When Breath Becomes Air

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When Breath Becomes Air is a non-fiction autobiographical book written by Paul Kalanithi. It is a memoir about his life and illness, battling stage IV metastatic lung cancer. It was posthumously published by Random House on January 12, 2016.[1]

In his last year of neurosurgical residency at Stanford University, Dr. Paul Kalanithi experiences negative changes in his health. Rapid weight loss, and severe back and chest pains begin to raise concern for him and his wife, Lucy. Paul worries that a possible cause for his symptoms is spinal cancer – unlikely for people in their thirties. However, when X-ray results in a routine medical check-up return looking just fine, his primary care physician and himself attribute the symptoms to aging and work overload. At thirty-six, Dr. Kalanithi had gained national prominence and become a respected member of the medical community.[2]

Determined to finish the last months of his residency, he ignores whatever symptoms have not subsided. A few weeks later, the symptoms come back, stronger than before. Around this time, Paul and Lucy experience a rocky moment in their relationship when Lucy feels that Paul is not communicating with her. Visiting friends in New York, Paul is almost certain that he has cancer and says it out loud for the first time to his friend Mike. Returning home, upon landing in San Francisco, Paul receives a call from his doctor telling him that his lungs “look blurry.” When he arrives home with Lucy, both of them know what is happening. The next day, Paul checks in to the hospital and the room where he examined his patients, delivering good and bad news, becomes his own. With this event, the future that Paul had worked so hard for these past years vanishes before his eyes.[2]

Background[edit]

Before writing When Breath Becomes Air, Paul Kalanithi was in residency in neurological surgery and a postdoctoral fellowship in neuroscience. In May 2013, Kalanithi was diagnosed with stage-4 non-small-cell EGFR-positive lung cancer.[3]

As Kalanithi underwent cancer treatment, he shared his reflections on illness and medicine, authoring essays in The New York Times, The Paris Review and Stanford Medicine, and participating in interviews for media outlets and public forums. He also began work on an autobiographical book of his experiences as a doctor and a patient facing a terminal illness.[3]

Kalanithi died in March 2015 at the age of 37. His memoir was published posthumously 10 months later.[4] The book included a foreword by Dr. Abraham Verghese and an epilogue by Kalanithi's widow, Lucy.

Plot[edit]

Following the prospect of a better life, Paul's father moves the family from Bronxville, New York to Kingman, Arizona when Paul is ten. A doctor himself, Paul's father dedicates most of his time to medicine and is notably absent from the house. Believing that to be a doctor, he would have to be away from the family like his father, Paul becomes disenchanted with medicine. Although Paul and his two brothers enjoy the newfound liberty of their desert town, their mother constantly worries for their academic future in a town that the U.S. census has declared “the least educated district in America.”[2] Unwilling to let anything halt their learning, she acquires college reading lists and instills in her sons a love for literature. The summer before heading to Stanford University for school, Paul reads Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S., by Jeremy Leven. The book's idea that the mind is the result of the brain doing its work awakes a curiosity in Paul for neuroscience.

After completing degrees in English literature and human biology, Paul feels there is still much to learn. He is accepted to a master's program in English literature at Stanford, and one afternoon—pushed by his desire to understand the meaning of life— discovers the calling to practice medicine for the first time. Preparing to apply to medical school, Paul uses the time off to study the history and philosophy of science and medicine at Cambridge. He later starts medical school at Yale. During his time at Yale, Paul meets his wife, Lucy, and sees the patient-doctor relationship as an example of life, death, and morality coming together. After two years of classroom learning, Paul experiences his first birth and death in his ob-gyn clinical rotation, when a set of twins could not be carried to term. It is then that Paul understands that intelligence is not enough in the practice of medicine, and that morality is also needed. After medical school, Lucy starts internal medicine residency at UCSF and Paul neurosurgical residency at Stanford. Hard at first, Paul grows used to the rigor of neurosurgery and, in his fourth year, joins the neuroscience lab of a professor affectionately called “V.” In the sixth year of residency, Paul returns to his hospital duties and having reached professional recognition, he feels he has finally found his place in the world.[2]

