Paul Kalanithi Teaches Us More About Life than Death in When Breath Becomes Air

When Paul Kalanithi passed away on March 9, 2015, I was a high school senior, concerned more with my on-again off-again boyfriend than anything remotely close to the meaning of life and death.

Five years later, I found myself sobbing into the pillow of my makeshift bedroom (thanks, quarantine), clinging to the final words of Paul’s book.

When Breath Becomes Air didn’t have me repeatedly tearing up and dabbing my eyes at multiple parts. Rather, the heavy emotion grew and grew inside me as I read, until I knew the tears were inevitable. And when I finished those final words, I ran to that pillow and gasp-sobbed into it, curling myself into a ball and shaking until I had nothing left to cry.

The name Paul Kalanithi hadn’t meant a thing to me three days earlier.

My close friend from college sent me the book in the mail for my birthday, proclaiming it to be a personal favorite and a highly recommended read. Sure, I’d heard of When Breath Becomes Air, although I can’t remember where or when or why.

Not long before, my high school best friend had sent me The Unwinding of the Miracle by Julie Yip-Williams, and When Breath Becomes Air sounded similarly emotional and heavy. While I enjoyed that book, it was easier to return to the comfort of romantic novels and contemporary fiction rather than confront cancer and nonfiction death through literature again so soon.

But I wanted to read the book for my friend, and stuck it in my luggage with me as I packed up for the roadtrip to spend quarantine back East with my family. A quick text to let my friend know that I was starting the book soon meant that I would have to do just that: start the book soon.

So a few afternoons later, I did just that. By the following afternoon, the book was closed and I was sobbing into that pillow.

The name Paul Kalanithi means a lot more to me now.

I’m not sure that his name — or the poetry of his language, the beautiful inner sentiments, his story of letting go — will ever leave me. And if it does, I’ll pick the book up and read it again to remind myself.

I never want to forget the experience of reading this book.


For those not unlike myself, who haven’t/hadn’t heard of Paul Kalanithi, Paul was an esteemed neurosurgeon and neuroscientist who developed Stage Four lung cancer at 36. As he tells us, that only happens to 0.0012% of 36 year olds.

The book opens with Paul’s realization of his disease. The bad news that he had to deliver to patients time and again, delivered to him. Much sooner than ever anticipated, and at the same time, not anticipated at all.

We are then taken on the journey of Paul’s childhood, a brief summary of his time in Kingman, Arizona and how he wound up becoming a doctor, after saying it would be the one job he wouldn’t do.

In fact, the book opens with the line, 

“I knew for certainty that I would never be a doctor.”

Right off the bat, we as readers, knowing the premise of the book, understand that certainty is never guaranteed.

Paul’s love of literature and its importance in his life’s journey is emphasized in this section, a testament to how he developed his gorgeous way with words. 

His mother instilled this in him; after moving her family to the area of the country with the worst performing school district, she forced her kids to read the best literature in hopes of them still being able to realize their potential (spoiler: it worked!).

This is followed by a chronological progression of Paul’s time in medical school and residency. As readers, we become invested in the case of each patient he shares — devastated by the death of premature twins, the recovery of an eight-year old with a brain tumor — whose stories only last a few page turns at most.

In the latter half of the book, we return to Paul’s diagnosis and the time he had left after that. The child that Paul and his wife, Lucy, chose to have amidst the cancer. His treatments, and the time they afforded him. His confusion about whether to spend time with family, return to surgery or write this book.

By the time Paul passes away, before the manuscript for the book in your hands is finished, it’s impossible to not be moved and rendered more or less speechless. At least, it was impossible for me. I’m only two days removed from finishing the book, and tears come back to my eyes as I write this.


When Breath Becomes Air is sandwiched by a foreword from physician Abraham Verghese and an epilogue by Paul’s wife, Lucy Kalanithi.

Abraham is a particularly interesting choice for a prologue, as he had only met Paul once. His introduction describes in depth that although he met Paul in reality, he only truly got to know and understand Paul after reading this book.

“But it was only when I received the pages that you now hold in your hands, two months after Paul died, that I felt I had finally come to know him, to know him better than if I had been blessed to call him a friend.”

That’s high praise for a 225 page book — and I’ll admit that I didn’t buy it at first. I thought the book would be moving, yes. But it’s not often that a book creates that kind of a bond between author and reader. 

After finishing, I regret ever doubting Abraham. This book does exactly as he says.

In her epilogue, Lucy commented on the style in which Paul wrote this book, noting that she wishes people got to know how incredibly funny he was in real life, amongst other things. I’ll disagree with Lucy a little bit here — there were a handful of moments that made me laugh out loud. Such visceral emotions across the spectrum because of words on a page is an incredible feat.

The following is one of my favorite funny moments. Paul had just started doing labs with real dead bodies, and was worried about how he would respond to cutting open and inspecting a real human body. This passage is a perfect balance between Paul’s elevated writing and down to earth nature:

“Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feelings: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the mere tedium of academic exercise. Everything teeters between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito.”

I can’t bring myself to spoil any more of the beauty of this book. I could have told you fifty pages in that this was a 5 out of 5, and I wasn’t wrong.

Read, read, read. And, most importantly, let yourself feel all of it.

5 out of 5 stars.

Red Hot Reads | © 2023 by Scarlet Marie

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