When Breath Becomes Air

When Breath Becomes Air is a non-fiction autobiographical book written by Paul Kalanithi. It is a memoir about his life and illness, battling stage IV metastatic lung cancer. It was posthumously published by Random House on January 12, 2016.

In his last year of neurosurgical residency at Stanford University, Paul Kalanithi experiences negative changes in his health. Rapid weight loss, and severe back and chest pains begin to raise concern for him and his wife, Lucy. Kalanithi worries that a possible cause for his symptoms is spinal cancer – unlikely for people in their thirties. However, when X-ray results in a routine medical check-up return normal, his primary care physician and he attribute the symptoms to aging and work overload.

Determined to finish the last months of his residency, he ignores whatever symptoms have not subsided. A few weeks later, the symptoms come back, stronger than before. Around this time, Kalanithi and his wife experience conflict in their relationship when Lucy feels that he is not communicating with her. Visiting friends in New York, Kalanithi is almost certain that he has cancer and says it out loud for the first time to his friend Mike. Returning home, upon landing in San Francisco, Kalanithi receives a call from his doctor telling him that his lungs "look blurry." When he arrives home with Lucy, both of them know what is happening. The next day, Kalanithi checks in to the hospital and the room where he examined his patients, delivering good and bad news, becomes his own.

Background

Before writing When Breath Becomes Air, Paul Kalanithi was in residency in neurological surgery and a postdoctoral fellowship in neuroscience. In May 2013, Kalanithi was diagnosed with stage-4 non-small-cell EGFR-positive lung cancer.

As Kalanithi underwent cancer treatment, he shared his reflections on illness and medicine, authoring essays in The New York Times, The Paris Review, and Stanford Medicine, and participating in interviews for media outlets and public forums. He also began work on an autobiographical book of his experiences as a doctor and a patient facing a terminal illness.

Kalanithi died in March 2015 at the age of 37. His memoir was published posthumously 10 months later. The book included a foreword by Abraham Verghese and an epilogue by Kalanithi's widow, Lucy.

Paul Kalanithi

The author of the book. Paul Kalanithi was born in Bronxville, New York on April 1, 1977. At the age of 10, his family moved to Kingman, Arizona where he spent most of his youth. At the early age of 10, his mother gave him books to read in order to educate his young mind. Kalanithi attended Stanford University where he earned Bachelor and Master of Arts in English literature and Bachelor of Science in human biology. He attended Cambridge for history and philosophy of science and medicine where he obtained his Masters. After Cambridge, Kalanithi attended Yale for medical school where he met his future wife, Lucy Goddard. After graduating Yale, he married his wife and they both began their residencies in California. Kalanithi started his residency back at Stanford while his wife attended University of California, San Francisco. Paul and Lucy have a daughter together.

Synopsis

Following the prospect of a better life, Kalanithi's father moves the family from Bronxville, New York to Kingman, Arizona when Kalanithi is ten. A doctor himself, Kalanithi's father dedicates most of his time to medicine and is notably absent from the house. Believing that to be a doctor, he would have to be away from the family like his father, Kalanithi becomes disenchanted with medicine. Although Kalanithi and his two brothers enjoy the newfound liberty of their desert town, their mother constantly worries for their academic future in a town that the U.S. census has declared “the least educated district in America.” Unwilling to let anything halt their learning, she acquires college reading lists and instills in her sons a love for literature. The summer before heading to Stanford University for school, Kalanithi reads Satan, His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S., by Jeremy Leven. The book's idea that the mind is the result of the brain doing its work awakes a curiosity in Kalanithi for neuroscience.

After completing degrees in English literature and human biology, Kalanithi feels there is still much to learn. He is accepted to a master's program in English literature at Stanford, and one afternoon—pushed by his desire to understand the meaning of life— discovers the calling to practice medicine for the first time. Preparing to apply to medical school, Kalanithi uses the time off to study the history and philosophy of science and medicine at Cambridge. He later starts medical school at Yale. During his time at Yale, Kalanithi meets his wife, Lucy, and sees the patient-doctor relationship as an example of life, death, and morality coming together. After two years of classroom learning, Kalanithi experiences his first birth and death in his OB-GYN clinical rotation, when a set of twins could not be carried to term. It is then that Kalanithi understands that intelligence is not enough in the practice of medicine, and that morality is also needed. After medical school, Lucy Kalanithi starts internal medicine residency at UCSF and Paul Kalanithi begins a neurosurgical residency at Stanford. Though he finds it hard at first, Kalanithi grows used to the rigor of neurosurgery and, in his fourth year, joins the neuroscience lab of a professor affectionately called “V.” In the sixth year of residency, Kalanithi returns to his hospital duties and having reached professional recognition, he feels he has finally found his place in the world.

Kalanithi's life takes an unexpected turn when, after weeks of health problems, it is confirmed that he has lung cancer. Images obtained from a CT scan show organ systems compromised by the cancer, causing him and his wife great sadness. Searching for the best experts in the field of oncology, Kalanithi begins treatment with a doctor named Emma Hayward. Because of his status, rather than stepping back and letting Hayward offer her professional opinion, Kalanithi expects to be treated as a consultant, even if it is his own case. Hayward suggests to find the root of his cancer before determining treatment options. In the meantime, Kalanithi's family helps him through his transition from doctor to patient, and together with Lucy, he decides to explore reproductive options before he dies. They visit a sperm bank and make the decision to have a child. Test results arrive and Kalanithi discovers that his cancer is derived from a mutation in the epidermal growth factor receptor (EGFR). This fact gives him a bit of relief because it means that he can be treated with Tarceva, which typically results in less-severe side effects compared to traditional chemotherapy.

