Book notes: When breath becomes air

When breath becomes air

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Book Author: Paul Kalanithi

My thoughts and what I learned:

I read this book right after I read “The top 5 regrets of the dying” which talked about the last few days and hours before a person’s death, from a caregiver’s perspective.  I knew this book covered a similar topic. But I was curious to find out how a neurosurgeon who has accomplished so much in a short span of life approaches death, and how he would think and act in the face of his own death.

Interestingly enough, like Bronnie, the author of “The top 5 regrets of the dying”, Paul also wrote an article in the New York times that gained publicity and later went on to write this book.

I instantly found similarities between his life and mine- his dad being a doctor, the south Indian parents who emphasize doing the best in academics, mom keeping up with the kid’s education and instilling the habit of reading books at a very young age.

I remember vividly the numerous trips to the bookstores with my dad. Waiting eagerly for weeks for the next book in the series to show up in that one book store we had in our small town.

Books became my new closest confidants finely grounded lenses providing new views of the world.

The book was divided into 2 parts. Part 1 was packed with medical terms and anecdotes from medical school. I found it fascinating, maybe because I have heard similar stories from my dad who is a doctor, about being a medical student, making that first cut through a body, and the “daily act of balancing joy and pain, life and death”.

I have more appreciation for the medical profession and the doctors who work tirelessly, making judgment calls, day in and day out, and living with the consequences of those judgment calls.

What makes life meaningful enough to go on living. Would you trade your ability or your mother’s to talk for a few extra months of mute life?

This is a question I asked myself when my mom went through brain surgery and was left blind for two years with several complications that took away major decision-making and motor skills. And complicated her life for the rest of the two years she was around before she was gone forever.

Cancer is a weird illness. It either tears your family apart or brings them together.  My mom’s illness brought me and my dad together.

As I made through the pages, I realized there is a myriad of things that can crash and break and kill you. I found myself appreciating every part of my body and every organ inside that is functioning well.

I thought web development was a tough job until I read his grueling long hours of work. Working 88 hours per week is unimaginable for me even when I was starting off.

And doctors can’t afford to make a mistake.

How do you set priorities? How do you decide which patient is ok to let go and which is to save?

How do you define a good day? When your patient is not dead but going to be feeding off the tubes for the rest of his life. Or when a patient is dead and out of his trauma.

Memories came flooding through as I read about the brain cancer references and stories. The shaved head, the paperwork signing off the surgery, the scared and confused family including me and my dad wondering if we will ever see my mom as the person she was before the surgery (we never did), making sense of the MRI scans and the tumor inside the brain, the prognosis after the surgery, the treatment plan.

Do you think my life has meaning? Do you think I made the right choices?

The questions we ponder In the face of mortality

The scenes in part 2 were all too familiar with what my family went through when my mom was diagnosed.  Finding the best surgeon to operate, the best clinic to get the RT, the belief that we are going to beat this, the ray of hope that shines through from every bit of the good news which makes you feel stronger. Like when the biopsy shows a grade 3 tumor and not grade 4 so we only need radiation treatment and not chemo!

This book makes you realize that just living and being healthy is a lottery in itself. Don’t take it for granted.  Celebrate every birthday. Make it a big deal. Cut that cake. Eat that dessert.

The first part is about Paul approaching his practice and patients as a doctor, a case, a treatment – using medicine and science to stave off death and return patients to their old life.

The second part shows him battling between doctor-self and patient-self as he calls it, looking at his patients as a human, understanding their emotions, guiding them and their families through, and making sense of their existence in life that will never be the same.

Even after a neurosurgeon, in the end, he resorts to scriptures and literature to find solace and make sense of what was happening. I wonder why we tend to go back to God/faith/scripture when faced with our mortality.

What amazes me is how someone can write so beautifully and poetically when they are terminally ill, with months to live ??

"The fog surrounding my life rolled back another inch and a sliver of blue sky peeked through."

I couldn’t get past the epilogue written by Lucy (Paul’s wife) without wallowing in tears. It was sweet to read about the life they shared that got them through managing his illness. This book is sure to leave you puffy-faced.

“This book is the story of a man who scratched his future plans to create a new one and fought the disease with grace and was not afraid to be vulnerable”

In the end, love and family matter the most, the simple moments with your family- the safe small village. The ones who will be around when you take that last breath and become air.

Quotes from the book that caught my attention:

  • When there’s no place for the scalpel, words are the surgeon’s only tool.
  • Each of us can only see a part of the picture.
  • Human knowledge is never contained in one person.  It grows from the relationships we create between each other and the world.