{"id":36115,"date":"2016-02-04T17:56:37","date_gmt":"2016-02-04T16:56:37","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=36115"},"modified":"2017-01-31T09:36:01","modified_gmt":"2017-01-31T08:36:01","slug":"when-breath-becomes-air-a-book-review","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/04\/when-breath-becomes-air-a-book-review\/","title":{"rendered":"When Breath Becomes Air: A book review by Salil Patel"},"content":{"rendered":"<figure id=\"attachment_36121\" aria-describedby=\"caption-attachment-36121\" style=\"width: 249px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-36121 \" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_in_hosp2-300x194.jpg\" alt=\"Paul_Kalanithi_in_hosp2\" width=\"249\" height=\"161\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_in_hosp2-300x194.jpg 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_in_hosp2.jpg 540w\" sizes=\"auto, (max-width: 249px) 100vw, 249px\" \/><figcaption id=\"caption-attachment-36121\" class=\"wp-caption-text\">Credit: Norbert von der Groeben\/Stanford University School of Medicine<\/figcaption><\/figure>\n<p>When Dr Paul Kalanithi (pictured) was 36, and with most of his neurosurgical training complete, his life was finally beginning to take the form he had anticipated. Just as pieces of the puzzle were shifting toward an idealistic future, classic symptoms of malignancy emerged. Scans confirmed the severity of the situation: he had stage IV lung cancer.<\/p>\n<blockquote><p>\u201cEven if you are perfect, the world isn\u2019t. The secret is to know that the deck is stacked, that you will lose.\u201d<\/p><\/blockquote>\n<p><!--more--><\/p>\n<figure id=\"attachment_36120\" aria-describedby=\"caption-attachment-36120\" style=\"width: 224px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-36120 \" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_scan2-300x194.jpg\" alt=\"\" width=\"224\" height=\"145\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_scan2-300x194.jpg 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_scan2.jpg 540w\" sizes=\"auto, (max-width: 224px) 100vw, 224px\" \/><figcaption id=\"caption-attachment-36120\" class=\"wp-caption-text\">Credit: Mark Hanlon\/Stanford University School of Medicine<\/figcaption><\/figure>\n<p>Practising neurosurgery gradually became increasingly arduous until he could no longer maintain the physical capabilities required for behemoth operations involving the brain and spine. <em><a href=\"http:\/\/paulkalanithi.com\/book\/\">When Breath Becomes Air<\/a><\/em> details Dr Kalanithi\u2019s difficulty in deciding whether to continue practising medicine or shift his focus to writing. He maintained the former as long as physically possible before relinquishing his obvious skill, both as a surgeon and empathic guide for patients. The result of this shift is this beautifully written book. Through the book&#8217;s numerous literary and philosophical references, Kalanithi\u2019s lifelong obsession with the medium\u2014resulting in a MA in English Literature from Stanford and MPhil in the History and Philosophy of Medicine from Cambridge\u2014is evident throughout.<\/p>\n<blockquote><p>\u201cWhile 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.\u201d<\/p><\/blockquote>\n<p>This is not yet another book rattling off a list of semi-interesting cases the author has operated on during their illustrious career. Yes, the act of brain surgery\u2014the drilling and clipping, cutting and sucking\u2014is described with a level of detail only a skilled surgeon and writer could achieve. And yes, the first section describes Dr Kalanithi\u2019s journey from school through to undergraduate studies, medical school, and residency. However, what could merely have been autobiographical prose is elevated by Kalanithi\u2019s philosophical inquires.<\/p>\n<figure id=\"attachment_36122\" aria-describedby=\"caption-attachment-36122\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-36122 size-medium\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_andlucy-300x169.jpg\" alt=\"Paul_Kalanithi_andlucy\" width=\"300\" height=\"169\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_andlucy-300x169.jpg 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_andlucy-768x432.jpg 768w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_andlucy-1024x576.jpg 1024w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/Paul_Kalanithi_andlucy.jpg 1280w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-36122\" class=\"wp-caption-text\">Credit: Mark Hanlon\/Stanford University School of Medicine<\/figcaption><\/figure>\n<p><em>When Breath Becomes Air<\/em> sets itself apart thanks to a steadfast contemplation of death. Dr Kalanithi wrote, \u201cYears ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving.\u201d His own striving to confront mortality is obvious\u2014thanks to his ability to juxtapose experiences as a doctor and patient. Dr Kalanithi\u2019s wife Lucy, an internal medicine doctor, writes the epilogue with a similarly unflinching gaze, depicting the last few days of Kalanithi\u2019s life poignantly.<\/p>\n<p>If life is about searching for a state of tranquillity, as Epicurus wrote in 270BC, then the birth of his daughter,\u00a0Cady, is the perfect antithesis to Dr Kalanithi\u2019s diagnosis. The overlap of father and daughter, for however brief a moment,\u00a0allows us to bear witness to spectacular feelings of warmth combined with heart-tugging pragmatism.<\/p>\n<p><em>When Breath Becomes Air<\/em> may not describe a triumphant survival story\u2014an escape from the brink of death thanks to the marvels of medicine. Instead its message is far more important. In moments when facing one\u2019s own mortality or that of a loved one, here is an example of fortitude,\u00a0but also understandable vulnerability. This ceaseless striving to document such a personal story is unsentimental yet (perhaps because of that very quality)\u00a0inspiring. I am convinced that readers will mourn the man but benefit from the life he led. \u201cAnd that is an enormous thing.\u201d<\/p>\n<p><em><strong>Salil Patel<\/strong> is a medical student at the\u00a0Peninsula College of Medicine and Dentistry and spinal surgery research fellow at the Royal Devon and Exeter Hospital. He is passionate about improving access to surgical care worldwide, and serves as coordinator of the UK Medsin Global Surgery National Working Group.<\/em><\/p>\n<p><strong>Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and declare the\u00a0following interests: None.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>When Dr Paul Kalanithi (pictured) was 36, and with most of his neurosurgical training complete, his life was finally beginning to take the form he had anticipated. Just as pieces [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/04\/when-breath-becomes-air-a-book-review\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[765],"tags":[],"class_list":["post-36115","post","type-post","status-publish","format-standard","hentry","category-literature-and-medicine"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>When Breath Becomes Air: A book review by Salil Patel - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/04\/when-breath-becomes-air-a-book-review\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"When Breath Becomes Air: A book review by Salil Patel - The BMJ\" \/>\n<meta property=\"og:description\" content=\"When Dr Paul Kalanithi (pictured) was 36, and with most of his neurosurgical training complete, his life was finally beginning to take the form he had anticipated. 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