Paul's life takes an unexpected turn when, after weeks of health problems, it is confirmed that he has lung cancer. Images obtained from a CT scan show organ systems compromised by the cancer, causing Paul and Lucy great sadness. Searching for the best experts in the field of oncology, Paul begins treatment with a doctor named Emma Hayward. Because of his status, rather than stepping back and letting Dr. Hayward offer her professional opinion, Paul expects to be treated as a consultant, even if it is his own case. Dr. Hayward suggests to find the root of his cancer before determining treatment options. In the meantime, Paul's family helps him through his transition from doctor to patient, and together with Lucy, he decides to explore reproductive options before he dies. They visit a sperm bank and make the decision to have a child. Test results arrive and Paul discovers that his cancer is derived from a mutation in the epidermal growth factor receptor (EGFR). This fact gives him a bit of relief because it means that he can be treated with Tarceva rather than chemotherapy.[2]

Symptoms subside with the treatment and, in Dr. Hayward's office, Paul feels like himself again. After weeks of using the medication, CT scans show a reduced number of tumors in Paul's lungs and he becomes determined to return to the operating room. Back in the OR, Paul cannot finish his first surgery because of his health. However, his strength and technique improve over time. With both graduation and a baby due in June, Paul takes another CT scan after months since the last. He discovers a big tumor in his right lung and without getting scared, Lucy and Paul research what other options are available. Paul retires from surgery indefinitely and begins chemotherapy. Paul's response to chemotherapy is adverse and his health worsens, forcing him to skip graduation. With the failure of chemotherapy, other treatment options do not provide much hope to Paul. His condition becomes so severe that even Dr. Hayward gives an approximation of how much time he has left – something she had strongly refused to do before. On July 4, 2014, Elizabeth Acadia “Cady” is born and Paul is filled with joy, even in his darkest hour.[2]

Reception[edit]

When Breath Becomes Air is a New York Times bestseller, spending 68 weeks on the non-fiction bestseller list.[5]

Matt McCarthy of USA Today gave it 4 out of 4 stars and said, "It's a story so remarkable, so stunning, and so affecting that I had to take dozens of breaks just to compose myself enough to get through it."[6] Nick Romeo of The Boston Globe wrote that it, "possesses the gravity and wisdom of an ancient Greek tragedy."[7] Melissa Maerz of Entertainment Weekly stated that the book was "so original—and so devastating. . . . Its only fault is that the book, like his life, ends much too early."[8]

Awards and honors[edit]

Other editions[edit]

The first US English edition was released in January 2016 followed by the UK English hardback edition by Bodley Head in February 2016. A UK paperback edition was released on January 5, 2017. The book has been translated and published in 39 languages.

