When Breath Becomes Air

After waiting a few weeks for this, I finally received it yesterday.

When Breath Becomes Air, a book by Dr. Paul Kalanithi, a Stanford trained neurosurgeon who was diagnosed with metastatic lung cancer during his residency.

The first part of the novel is about his early years, and his foray into the world of medicine. He shares his experiences during residency, and having gone though this myself, at many levels this hit close to home.
The 2nd part is about his struggles after his diagnosis. As a doctor and surgeon. As a husband, And later on, as a father. This too, hit close to home.

It was an easy read. It was a difficult read. It was a good read.

I couldn't put it down- and so I began reading the book at 6:30PM, and finished it at 10:45PM. By the end, I was a mess. I was quietly crying in bed as my wife and kids slept.

For one, this brought back all kinds of memories, experiences I have always been ashamed of, but could relate to. I remember the torture, the sheer exhaustion, as an intern. I remember the times when I could not take it any more, and had to go into the bathroom during rounds to just sit down and cry for a few more minutes, before I could go on with work again. We all start off human, but the truth is the training kills off part of the soul, part of the human side. Paul shares a story of how his colleague wished a patient had metastatic pancreatic cancer just so his Whipple's would be cancelled, and she could get some much needed rest; of how when she realized what she was thinking, she just broke down in shame. I can certainly relate to that. No matter how we try not to lose our humanity, sometimes you are so beyond exhausted that you think the unthinkable. I remember having had those days; when the nurse calls to tell you that your patient died overnight- the first thought that comes is that of gratitude, so that you have one less patient to round on, and you get perhaps another 15 minutes of precious sleep. I remember having that exact reaction- moments thinking that, that I started to cry uncontrollably in the oncall room because of the sheer shame I felt, even having that thought cross my mind. No, I've never ever told anyone those thoughts, until now. In a way, I'm relieved that I wasn't the only one cruel enough to think that, and I'm glad that was a phase of my training that is well behind me.

The 2nd part was difficult for me to read too, for obvious reasons. We've all lost patients, family, loved ones. And the person that obvious comes to mind was Buddy. After all, he could have written a book like this. Indeed, a now-stalled dream of mine once was to write a book about him- and though I have a few stories in my hard drive, the momentum is lost and the stories will instead be committed to the heart and mind. Anyway, this could have been his story though perhaps being a medical oncologist and not neurosurgeon, perhaps the work-related stories less dramatic. And instead of Stanford, we were at the other premier medical center. And instead of lung cancer, it was high grade adenocarcinoma of the distal esophagus. Paul died at 36; Buddy at 32. And though I would have loved to share his story on print, the reality is the stories will die with us, those of us who had the privilege of knowing him, and spending those last few precious years with him.

I remember how he broke the news about his cancer. I remember the chemotherapy sessions, the many hospital admissions for intolerable emesis and dehydration. I remember the discussions we had about sperm banking before the chemotherapy would kill his chances of fathering offspring. I remember being in awe of his apparent strength, his peace, despite the unfairness of having an uncurable cancer, with a dismal prognosis that as a cancer specialist he was only too aware of. I remember when Buddy asked me if he should marry his sweetheart, knowing very well that he would make her a widow. I remember asking myself, asking God, why him? Why Buddy, who was such a talented, wonderful human being? I remember asking the obvious: Why not me? It's a question I sometimes ponder still. Why him, and not me? He would have made such a positive difference in so many lives. Buddy was such a better human being, a doctor, than I would ever be. God, I miss him; but reading Paul Kalanithi's books brought back a flood of memories of my friend. And in a way, it was comforting reading Paul's words as it seemed to give me some insight into Buddy's psyche.

This would be the last I'd ever see him alive. We both knew; it was pretty obvious the way we said our goodbyes. He passed away a months after we visited him.

It's a good book. It was a real tearjerker for me. And perhaps in part because I am now a husband and father, it was particularly poignant that the book was completed posthumously by his wife because he took a turn for the worse unexpectedly. It made me think about how things would have been if I was in his shoes, at this stage of my life.

Ultimately, it's a book about faith, strength and love. I'd highly recommend it.