him)...I feel so sad for Paul now. This was a man who struggled desperately to do the right thing in the only way he was taught to and the only way he knew how. But he was not rewarded for it ultimately.I think now, that what Paul maybe valued most of all, was maybe trifold - relationships in conjunction with giving value to others and achievement. When he returned to neurosurgery and he was only doing the surgeries, he had said that the job had started to feel empty and he’d stopped enjoying it. And that it was only when he returned to consulting with patients that it became meaningful again.And at the very end of the book, his final letter to his daughter, he tells her that when she questions if her life has had meaning, to know that she gave a dying man joy such that all his desires were sated. Finally in death, he had stopped the chasing that had been set up in his childhood and persisted in this crazy world we live in permeating a job that he loved and had tremendous value. Finally he found value and found himself being valued by a child who was till a baby and asked nothing of him other than to love and adore him and be loved and adored back in return. No chasing, nothing about his past or his future, all she wanted and needed from him was his attention now, here, in the present.I've realised that this book was actually his real gift to his daughter. In it she can learn everything that her father was, what he stood for and believed in, what he loved and what he struggled with. Within the pages if she looks closely enough, she will find a guiding compass as to what kind of questions to ask yourself in life so you can be proactive in making your life meaningful and valuable.For me, Paul and our bookclub members have given me an immeasurable gift. I have realised that like Paul, I myself need to more actively prioritise my health. Maybe that is why I was so mad with Paul, because he did what I do myself so regularly. Sacrifice longevity for quick wins in the scheme of things.And perhaps equally importantly, I've recalled that none of us know how long we have truly. And that if we live our life without prioritising what's really the most important thing in the world for us, regardless of how long we have left, then we can only win ultimately. We must find a way to balance the scenario where we might live for several decades more and yet today might be our last day too.I think this is actually possible and achievable. But it requires us to stop and take a step back every now and then, so that we look deeply into how we our lives now. And consider what it would be like if everything was to phase out to black in the next moments, as death stole us away. What would be the urgent need in these final moments?Paul's sweet wife, Lucy, says in the afterword that Paul's hope was that the book might prompt readers to walk in his shoes a moment and feel what it's like to facing a difficulty such as his, before stepping out of them again. It's definitely done this for me. What a tremendous profound gift.I don't know what the book might have been if Paul had had an opportunity to complete it. But I feel that paradoxically, not achieving completion was his greatest achievement of all. He perfectly demonstrates the future that awaits us all, and gives a profoundly valuable opportunity to breathe more life into our remaining days and years as a result.

Livro com reflexões valiosas sobre a vida. Para refletirmos sobre a nossa finitude. Vale a pena ler essa historia inspiradora de um medico que inverte seu papel para de um paciente terminal.

5\5 Not a fraction less. As I finished this book tears rolled down both my cheeks. Breathing was hard for the last 40 pages, as I struggle to choke back the conflicting emotions I felt in reading Paul's last words and those his wife Lucy would conclude with. On the one hand I felt heartbroken with sorrow for the fate of this man who would strive so hard to help others live or to ease the agony of those who would die. Yet this book was as heart wrenching as it was beautiful. It was as uplifting as it was sad.This book deeply touched me on an emotional and what some would call a spiritual level. While I am not spiritual, I cannot deny the spirit of this man, who lived, loved, triumphed and accepted his fate with courage and strength, even as cancer weakened him physiologically.Paul died very near my own age. I struggle to find meaning in life, especially as I see others die around me every year. I also grapple with my own impending end which could come any moment, future or present. I began to question everything as I've aged. I fear perhaps I have made the wrong choices in life. I question what it is all for. Being an atheist is a blessing and a curse, for it gives life at times a hollow definition. We live to die. Most of us spend the majority of our lives dying, or declining until our last day. This does not have to be a sad thing though. This book has revealed to me that there is another way in which to die. That is, to live... until death.From the bottom of my heart I am thankful to Paul, for this book, and to Lucy for her epilogue, for her kind words which will touch my own spirit, my core being, until the end. It will forever remind me that our fate may not always be what we want it to be but our lives are what we will make of them. We will all die, some sooner, some later. This is a fact. While we live to die this does not mean we cannot also live to live, to live life appreciatively.While I do not share the expansive and loving family Paul did and while I feel at times vastly alone in this world, I have learned the deep lessons of this book. I have no one to truly comfort me in my sorrows as I grind through life. This book, these words, are my comfort. Alone we embrace, this philosophy and I. I am not dying such as Paul was. I am merely dying as life would naturally have it, as we all are, until something decides to speed this natural process up, like a cancer or some other malignance. I merely suffer the physiological strife that comes with working on a farm in rural Nova Scotia. I toil so others may not. Someone must till the soil, grow the food, harvest from life to give life. Though I often feel I should be doing more.My English degree hangs on a wall, a banner of achievement, yet a reminder of failure. I relate to Paul in that, like him, I want to help others. After all, there is no better feeling than having consoled or counselled another. I have often had the dream of using words to ease the pain of suffering. Paul has awakened me to the fallacy of how I see that piece of paper in the negative. Perhaps I will do no more than I have. Some do nothing. Some live and die, forgotten to the winds of time. The important thing is to understand that life is a treasure. It is a thing to be cherished, this consciousness, this awareness, our ability to think and see and question and comprehend. To compel or be compelled is to live. Whether alone or in the company of loved ones, we should hold dear this thing we call life. Find your happiness where you can. Be it within the pages of a book such as this or in the company of others, seek it and embrace it, for a life lived happily is to truly live. Whether short or long, alone or otherwise, we need not despair the eventuality of our end. Smile, my fellows, for were we not alive, we would not know what it is to live.Thank you Paul. Thank you Lucy. You have both, in death, and life, warmed my heart beyond what other words have elsewhere been able.

This is an ultimately beautiful memoir of Dr. Paul Kalanithi. insightful, touching and quest of what makes human life meaningful!Thank you for publishing his memoir, it's a wonderful gift.

Libro bien escrito, del principio hasta el final. Sorprendente la última parte ya que toca la fibra y es muy emotivo.

As expected.