The title is poetic. This first caught my eye. Then I read what it is about: the memoir of a brilliant young neurosurgeon dying of stage IV lung cancer. ..When breathe becomes air….the moment when he made the transition from a breathing human being to living in the everywhere, the oneness of existence some call Eternity.

How could I resist?

Never mind that I lost my soul mate, my mentor, my cousin, David, to the same disease two years ago next month. Perhaps this is the book David would have written had he been a writer. He was a therapist, and as Paul Kalanithi continued to do brain surgery up until a few months before he died, my cousin chose to spend his last months with family, friends, and his patients.

Paul Kalanithi opens a world for us that is far more about living than dying. A literature major and lover of books from childhood, he had always wanted to write. He mapped out the course of his life in neurosurgery and the vast and dynamic horizon of neuroscience. In one section he details doing an operation with tiny electrodes that target an area unreachable by surgery. The patient is wide awake, and suddenly reports, “I feel sad. Crushingly, terribly sad—“ Paul adjusts the electrode almost imperceptibly. After a few minutes, the patient sighs, “I’m myself again.”  Paul reflects that it is of little use to cure the cancer if his patient lives with a terrible sadness. And so opens the possibilities for the future of treatment for so many brain disorders, from schizophrenia to Huntington’s.

Paul had a beautiful and brilliant wife, and had every reason to chart his life in decades: twenty years in neuroscience, the last ten as a writer.

With the diagnosis all of this shifted. Alongside the precious time with his patients in the operating room, he took up the pen – or these days, the laptop—as his way of finding meaning in the morass of the tragedy unfolding inside his body.

What is it about words that opens doors into the soul? I could ask that about any art form. It requires a peeling away of the layers of protection we erect in ordinary life. The role of “Doctor Kalanithi” gave way to a man who was entirely vulnerable, one foot in this world, the other in a much larger reality.

From this place as half man. half eternity, he writes not only the story of the course of his illness, but opens the book with Part One: “In Perfect Health I Begin”. We become a fly on the wall in his loving childhood family, his decision to focus as much on science as literature. The grueling hours of medical residency in brain surgery. The mistakes made. The evolution of his soul and consciousness in relation to the realities of medical practice.

His guiding principle? Meaning. Paul was ignited with the vision that  penetrating the physical properties of the brain can tell us even more about the mind and the soul and the meaning of life than the most enduring works of classical literature.  His quest – right to the end – was to find the connections through the healing pathways of brain circuitry that link us to purpose, to the core of existence, to each other.

His revelations, the mere persistence of his vision, his strong relationships with colleagues, patients, and his beloved wife, propel us through the story.  A portrait emerges of a man whose allegiance to meaning is so deeply embedded in his character, he is astonished to learn that after medical school most doctors choose “light” professions such as radiology, or dermatology. For Paul it had to a journey of the soul that took him into moments of life and death with patients and their families, finding in these moments, the most extraordinary and meaningful experience of life possible.

I leave you with Paul’s own words:

“Being with patients in these moments certainly had its emotional cost, but is also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—and not merely life but another’s identity, it is perhaps not too much to say another’s soul –was obvious in its sacredness.”



Kalanithi, Paul ( 2015) When Breath Become Air Random House. New York.

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