When Breath Becomes Air

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When Breath Becomes Air by Paul Klanithi

#CancerBookClub Date: Sunday, November 20, 2016  



While this is a free ranging discussion, we’ll also be discussing some talking points at #CancerBookClub.  Click here to download the talking points for When Breath Becomes Air.

Check out the ongoing conversation below!



  1. Anti-Cancer Club / September 11, 2016 at 8:45 am /Reply

    This is actually my second time reading this book. The first time I read it, I put it in the genre of “only when doc becomes patient do they get it”. But my second reading let me look more closely at some of the universal themes that touch all of us. It is a beautifully written book with deep insights into the human experience of life, death and cancer.

    Early on (page 5 on my Kindle) Paul writes: “Why was I so authoritative in a surgeon’s coat, but so meek in a patient’s gown?” Last month, Kathleen brought up the same issue in From Both Sides of the Stethoscope. Isn’t it interesting that we respond to our perceived role? Patient=passive. How does one combat that to work WITH their medical team?

  2. Robin / September 11, 2016 at 9:38 am /Reply

    I wonder if modern medicine is so siloed today that Paul’s background in neurosurgery left him as bewildered about oncology as we would have been

  3. Anti-Cancer Club / September 11, 2016 at 1:39 pm /Reply

    That’s an interesting point. He obviously could read all the test results and understand the gross prognosis. For quite some time he was focused on quantifying it. I thought his oncologist handled it brilliantly with her emphasis on a values based life.

    I also found it interesting that he decided to “be a patient” rather than a doctor in his care. Cancer is so overwhelming. How does one straddle both worlds?

  4. Kathleen Thompson / September 12, 2016 at 5:14 am /Reply

    Really interesting points. I guess in Paul’s case it was cancer, but actually he was faced with the overwhelming horror of knowing that his life would definitely be cut very short, at an age too young, and he would have no chance to see his children grow up. It could have been any illness, although cancer is the commonest. This is one of the worst situations we have to deal with as humans and I think he conveys it beautifully. At that point it doesn’t matter if you are a doctor, or rich, or famous, or have any other perceived privileges – none of these can save you from fatal illness. Paul’s book purveys a powerful peace and calmness. Even the physical book and the cover themselves seem to have captured this. Unlike my book, From both ends of the stethoscope – getting through cancer by a doctor who knows -which is very much a practical guide on how to live, this book is almost metaphysical. it teaches us about life and death with a wisdom beyond the authors years, and I do believe it brings comfort. The book review is going to be fabulous. Kathleen

  5. Anti-Cancer Club / September 12, 2016 at 7:01 am /Reply

    There are many aspects of Paul’s experience that are transcendent. And they are all achieved through his humanity.

    One of my favorite lines is “We would carry on living, instead of dying”. This particular line related to their decision to go ahead and have a child, an ultimate statement of life and continuity. A page or two later, writing about in vitro technology he notes: “We would need to create at least a few embryos in vitro and implant the healthiest. the others would die. Even in having children in this new life, death played its part.”

    I find it so interesting that not until we become acutely aware of the ongoing presence of death in a very personal way, do we see it as part of the dichotomy of life. This awareness brought Paul a new standard of measurement; of joy; and undoubtedly despair. How has this awareness shown up in each of our lives?

  6. Stephie Zimmerman / September 15, 2016 at 5:08 am /Reply

    Paul’s utter humility has brought me to the point of wondering what it would have been like to be under his care.

    On page 98, he speaks to the import of knowing the mind of each patient before undertaking neurosurgery: “his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end.” Furthermore, he speaks of “unbearable guilt” and these “burdens” he bore, burdens that make “medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight”.

    Paul was fulfilling the call on his life; he was not just doing a job. To have a physician who gives his utmost, who runs the risk of being crushed by the weight, who recognizes the privilege of being a part of a patient’s life is the mark of a servant heart, a heart that serves the patient.

    Amazing man, extraordinary physician, a set apart surgeon, an incredible loss.

  7. Anti-Cancer Club / September 15, 2016 at 7:36 am /Reply

    Here’s a video on Paul, in his own words:

  8. Anti-Cancer Club / September 20, 2016 at 6:44 am /Reply

    I also want to share Lucy’s (Paul’s wife) piece from the New York Times on being a widow. (Caution: tissues are needed!) It adds another dimension to Paul’s story, and to all our stories.

