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When Breath Becomes Air - Book Review

Updated: Feb 18, 2021

As with all reviews on this website, our goal is not to provide a complete overview of the book; rather, it is to examine how the book relates to the meaning of life.

About the Book: When Breath Becomes Air is about a 36-year-old neurosurgeon resident, Paul Kalanithi, who strives to find what is meaningful in life in light of discovering he has a terminal illness. Kalanithi died March 9th, 2015, roughly two years after his diagnosis, and the book was published in 2016. This much was said in the introduction. Nevertheless, as you progress through the book, you find yourself drawn in, no longer believing that the introduction could be true; no longer believing that a life, this life could possibly be cut short. Yet, that is precisely what happens.

Even at an earlier age, Kalanithi was captivated by what gave life meaning. In a college essay, after reading Brave New World, he argued that happiness could not be the point of life. But if happiness is not the point, then what is? Or rather, what gives life meaning? Kalanithi answers the question in part early on—relationships. As a literary/neurosurgeon student, he soon realizes that the brain, that evolutionary super-computer is what allows us to form these relations to make life meaningful; and these relations must be understood amidst the cycle of life and death. As a medical student, there would be no shortage of both, as all organisms, whether goldfish or grandchild, die.

For those that follow medical science, neurosurgery, neuropsychology, and the like; know that brain injuries can render life meaningless, or alter life so completely that the individual we once knew and loved no longer exists. Oliver Sacks is probably one of the most famous writers to share his fascinating and often times tragic stories. However, Kalanithi also tells his share of tales throughout the book and remarks that he continuously had to make the decision on whether surgery or resuscitation would result in a meaningless life. One case he discussed was of a normal child, and after brain surgery become a demon summoned by one millimeter of damage.

Diagnosed with terminal cancer, facing his mortality, and the uncertainty how long he had left, Kalanithi struggled day to day on how to find meaning and what to do with his remaining days. 10 years left and he'd finish his residency, 1 year left and he'd write a book, 5 years and he'd do a combination of the two, etc. In the end, he chooses a combination of the two, he writes and also finishes his residency to become a neurosurgeon, and in doing so, in reconnecting with his patients, he finds meaning in his work. Throughout his downward spiral, or spiritual transcendence; depending on which side of the coin you like best, he wrestled with his scientifically led atheism by going to church, by reflecting on all he had learned throughout life. This is best summarized in his words below:

The problem, however, eventually became evident: to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning—to consider a world that is self-evidently not the world we live in. That’s not to say that if you believe in meaning, you must also believe in God. It is to say, though, that if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn’t have any. In other words, existential claims have no weight; all knowledge is scientific knowledge.

The meaning of life lies in the relationships that we create, and the people we help along the way. What Kalanithi concludes is that most of life's ambitions are either achieved or abandoned, and that many things we strive for, money, status, etc. have no real value when it comes to our existence. Like Viktor Frankl would have guessed, Kalanithi found meaning in his work, he found meaning through the relationships he built, and finally, he found meaning through his attitude towards his inevitable demise. His book was published, but not by him; rather by others with whom he built relationships, with those whom he loved, with whom he shared meaning and his life.

Book rating: Overall - 9 Meaning of Life Relevance - 8 Uniqueness – 6

Other great quotes in the book:

Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.

I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.

I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I'm dying, until I actually die, I am still living.

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