When Breath Becomes Air

Posted by Philip Shano, SJ in Our Spirituality


Rather than prepare something entirely new for this Sunday's post, I'm offering a piece I wrote many months ago. It is an appreciation of Paul Kalanithi's When Breath Becomes Air. This is a heartbreaking and beautiful memoir by a dying man, a skilled neurosurgeon. It's been a bestselling book since it appeared. To read it is to understand why it teaches us so much. My mother ribs me about the fact that so many works I recommend are about death and dying. But I really believe that the dying are the ones who can teach us the most about life. To say that about Kalanithi is an understatement. 

Source: cupofjo.comA clear indication that I have read a work that I think has significance for understanding the human situation is that I want to recommend it to everyone I know. This is the case with Paul Kalanithi's When Breath Becomes Air (Random House, 2016). I posted about it on Facebook and on Instagram and I have given away five copies thus far. I immediately integrated it into the curriculum of a course I'm teaching. Kalanithi's beautifully written book will have a profound effect on you if, like me, you have an interest in what makes life meaningful, even in the face of death and decay.

Paul Kalanithi is in the final year of his residency as an exceedingly successful neurosurgeon. His program director at Stanford had told him, "Paul, I think you'll be the number one candidate for any job [for which] you apply." He had reached the pinnacle of residency. And then the bottom fell out from under him.

He was confronted by the truth of his own CT scans, showing tumours in his lungs and several other areas of his body. Once admitted to hospital, he found himself in the very same room in which he had seen hundreds of patients over the years. "And with that, the future I had imagined, the one about to be realized, the culmination of decades of striving, evaporated." Kalanithi was 36 with a wife, Lucy, who was an internist at the same hospital.Paul Kalanithi. Source:

Kalanithi saw his profession as a vocation. He had moved from studies in English literature to neurosurgery. The transition seemed natural to him. The questions that drove him were about the meaningfulness of life. He desired to explore the question of where biology, morality, literature and philosophy intersected.

Long before his own diagnosis, Kalanithi was asking what makes life meaningful, even in the face of death and decay. He saw that the most important questions, the ones intersecting life, death and meaning, "questions that all people face at some point, usually arise in a medical context." It is at those critical junctures that the question is not simply whether to live or die, but what kind of life is worth living. He describes the pastoral dimension to his interaction with patients.

The new situation meant that, "instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused." He discovered that his carefully planned future no longer existed. "Death, so familiar to me in my work, was now paying a personal visit." He was starting to see death from the perspective of both patient and doctor. He had moved from being able to spend thirty-six hours in the OR to being an invalid. "I had passed from the subject to the direct object of every sentence of my life."

Paul, Lucy and their daughter Elizabeth. Source: npr.orgWhen Breath Becomes Air is beautifully written, almost poetic, and filled with powerful images. Paul and Lucy went through the journey known to most cancer patients. Despite the situation, they decided to have a child. Kalanithi had always wanted to spend his last years as a writer. Indeed, most of this book was written in the months before he no longer had the ability to write.

Lucy wrote the epilogue. His final words were directed to their daughter, "Do not, I pray, discount the fact that you filled a dying man's days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing." Lucy stresses that Paul described the terrain of dying and traversed it bravely. Paul faced death with integrity. He often spoke of the necessity of striving. We cannot reach perfection, but we have to be ceaselessly striving. This is a book I highly recommend!

About The Author

Philip Shano, SJ has many years of rich and varied experience working with Ignatian spirituality: teaching, writing and using it in his ministry. He resides in the Jesuit community in Pickering, Ontario.

(Comment Moderation is enabled. Your comment will not appear until approved.)

Stephanie Molloy on May 7, 2017 - 12:57 PM

Philip, I just read this and was blown away. It is an absolutely remarkable read -- very insightful and down to earth. I have already recommended it to several people and suggest it as a must read.