“I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.”
~ Paul Kalanithi, When Breath Becomes Air ¹

I first read about this book through Gates Notes², where Bill Gates mentions that the book left him in tears. It has been on my reading list for some time. Glad to have read it this year. It is far from being just a sad story about a person dying. It touches many aspects of human life, as though Paul lived many lives in a short span of 37 years. As a son of parents from different religions, son of immigrants, as someone who experienced competitive city life and outdated education in the suburbs, as someone who lived closely with nature, as an explorer, as a wanderer studying different subjects and earning degrees in literature and medicine, as a neurosurgeon, as a husband, as a father, as a son, as a brother.. he indeed lived a fascinating life. The book is a gift to the world. It was truly altruistic of him to write during his last few months as he was going through extreme physical pain due to Chemotherapy and other treatments for his cancer.

I was taken aback by the foreword itself. The foreword, written by Abraham Verghese, another man of medicine who is also a writer, was quite touching and memorable. I read it more than twice. He underscores the point that you often get to know a person intimately after the person has passed on. He knew Paul at Stanford and had read a couple of his essays, but he really started getting to know him during his funeral through the stories that people recounted and afterward.

Part 1 of the book is set in the past - recounting his life from childhood to becoming a neurosurgeon at Stanford. His father was a doctor. He credits his mother for instilling a love of literature in him. Though they moved from New York to Arizona, his mother didn’t want them to be behind in studies. So she made sure her kids read books from the AP list and were on par with students from the best schools in the US, in preparation for SAT and college. I got intrigued to find out what this list was. Googled for it and found that the recommendations are varied. Goodreads has 205 books as recommendations³, The Ultimate AP English Literature Reading List from Albert.io has 40⁴, another list had the top 22⁵, etc. But all these books are quite famous, and I haven’t read all of them. Just imagining someone reading all these books in their teenage years was mind-boggling.

It was also good to read about intense schedules, being completely immersed in work, being on call for emergencies, having no time for anything else, and yet finding fulfillment in the work since he viewed it as a calling. It is something that I could relate to. Paul says that most people find jobs that fit their lifestyle.

“Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job - not a calling.”

In Part 2, Paul returns to the day he is diagnosed with cancer. Then it is a detailed account of what he goes through. At one point, it seemed like he would overcome it, but then cancer wins. In between all this, he goes through tough decisions in life - whether to take a job offer in a different state, whether to have a child, etc. The most challenging part of life is being in a state of uncertainty where you’re not able to decide on basic things that are probably much easier for most of the others. NYT book review⁶ captures this really well -

"..Dr. Kalanithi tries to reinvent himself in various ways with no idea what will happen. He can’t gauge how much strength his body still has until he tests it, and sometimes the consequences are horrific. He no longer knows who he is or what he wants. His whole sense of identity is shaken."

Overall, it is a great book to reflect upon one’s life. Nuggets of wisdom are peppered throughout the book and there are some great quotes that would make you stop and think. By talking about death, the book talks volumes about life and relationships. Here are some quotes to reflect upon -

“Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.”

“There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.”

“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

“Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.”

“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.”

“Most lives are lived with passivity toward death – it’s something that happens to you and those around you.”

“Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection.”

“If the unexamined life was not worth living, was the unlived life worth examining?”

“Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”

“While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves.”

“All have a notion of what it means to be good, and we can’t live up to it all the time.”

“Moral duty has weight, things that have weight have gravity.”

“Suffering can make us callous to the obvious suffering of another.”