Book review of: When Breath Becomes Air by Paul Kalanithi. New York, NY, Random House, 2016, 228 pp

Silk, Hugh

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University of Massachusetts Medical School eScholarship@UMMS Open Access Articles Open Access Publications by UMMS Authors 2017-03-01 When Breath Becomes Air [book review] Hugh Silk University of Massachusetts Medical School Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/oapubs  Part of the Medical Education Commons, and the Medical Humanities Commons Repository Citation Silk H. (2017). When Breath Becomes Air [book review]. Open Access Articles. Retrieved from https://escholarship.umassmed.edu/oapubs/3128 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Articles by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. FAMILY MEDICINE VOL. 49, NO. 3 • MARCH 2017 237BOOK AND MEDIA REVIEWSThroughout both sections, Baldwin inter-weaves a compelling narrative of her own son’s struggle to live and work with schizophrenia. She recalls the struggle to care for her son while his promising college career fell apart and he bounced from one hospital to the next. He eventually found adequate medical treat-ment and enrolled in a faith-based skills train-ing program that lead to a successful career in construction. Overall, this is a good resource for clinicians and researchers. Clinicians will appreciate the first section of the book while economic re-searchers will value the second section. I do not recommend this book for family caregivers, which are not the intended audience. All clini-cians, including physicians, should recognize the importance of connecting patients with schizophrenia to caring and competent medi-cal professionals; now, as a result of this book, I strongly believe that we need new policies and support systems to make employment just as accessible as medical treatment.Matt Martin, PhD Duke/SR AHEC Family Medicine Residency ProgramFayetteville, NCWhen Breath Becomes AirPaul KalanithiNew York, NY, Random House, 2016, 228 pp., $25, hardcoverUpon death our breath becomes only the air that surrounds us. So live fully while the air is breath! This pro-found yet simple con-cept should make one pause. That is what this book will cause the reader to do over and over again. This is a book about the author’s dying process, but it is much more than that. It is a trea-tise about the various aspects of death that we encounter. Paul Kalanithi takes us on a journey through the cadavers of anatomy, to patients on the wards, to a fellow resident com-mitting suicide, and finally the dying of family members and his own untimely death at age 37. It will not be lost on the reader, however, that this book about death is actually a lesson about how we should live. For those of us in medicine, he reminds us that it took him get-ting sick to finally feel what physical therapy and an IV actually feel like. Perhaps by read-ing this book, we will pause as we order tests and treatments for others. He provokes us to simply take notice of such actions.Paul was unique. He was a neurosurgical resident who studied English as an under-graduate. He was fascinated by the human nervous system, yet also by language (calling it a “supernatural force”). His interest in lit-erature began when his mother made him and his brother read the classics (Twain, Tolstoy, Dickens) because their school system in Arizo-na was inept. His hard work led him to Stan-ford and a dual degree in neuroscience to study the elegant rules of the brain while immers-ing himself in literature to explore the life of the mind and moral reflection. He eloquently describes this cerebral journey as a pursuit to figure out where biology, morality, literature, and philosophy intersect. He concluded the only way to move from moral speculation to moral action was to pursue medicine. This journey is a noble one, and the reason this book should be read by those consider-ing medicine or early in one’s training or ca-reer. This is the stuff of metacognition and the questions a thoughtful practitioner must ask to become a compassionate healer.  While his story is that of a neurosurgeon, the messages are universal—the challenges of being over-worked, of breaking bad news, and trying to stay connected to loved ones during training. Paul is the thinking-man’s doctor. Abraham Verghese describes it this way in the foreward: “Be ready, be seated. See what courage sounds like. See how brave it is to reveal yourself in this way” (p. xix). His humanistic lens is re-vealed in many vignettes. When he discovers an undigested morphine pill in the stomach of a cadaver, he is saddened to think that the person must have died in pain. His observa-tions are powerful, and he shares wisdom from colleagues too. A friend is crushed when she thinks more deeply about the practice EKG she is reading – this fatal tracing belonged to a real person who died suddenly. The book is a joy to read; his prose often reads like poetry. He describes dissections like this: “The scalpel is so sharp it doesn’t so much cut the skin as unzip it, revealing the hidden and forbidden sinew beneath and despite your preparation, you are caught unaware, ashamed 238 MARCH 2017 • VOL. 49, NO. 3 FAMILY MEDICINEBOOK AND MEDIA REVIEWSand excited […] a trespass on the sacrosanct, engendering a legion of feelings” (p.44).Friends of mine have offered the criticism that the book comes up a bit short.  The beau-tiful descriptions of medical training and the discourse on dying seemed like a build up for more of an account of the authors own pro-cess of dying. And yet we don’t seem to get completely what we came for. That being said, the book is still a powerful read, and I person-ally have given it as a gift to students I men-tor. When it comes to his death he does offer us sentiments along the way: “My relationship with statistics changed as soon as I became one” (p. 134).This book will encourage learners and prac-ticing providers to reflect upon their training, the death that surrounds us all, and challenge each of us to be a little more reflective. He in-spires us to use our words for healing: “When there’s no place for the scalpel, words are a surgeon’s only foil” (p. 87). There is a reason why this book has been on the best seller list so long—the public is curious about two things: their healers and the topic of dying. Maybe this book will act as a catalyst for us all.Hugh Silk, MDHahnemann Family Health CenterWorcester, MAReviewers interested in writing reviews for publication should contact Book and Media Reviews Editor William E. Cayley, Jr, MD, at bcayley@yahoo.com.Publishers who wish to submit books for possible inclusion in Family Medicine’s book reviews section should send texts to Traci Nolte, Society of Teachers of Family Medicine, 11400 Tomahawk Creek Parkway, Suite 240, Leawood, KS 66211. fmjournal@stfm.orgAll books reviewed in this column are available for purchase at amazon.com through the STFM portal at www.stfm.org/bookstore.

When Breath Becomes Air [book review]

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When Breath Becomes Air [book review]

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