Country Publisher Date Language Title
Brazil Sextante May 2016 Portuguese O Último Sopro de Vida
Bulgaria Ciela March 2017 Bulgarian И ДЪХЪТ СТАHА ВЪЗДУХ
China Owl Media/Zhejiang Publishing House of literature and Art December 2016 Chinese (Simplified) 当呼吸化为空气
China Beijing Xiron Books August 2016 Chinese (Traditional) 當呼吸化為空氣 (Dang hu xi hua wei kong qi)
Croatia Mozaik knjiga March 2017 Croatian DAH KOJI ŽIVOT ZNAČI
Czech Republic Noxi October 2016 Czech Můj poslední výdech
Denmark Lindhardt og Ringhof September 2016 Danish Før jeg forsvinder
Estonia Ajakirjade September 2016 Estonian Kui hingusest saab õhk
Finland Bazar January 2017 Finnish Henkäys on ilmaa vain
France JC Lattes February 2017 French Quand le souffle rejoint le ciel
Germany Albrecht Knaus Verlag April 2016 German Bevor ich jetzt gehe
Hungary Casparus Kiadó July 2016 Hungarian Elillanó Lélekzet
Iceland Forlagið February 2017 Icelandic Andartak eilífðar
Italy Mondadori April 2016 Italian Quando il respiro si fa aria
India DC Books February 2017 Malayalam പ്രാണൻ വായുവിലലിയുമ്പോൾ
India Sandhya Publications February 2017 Tamil சுவாசம் காற்றில் கரைந்தபோது
Indonesia Mizan September 2016 Indonesian When Breath Becomes Air
Israel Matar June 2016 Hebrew בטרם לכתי (btrm lkty)
Japan Hayakawa Shobo December 2016 Japanese いま、希望を語ろう (Ima kibo o kataro)
Korea Next Wave September 2016 Korean 숨결이 바람 될 때 (Sumgyŏli param toel ttae)
Latin America Oceano September 2016 Spanish El buen doctor
Lithuania Baltos Lankos June 2016 Lithuanian Įkvėpti tylą
the Netherlands Holland Diep October 2016 Dutch Als adem lucht wordt
Norway Forlaget Press September 2016 Norwegian Når pust blir til luft
Poland Wydawnictwo Literackie September 2016 Polish Jeszcze jeden oddech
Portugal Saida de Emergencia April 2016 Portuguese Antes de Eu Partir
Romania Nemira September 2016 Romanian Cu Ultima Suflare
Russia Eksmo January 2017 Russian Когда дыхание растворяется в воздухе
Saudi Arabia Jarir January 2018 Arabic عندما تتحول الانفاس الى هواء
Serbia Laguna June 2016 Serbian Dah života
Slovakia Noxi October 2016 Slovak Môj posledný výdych
Slovenia Ucila/Taught International May 2016 Slovenian Ko Dih Postane Zrak
Spain Seix Barral September 2016 Spanish Recuerda que vas a morir. Vive
Sweden Norstedt May 2016 Swedish När andetagen blir till luft
Thailand Openworlds October 2016 Thai เมื่อลมหายใจกลายเป็นอากาศ
Turkey Altin Kitaplar December 2016 Turkish Son Nefes Havaya Karışmadan
Ukraine Family Leisure Club July 2016 Ukrainian КОЛИ ПОДИХ СТАЄ ПОВІТРЯМ
Vietnam Alphabooks June 2017 Vietnamese Khi hơi thở hóa thinh không

References[edit]

  1. ^ Maslin, Janet. "Review: In 'When Breath Becomes Air,' Dr. Paul Kalanithi Confronts an Early Death". New York Times. Retrieved 16 January 2016.
  2. ^ a b c d e f Paul,, Kalanithi,. When breath becomes air. Verghese, A. (Abraham), 1955- (First ed.). New York. ISBN 9780812988406. OCLC 909925278.
  3. ^ a b "Paul Kalanithi, writer and neurosurgeon, dies at 37". News Center. Retrieved 2017-02-18.
  4. ^ O'Kelly, Lisa (2016-02-14). "Lucy Kalanithi: 'Paul's view was that life wasn't about avoiding suffering'". The Guardian. ISSN 0261-3077. Retrieved 2017-02-18.
  5. ^ "The New York Times Best Sellers Hardcover Nonfiction". Retrieved 2018-07-03.
  6. ^ "Doctor's cancer memoir is a best seller". USA TODAY. Retrieved 2017-02-18.
  7. ^ "Young doctor, husband, father traces his losing cancer fight in memoir - The Boston Globe". BostonGlobe.com. Retrieved 2017-02-18.
  8. ^ "'When Breath Becomes Air' by Paul Kalanithi: EW review". EW.com. 2016-01-07. Retrieved 2017-02-18.
  9. ^ Danuta Kean (14 March 2017). "Wellcome prize shortlist announced: books that 'will change lives'". The Guardian. Retrieved 24 April 2017.
  10. ^ "Pulitzer Prize: Biography or Autobiography".
  11. ^ "2017 Edition". Jan Michalski Prize for Literature. Retrieved September 29, 2017.