Book: When Breath Becomes Air

Paul Kalanithi was a neurosurgeon, defined by his lifetime endeavour to decipher and manipulate the human body, and who was ultimately prematurely destroyed by a random quirk of his own body. Molecule by molecule, what happened to Paul is easy to understand. A strand of DNA in one of the cells forming the lining of his lungs was incorrectly copied, the resulting protein rendered non-functional, and the cell switched to default mode — rapid division. A tumour formed, and in time its cells dislodged themselves and were carried in the bloodstream to new sites of replication: Paul’s spinal column and other areas of his lung. The ceaseless growth sapped his strength and he found himself tightening his clothes around a new and unrelenting pain in his back. A non-smoker, Paul had developed incurable lung cancer at the age of 36.

This book, extraordinary in all ways, is a memoir and a chronicle. A surgeon with a glittering future, Paul was devoted. Not only did he strive to perfect the precise skill of the tender scalpel nick required to gently peel the membranous dura from the surface of the brain or dissect a millimetre malformation deep in the brainstem, but he also immersed himself in literature in a bid to make sense of consciousness, humanity, and mortality. Skill enabled him to exert order over random physical processes, carve out anomalies, restore circuits, but ultimately he himself was a victim of statistical entropy.

The physical and psychological details of this book are hard to bear. Driven, Paul, his wife, and his oncologist seize chance after chance, even as Paul is crippled by disease and endless rounds of ever more extreme chemotherapy. Paul’s wife, Lucy, gives birth to a daughter, Cady, and Paul continues to operate, despite increasing pain and frailty. As a neurosurgeon, the usual shields aren’t applied; Paul reads his fate in spreading opacities shown in serial scans, survival curves sinking to insignificant numbers, a growing uncertainty in the voices of those around him.

When Breath Becomes Air is an eloquent evocation of a life defined by success and tragedy. Juxtaposed with poignancies common to all physicians: new life, old life, failure (death or otherwise), Paul’s unravelling of unimaginable circumstances is terrifyingly real and heartbreakingly honest.

• © British Journal of General Practice 2016