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When Breath Becomes Air - Book Review

June 2022
Fateha Khawaja
UCL - 1st Year Medical Student

When Breath Becomes Air by Paul Kalanithi

First Impressions

‘When Breath Becomes Air’ is one of those books that gets recommended to you instantly when you tell someone you're applying to medicine. When I first picked it up, I found the cover quite striking and on first glance, I assumed this was going to be a story about a doctor's experiences, maybe something a little similar in nature to 'This is Going to Hurt' by Adam Kay, exploring a doctor’s interactions with their patients.

After reading the blurb however, it is clear that although this story is written by a doctor, it is primarily about his experience as a patient and everything this taught him about the healthcare system, the patient experience, and what being a doctor means.

The book is written by Paul Kalanithi, a thirty-six-year-old man, whowas on the cusp of completing his training as a neurosurgeon when he was diagnosed with inoperable lung cancer. The book captures the essence of mortality and the fragility of life. After reading the blurb, I was definitely inspired to read the book and learn about Dr Kalanithi’s story.

My Top Three Quotes

This book was incredibly powerful and emotional; it made me truly reflect on the value of life and particularly on the experience of patients suffering with terminal illness. Here are my top three quotes from the book:

‘Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?’

This quote comes after Dr Kalanithi reflects on why he decided to go into neurosurgery and how risky the specialty is - as it directly affects the brain. The question he asks reminded me of how before a surgery, both the patient and family make an informed decision based on whether the benefits of surgery on the patient's health and quality of life outweigh any risks of complications. They need to assess what their life is now with their health condition, and what it could be like after treatment, and what this change would mean to them. I think this quotation is a perfect moment to reflect on the instability of life when suffering with terminal illness and the very real and scary decisions patient's are forced to think about.

‘Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.

One of the most difficult parts when reading this book is experiencing the diagnosis of Dr Kalanithi as he recounts it because his life changed so drastically in such a short period of time. We were witnessing Dr Kalanithi learn that even though he was very well aware of what it meant to die from a physical point of view and the physiological changes that happen, he was learning for the first time what it meant for him personally and emotionally. He was learning something about death he never truly understood, despite having seen so many patients die over the years.


‘The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out… Death may be a one-time event, but living with terminal illness is a process.’

Dr Kalanithi talks about illness when recounting his experiences practicing as a surgeon after his cancer diagnosis and the difficulties he had, such as managing his patients whilst also separately taking his own medications and seeing his own doctor. I found this quote extremely powerful because it highlights how your priorities will shift when you are faced with the uncertainty of death.  


One Sentence to Summarise the Book

A beautifully written piece about the mortality of humans and the importance of experiences within the healthcare system, both as a patient and as a doctor.


Who should read this book?

I think this is a definite must-read for anyone who is considering applying to medical school because it is a book that does not hesitate to discuss the difficulties of being a doctor as well as the challenges doctors face when interacting with terminal illness, both in regard to the patient and the family of the patient. Seeing the experience from the perspective of the doctor and the patient is eye-opening because it makes you aware of how the patient must be feeling but also how you as a doctor should react to this. I think this book will solidify an interest in medicine if you have one because it emphasises the impact doctors can have on patients which for many, is one of the reasons they want to work in the field of healthcare.

In general, this book is a philosophical book that focuses on the beauty and the tragedy of life, and how everything can change so fast. I was incredibly moved by this book, and it pushed me to reflect on what it means to be living, and to be dying. As aspiring doctors, it is important to think about death, as it is something we will be confronted with regularly. Through reading these types of books, we can learn more about how dying affects patients and their families, and in turn, this will hopefully allow us to become more compassionate and empathetic healthcare professionals.


Last Thoughts

This book definitely was worth all the praise surrounding it- it is beautifully written and an emotional page turner. It is one of those books I feel like I can come back to time and time again, and learn a new lesson each time. I would highly recommend it to everybody to read at least once!


Author: Fateha Khawaja

Editor: Dr Latifa Haque

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