    The themes of life, death, service, loyalty, grief run through Lucy’s writing as well…#CancerBookClub may run a bit long in October! Here is the link:


  9. Kathleen Hoffman / September 20, 2016 at 1:44 pm /Reply

    You definitely want to read “My Marriage Didn’t End When I Became a Widow”
    By LUCY KALANITHI http://opinionator.blogs.nytimes.com/2016/01/06/my-marriage-didnt-end-when-i-became-a-widow/ It is beautiful and heart-wrenching bringing the reader intimately into their world, now her (and their daughter’s) world.

  10. Anti-Cancer Club / September 20, 2016 at 4:26 pm /Reply

    Great minds must think alike! I loved this article; Lucy writes with the same depth of soul and care that Paul did.

    When Breath Becomes Air is a story on so many levels. It’s an imperfect love story. It’s a story of delayed gratification and achievement; of hope and despair…I could go on and on.

    One very interesting series of passages from Paul’s book:

    “A local meeting of former Stanford neurosurgery graduates was happening that weekend, and I looked forward to the chance to reconnect with my former self. Yet being there merely heightened the surreal contrast of what my life was now…”

    Cancer shifts the ground from beneath us, in ways none of us expect. The professional and personal losses; the need to reconfigure our lives; to remake or discard friendships that don’t survive the dislocation….No one talks about the social cost of cancer.


    On so many levels.

  11. Anti-Cancer Club / September 21, 2016 at 10:19 am /Reply

    I found Paul’s musings on statistics intriguing.

    An over achiever in life, Paul found himself powerless in the face of cancer:

    “Could we divide the (hope) curve into existential section, from “defeated” to “pessimistic” to “realistic” to “hopeful” to “delusional”? Weren’t the numbers just the numbers? Had we all just given into the “hope” that every patient was above average?

    It occurred to me that my relationship with statistics changed as soon as I became one.”

    As Paul struggled to make sense of his prognosis and the uncertainty of his health and his future, Emma guided him into a dimension without measurement or time:

    “Two months in, Emma remained vague about any prognostication, and every statistic I cited she rebuffed with a reminder to focus on my values.”

    Emma was brilliant.

    Your thoughts?

  12. Stephie / September 27, 2016 at 5:16 am /Reply

    “As I stepped out of the car this morning at 5:20 the next morning, Inhaled deeply, smelling the eucalyptus and…was it pine?Hadn’t noticed before.”

    This experience occurred the morning after Paul had reviewed his scans and noted disease progression.

    Just as blindness enhances the sense hearing, cancer can transform our experience of the ordinary and mundane causing us to breathe in that which we have historically taken for granted, so to speak.

  13. Anti-Cancer Club / September 27, 2016 at 7:37 am /Reply

    So true! It seems that time becomes suspended, and the everyday mundane takes on such depth and beauty. As Gilda Radner once said of cancer:

    “If it wasn’t for the downside, having cancer would be the best thing and everyone would want it.’ That’s true. If it wasn’t for the downside.”

    If it wasn’t for the downside…

  14. Robin McGee / October 2, 2016 at 12:47 pm /Reply

    I really appreciate the posting of the video. His comments about the verb “to be” as in “I was, I am, I will be, I may be…a neurosurgeon” were very real and poignant to me. When off work due to two years of treatment, I remember the same struggle when people asked me what I was. Paul went in and out of the patient limbo, returning to work and then leaving it. I could really relate to his struggle to hold on to his identity, and his yearning for new identities. How about you?

  15. Anti-Cancer Club / October 2, 2016 at 2:31 pm /Reply

    Cancer immediately “gives” one a new identity, wanted or not! David Servan-Schreiber (Anticancer a New Way of Life, next month’s book) also talks about this and his being socially ostracized from the medical community when he crossed the line from doctor to patient. Kathleen also talked about the transition from an “in charge” doctor to the position of patient.

    I think part of the problem is that cancer treatment is an out-take in our lives. We don’t know if we’re going back to life-as-we-knew-it. We don’t know if we’ll survive, and if we do, what we will be able to do. What if we can’t go back to our old selves? What if our old selves no longer exist? Cancer changes ones perspective. Sometimes the only path is forward, into the unknown.

    For a young surgeon, to have that identity brutally stripped away is especially painful. Everything in the last 10-15 years of his life had been geared towards “becoming a surgeon”. Was this entire training process nothing more than an “out take”? If so, should he follow his soul and write? Or follow his trained-for destiny as a surgeon?

    His oncologist was brilliant in her advice. Did anyone else pick up on this?

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