When Breath Becomes Air {A Book Review}

I'll never forget the moment I realized that doctors are frail human beings, just like the rest of us: I was very young, perhaps four or five, and the missionary nurse who helped bring me into the world had to return to the United States for cancer treatments. 

I remember asking my mom: "But Mom, why is she sick? Isn't she a doctor? Can't she heal herself?" 

This was one of the first times I remember being confronted with living in a broken world--a world where there are lots of good things, but there is also a lot of pain and sickness, even for good people who love God. 

Life shouldn't be this way, but it is. 

I was recently reminded of this particular childhood memory when I read When Breath Becomes Air by Paul Kalanithi, for it brings to the table the reality of a doctor-turned-patient, and how even the life of a skilled doctor is in the hands of a sovereign God.   

When Breath Becomes Air is the memoir of a 36-year-old neurosurgeon-in-training who was diagnosed with stage IV lung cancer in his last year of medical training. He was a brilliant thinker (he originally pursued a BA, and then a MA, in English literature at Stanford University). However, while seeking after that which produces meaning in life, Kalanithi changed the direction of his studies in English literature to instead pursue becoming a neurosurgeon. 

Having once fancied myself becoming a nurse (but I now realize that I am not cut out for such a calling), I found it fascinating to read of Kalanithi's ponderings about time spent in the cadaver lab, his emotions the first time one of his patients died, and the intentional way that he interacted with patients. However, with each recollection, Kalanithi always pointed it towards his desire to identify that which gives meaning in life.

About halfway through the book, roles are swapped and Kalanithi is no longer the doctor treating patients: rather, Kalanithi becomes the patient sitting in the doctor's office, awaiting the doctor's prognosis. Being a doctor himself, Kalanithi obviously approached his disease with more knowledge about it than the average person. But even in recounting all of these events, they all revolved around his quest to find meaning in life. However this time, this passion also influenced how he faced the grim reality that death almost certainly awaited him in the near future.  

Throughout the book, I found myself often thinking that if I were to have brain surgery, I would want Kalanithi to be my surgeon, for his book just oozed with a passion not only for his job, but also the the very real person whose skull he was sawing on to open up and remove an offending tumor.

I also found myself anxiously awaiting some indicator in the book that would reveal that Kalanithi was a believer, washed in the Savior's blood: everything from his values as a doctor to how he approached life in general seemed to indicate that he had some form of belief of a life beyond the here and now. From a human perspective, he was what we would call a "good" person. 

However, there is essentially only one little section--about four pages--where he directly addresses religion and his perspective of it. In a few short paragraphs, we learn what Kalanithi believed about sin and God Himself:

"...I returned to the central values of Christianity--sacrifice, redemption, forgiveness--because I found them so compelling. There is a tension in the Bible between justice and mercy, between the Old Testament and the New Testament. And the New Testament says you can never be good enough: goodness is the thing, and you can never live up to it. The main message of Jesus, I believed, is that mercy trumps justice every time.

"Not only that, but maybe the basic message of original sin isn't 'Feel guilty all the time.' Maybe it is more along these lines: 'We all have a notion of what it means to be good, and we can't live up to it all the time.' Maybe that's what the message of the New Testament is, after all. Even in you have a notion as well defined as Leviticus, you can't live that way. It's not just impossible, it's insane.

"About God I could say nothing definitive, of course, but the basic reality of human life stands compellingly against blind determinism. Moreover, no one, myself included, credits revelation with any epistemic authority. We are all reasonable people--revelation is not good enough. Even if God spoke to us, we'd discount it as delusional." (pages 171-172) 

In the end, Kalanithi concludes that his task was to "[s]truggle toward the capital-T Truth, but recognize that the task is impossible--or that if a correct answer is possible verification certainly is impossible."  (page 172)

It was sad to read of one so gifted, yet seemingly so far from the saving Truth of the gospel! For, unlike Kalanithi's conclusion, we know that we can indeed know the Truth with confidence, for God has revealed Himself to us through His Word so that we might know Him and spend eternity with Him. 

The book closes not with Kalanithi's words, but with his wife, Lucy's, words, for she writes of his last days alive and then his death. To read of such private moments before one's breath turns to air made me cry.

Perhaps more haunting, however, despite Kalanithi's valiant confrontation with death and his wife's subsequent confidence and peace, was the fact that there seemed to be no indication that their hope and comfort was grounded in Christ, the One who gives true hope and comfort in life after death. Indeed, the title does seem to be an appropriate reflection of the conclusion to the book: in the end, no matter who you are, if one has not found eternal life through Christ, life is but a vapor. 

But in Christ, we have a defined hope: this is the very reason we celebrate Easter, for Christ's death and resurrection conquered death and gives us the confident expectation of eternal life beyond death! 

What a glorious hope!