When a friend, who has never sent me a book nor discussed books with me, sends a book, I am curious. I am curious also because I had already heard about this book and was about to order. P.V. Giri, Chairman of Siddharta Group, could not have sent this book a day sooner. The title of the book is also rather curious — “When Breath Becomes Air” by Neurosurgeon Dr. Paul Kalanithi.

Son of an immigrant-American medical doctor, Christian, with the name suggesting India or Sri Lanka connections, the book is a memoir steeped in melancholia.

The contents deal with the author’s early life, education, tottering marriage, lung cancer, fathering a child per alternative medical method and death narrated in a way that shows his scholarship in English language and the rhetoric. I was also curious about the choice of the title given to the book. It was an apt title and taken from a book “Caelica 83” and quoted here in the opening page. It reads: 

“You that seek what life is in death, 

Now find it air that once was breath.”

So manipulate the sentence and you get “when breath becomes air.” This answered my curiosity.

I am taught to be curious as a journalist, to be a good journalist. So I went about satisfying my curiosity about the book by going through it page by page from the beginning to the end. Usually we find the Prologue and the Epilogue of a book written by the author himself. But here I found, the Prologue written by the author Dr. Paul Kalanithi and the Epilogue by his wife, Dr. Lucy Kalanithi. The reason is obvious. The author died… aged 37.

As I began to read the book, I could not help remembering two books, very popular and best-sellers. One was “The Final Diagnosis” by Arthur Hailey and another “Love Story” by Erich Segal. First one dealt with the tragedy that might result following an error in Pathology Lab which would lead to faulty diagnosis and wrong treatment etc. A story through the lens of a Pathology Lab.

The second book, “Love Story” gets you hooked with its opening para — “What can you say about a twenty-five-year-old girl who died? That she was beautiful. And brilliant. That she loved Mozart and Bach. And the Beatles. And me.”

I think, every value and emotion of human life is packed in this small opening paragraph of the novel. And she dies of cancer, leukaemia. Like Dr. Paul Kalanithi, who also dies of cancer, lung cancer stage IV.

The book is about a couple who find the world around them falling apart because of the lung cancer of the protagonist, Dr. Paul Kalanithi.

Reading the book, I got the feeling that destiny and luck play a major role in our life, health and death. About six months before he went to see his Primary Care Doctor, he had started losing weight and having ferocious back pain. He was 35 years old and a medical doctor himself and there was delay in getting diagnosed! The Primary Care Doctor suspects cancer. Then, a few weeks later, bouts of severe chest pain and developed a persistent cough. While he wished it was not C, his wife Lucy was upset he was not talking to her about it. Simultaneously, she was considering the state of their marriage. Hard to imagine a situation like this at a time he was undergoing the trauma about his health.

It was an issue of expectations from their relationship as a couple. Reader would be shocked or surprised to read that he was attending to surgery as a Neurosurgeon even when he was under the agony of pain and fatigue. When finally cancer was confirmed, his wife promises — “I will never leave you.” From here the tale of his life with cancer begins, memory going back to his school days, college days, pursuit of study in English literature and finally becoming a Neurosurgeon of distinction — ready to arrive at his promised land. But alas…

His, nay Lucy’s also, expectation to have a child and the efforts they make are beautifully delineated with deep emotion. And finally they get a healthy baby girl, named Elizabeth Acadia, nicknamed Cady. The book is dedicated to her, most aptly.

The book has many information about the diagnosis, the nature of disease and treatment. All lessons to learn both by the patients and the medical fraternity. It is difficult to imagine how he could continue to work even when he was physically too weak with deteriorating health condition. Well, will it NOT endanger the patient under his scalpel?

At one point, he told his wife to remarry. But instead they go for a child as mentioned earlier. It is a disturbing book to read, but a good book teaching lessons of our life to be lived while alive.

When he realised that he had been diagnosed with a terminal illness he asks an existential question: 

Why me?

The answer he himself gives philosophically is: 

Why not me?

Dr. Paul writes about his and Lucy’s visit to Church on a Sunday with his parents. There was Pastor’s Scripture reading that made him chuckle because “it featured a frustrated Jesus whose metaphorical language receives literal interpretation from his followers.” He then quotes examples from the Bible. It is very interesting (page 167). Reading this, I remembered the answer given by Jesus to a question:

Are you the King of Jews?

Jesus says: You say so.

A subterfuge, rigmarole?  We do not know; but there  was no straight answer, yes or no. Let it be.

Writing further on the subject, he says that his notion of God and Jesus had grown tenuous. The Ockham’s razor cut the faithful free from blind faith.  Apparently, Dr. Paul’s understanding of God and blind faith have been subjected to Ockham’s razor. “There is no proof of God; therefore, it is unreasonable to believe in God.” Final words?

Anyway, as he himself quotes about human fate, at the end it is fate that plays out. Humans are like “flies to wanton boys” or as “no amount of effort can help Oedipus and his parents escape their fate.”

Dr. Paul died on March 9, 2015, eight months after the birth of Cady, his daughter. His last days were written by his wife Dr. Lucy Kalanithi and were melancholic to read. Everyone around her young husband, with limited life expectancy, was helpless. It was an agonising scene.

After he was diagnosed of terminal illness, he had one desire, that was to save his marriage — that was fulfilled. Next desire was to have a child — that too was fulfilled. And his dying-desire was to ensure the publication of this book — that desire too was fulfilled.

In his deathbed, Paul’s breath grew more quiet… “his lips apart and eyes closed, Paul inhaled and then released one last, deep, final breath.” The breath became air. Body buried. “Dust thou art, and unto dust shalt thou return.” It was so.

A must-read book for all doctors and those connected with medical practice, science and technology.

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