First Person

Paul Kalanithi, when breath becomes air: Dr. Paul Kalanithi.Figure‘The fact of death is unsettling. Yet there is no other way to live,” Paul Kalanithi, MD, wrote in his memoir When Breath Becomes Air. He succumbed to stage 4 lung cancer at age 37 at the height of his career, just after completing his neurosurgical residency. We cringe when we hear of a fellow physician's untimely death. We immediately think of the innumerable hours we spent studying, researching, shadowing, and sleeplessly shuffling through the hospital during medical training, and we revisit the long-suppressed fear that, in the face of mortality, all that time would have been wasted. Yet, Dr. Kalanithi's memoir does not linger on the author's bad luck; rather, it dives into the spirit, philosophy, and nature of the human condition that allow us to go on in the face of a devastating diagnosis. He repeats the mantra, “I can't go on; I must go on.” His poignant prose is uplifting and even humorous at times while introspective, sobering, and candid at others. He doesn't simply recount the events of his diagnosis and decline but guides his readers to find their own conclusions about the meaning of life in the face of death. As Dr. Kalanithi struggles to make critical decisions about his future, legacy, and family, we can't help thinking of what we would do in his shoes. Inspiring Mentor and Friend Dr. Kalanithi was an incredibly talented neurosurgeon, researcher, and writer. He was also a good friend of mine for the last 11 years of his life. I was introduced to Paul as an engaging and profoundly inspiring bioethics TA in college who challenged his students to think critically and confront difficult ethical questions in medicine. Later, he and I worked at the same summer camp in South Lake Tahoe. He played a significant part in my decision to choose medicine, and I was honored to work alongside him during my residency at Stanford, where he earned the adoration and respect of colleagues, faculty, nurses, and staff alike. He was kind, cheerful, and incredibly funny. I have met few people in my life as compassionate as Paul, or as multitalented, due in large part, I believe, to his insatiable appetite for learning. He wrote, “You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” He took his diagnosis as a call to action and became a better father, husband, writer, thinker, and surgeon during the last chapter of his life despite the ominous tumor progression. Paul selflessly continued practicing medicine after his diagnosis, prioritizing patients' needs over his own until he was physically unable to do so. He then turned his focus toward writing: “When there's no place for the scalpel, words are the surgeon's only tool.” This book is the result of that final effort. The world has lost an outstanding physician, but his wisdom and spirit will live on in these pages.FigureCertainly, this review is biased by my friendship with the author, but I hope you do not discount it. Others have also sung praises for this book: Abraham Verghese, MD, wrote the laudatory foreword while Atul Gawande, MD, added that “Kalanithi's memoir is proof that the dying ones are the ones who have the most to teach us about life.” Dr. Kalanithi's Wisdom Reading When Breath Becomes Air will let you get to know the man I knew. You will be invited to peer deeply into his thoughts and experience how life can be transformed by a fatal diagnosis in ways that are powerful and devastating. It is empowering to read how one man can overcome the worst to create something beautiful and to approach death courageously. We emergency physicians see people day after day at their worst. The way in which we treat them with compassion, respect, and care is grounded in our own capacity for empathy. It is a true skill that requires clinical and emotional intelligence in equal measure to feel and make connections with strangers while dealing with their acute medical issues. Dr. Kalanithi wrote, “Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” Reading this memoir may help us better understand these aspects, and that understanding will undoubtedly make us all better physicians. I cannot underscore enough the power of the epilogue written by Paul's wife, Lucy, after his death. Her perspective and character shine through and add a depth and contrast that complete Paul's narrative. Her New York Times essay, “My Marriage Didn't End When I Became a Widow,” is equally not to be missed. (The New York Times, Jan. 6, 2016; http://nyti.ms/1mFCkQK.) When Breath Becomes Air By Paul Kalanithi, MD Random House; 1st Edition (January 12, 2016) 256 pages, List Price: $25 Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

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