When The Breath become Air

When Breath Becomes Air

— What Did the Death of a Young Doctor Leave Behind? —

Young B. Lee

When I came across the title When Breath Becomes Air at the library, I felt an inexplicable attraction to it and picked up the book to look over its front and back covers. Its author, Paul Kalanithi, was a young doctor who had been undergoing the long, demanding seven-year training program at Stanford University Hospital to become a neurosurgeon.

He had only one more year to go. Just as he was looking forward to finally completing his training, he saw his own CT and MRI scans. There was a large tumor in his lung, and the cancer had already spread to his spine.

His wife, also a physician, was deeply shocked. So was Paul. If I had been in his place, I certainly would have been as well. Paul, the doctor who had so often had to tell patients that they were facing death, had now become the patient himself.

The most urgent question for him was:

“How much time do I have left?”

It was the very question his own patients had so often asked him. It is an essential question, because we need some sense of how much time remains in order to decide how we want to live it.

Those of us who are growing old face the same question.

After I passed my ninetieth birthday, I once asked myself, How many more years might I have? Five? Seven? To my surprise, two years have already slipped away. So I ask myself again: Are those numbers still valid?

Fortunately, Paul’s medical team discovered a particular genetic mutation in his cancer that could be treated. They tried a targeted therapy, and his condition improved without surgery.

Kalanithi returned to his life as a neurosurgeon. He was not cured, of course. At first, his body was so weak that even performing surgery was difficult. But little by little, he regained his strength and began treating patients again.

He did not wait for the shadow of death to disappear completely before beginning to live again. Still surrounded by uncertainty, he stepped back into the very center of life.

Perhaps this is one of the most important lessons Paul showed us through the way he lived.

Life is always uncertain. We have all seen how time can slip away while we hesitate, frightened by uncertainty and waiting for the right moment to begin living.

Thirty-five seems far too young an age to die.

At this point, Paul and his wife, Lucy Kalanithi, made an extraordinarily courageous and deeply personal decision: they decided to have a child.

Paul knew very well that he might not live long enough to watch his child grow up. Why, then, would they choose to bring a child into the world?

They struggled deeply with this question. In the end, they came to understand that the nearness of death could not erase the meaning of love.

And so their daughter, Cady, was born.

While death was knocking at the door of their home, they answered with new life.

What does it mean for a dying man to choose to have a child? Is it foolish to begin loving someone when you know you may not have many years together? Or is that love even more precious and beautiful precisely because your time together will be short?

On one side, a life was slowly fading away. On the other, a new life was beginning.

After seven long and difficult years of training, Paul finally graduated and became what he had worked toward for so many years: a neurosurgeon.

It was the joyful fulfillment of a lifelong dream, but the joy did not last long. His cancer eventually began progressing again. Breathing became increasingly difficult, and the possibilities for treatment diminished.

Should he continue aggressive treatment in the hope of extending his life a little longer? Or should he remain close to his family, reduce his suffering, and meet his final moments in peace?

Kalanithi chose the latter.

Surrounded by the family he loved, he died.

I ask myself:

“Why has this man’s death stayed with me so deeply?”

Perhaps it is because of the image of a father’s fading breath and his daughter’s newly beginning breath meeting beneath the same roof.

Death had come very close, but Paul and Lucy did not spend their remaining days looking only at death. By choosing new life, they continued to affirm life even in the midst of dying.

Cady’s birth brought new meaning and vitality to the little time Paul had left. Thinking of the day when his daughter might grow up and wonder what her father had felt for her, he left words behind for her.

He wanted her to know that she had filled the final days of his life with a joy beyond measure.

Success, after all, was not everything.

To leave this world having given genuine love to those we cherish—perhaps that is one of the greatest successes a human being can achieve.

Paul became the neurosurgeon he had dreamed of becoming. Prestigious universities offered him distinguished positions. Yet at the end of his life, what remained in his hands was neither a title nor a salary.

There was his wife.

There was his little daughter.

And there was the love he could leave behind for them.

Perhaps a human life is not ultimately measured by how many years we continue to breathe.

Perhaps what tells the true story of a life is what we loved until our final breath, whom we loved, and what we left behind for them.

Paul Kalanithi lived only thirty-six short years, and his breath became air.

But the love he left behind did not disappear into the wind.