Symptoms subside with the treatment and, in Dr. Hayward's office, Kalanithi feels like himself again. After weeks of using the medication, CT scans show a reduced number of tumors in Kalanithi's lungs and he becomes determined to return to the operating room. Back in the OR, he cannot finish his first surgery because of his health. However, his strength and technique improve over time. With both graduation and a baby due in June, he takes another CT scan after months since the last. He discovers a big tumor in his right lung and without getting scared, he and Lucy research what other options are available. Kalanithi retires from surgery indefinitely and begins chemotherapy. His response to chemotherapy is adverse and his health worsens, forcing him to skip graduation. With the failure of chemotherapy, other treatment options do not provide him much hope. His condition becomes so severe that even Dr. Hayward gives an approximation of how much time he has left – something she had strongly refused to do before. On July 4, 2014, their daughter is born and Kalanithi is filled with joy.

The epilogue is written by his wife Lucy Kalanthi, after his death. It shows her point of view of the experience with her husband Paul Kalanthi's lung cancer. It is an in depth personal explanation of her experience.

Reception

When Breath Becomes Air is a New York Times bestseller, spending 68 weeks on the non-fiction bestseller list.

Matt McCarthy of USA Today gave it 4 out of 4 stars and said, "It's a story so remarkable, so stunning, and so affecting that I had to take dozens of breaks just to compose myself enough to get through it." Nick Romeo of The Boston Globe wrote that it, "possesses the gravity and wisdom of an ancient Greek tragedy." Melissa Maerz of Entertainment Weekly stated that the book was "so original—and so devastating. . . . Its only fault is that the book, like his life, ends much too early."

Awards and honors

• 2017 Wellcome Book Prize shortlist
• 2017 Pulitzer Prize, Biography or Autobiography, finalist
• 2017 Jan Michalski Prize second selection
• 2016 Goodreads choice winner

Other editions

The first US English edition was released in January 2016 followed by the UK English hardback edition by Bodley Head in February 2016. A UK paperback edition was released on January 5, 2017. The book has been translated and published in 39 languages.

Country	Publisher	Date	Language	Title
Brazil	Sextante	May 2016	Portuguese	O Último Sopro de Vida
Bulgaria	Ciela	March 2017	Bulgarian	И ДЪХЪТ СТАHА ВЪЗДУХ
China	Owl Media/Zhejiang Publishing House of literature and Art	December 2016	Chinese (Simplified)	当呼吸化为空气
China	Beijing Xiron Books	August 2016	Chinese (Traditional)	當呼吸化為空氣 (Dang hu xi hua wei kong qi)
Croatia	Mozaik knjiga	March 2017	Croatian	DAH KOJI ŽIVOT ZNAČI
Czech Republic	Noxi	October 2016	Czech	Můj poslední výdech
Denmark	Lindhardt og Ringhof	September 2016	Danish	Før jeg forsvinder
Estonia	Ajakirjade	September 2016	Estonian	Kui hingusest saab õhk
Finland	Bazar	January 2017	Finnish	Henkäys on ilmaa vain
France	JC Lattes	February 2017	French	Quand le souffle rejoint le ciel
Germany	Albrecht Knaus Verlag	April 2016	German	Bevor ich jetzt gehe
Hungary	Casparus Kiadó	July 2016	Hungarian	Elillanó lélekzet
Iceland	Forlagið	February 2017	Icelandic	Andartak eilífðar
Italy	Mondadori	April 2016	Italian	Quando il respiro si fa aria
India	DC Books	February 2017	Malayalam	പ്രാണൻ വായുവിലലിയുമ്പോൾ
India	Sandhya Publications	February 2017	Tamil	சுவாசம் காற்றில் கரைந்தபோது
Indonesia	Mizan	September 2016	Indonesian	When Breath Becomes Air
Israel	Matar	June 2016	Hebrew	בטרם לכתי (btrm lkty)
Japan	Hayakawa Shobo	December 2016	Japanese	いま、希望を語ろう (Ima kibo o kataro)
Korea	Next Wave	September 2016	Korean	숨결이 바람 될 때 (Sumgyŏli param toel ttae)
Latin America	Oceano	September 2016	Spanish	El buen doctor
Lithuania	Baltos Lankos	June 2016	Lithuanian	Įkvėpti tylą
the Netherlands	Holland Diep	October 2016	Dutch	Als adem lucht wordt
Norway	Forlaget Press	September 2016	Norwegian	Når pust blir til luft
Poland	Wydawnictwo Literackie	September 2016	Polish	Jeszcze jeden oddech
Portugal	Saida de Emergencia	April 2016	Portuguese	Antes de Eu Partir
Romania	Nemira	September 2016	Romanian	Cu Ultima Suflare
Russia	Eksmo	January 2017	Russian	Когда дыхание растворяется в воздухе
Saudi Arabia	Jarir	January 2018	Arabic	عندما تتحول الانفاس الى هواء
Serbia	Laguna	June 2016	Serbian	Dah života
Slovakia	Noxi	October 2016	Slovak	Môj posledný výdych
Slovenia	Ucila/Taught International	May 2016	Slovenian	Ko Dih Postane Zrak
Spain	Seix Barral	September 2016	Spanish	Recuerda que vas a morir. Vive
Sweden	Norstedt	May 2016	Swedish	När andetagen blir till luft
Thailand	Openworlds	October 2016	Thai	เมื่อลมหายใจกลายเป็นอากาศ
Turkey	Altin Kitaplar	December 2016	Turkish	Son Nefes Havaya Karışmadan
Ukraine	Family Leisure Club	July 2016	Ukrainian	КОЛИ ПОДИХ СТАЄ ПОВІТРЯМ
Vietnam	Alphabooks	June 2017	Vietnamese	Khi hơi thở hóa thinh không
Mongolia	Bolor Sudar Publishing	March 2018	Mongolian	Амьсгал агаар болохуйд