When Breath Becomes Air

Paul Kalanithi, 2016, Bvtn 921 KAL

Paul Kalanithi (PK) (April 1, 1977 – March 9, 2015) , son of immigrants, two brothers, moved from NY to AZ age 10. Christian Cardiologist father, Hindu mother, severed ties to southern India.

Stanford dual degree, literature and biology, 2000. Cambridge Master of Arts, Yale School of Medicine, 2007. Married internist Lucy Goddard, daughter, Elizabeth Acadia ("Cady") born July 4 2014.

Started with severe back pain (perhaps isthmic spondylolsthesis?), X-rays clear, then chest pains a few weeks later, weight loss from 175 to 145 pounds. Not frank with wife, left alone for visit to friends in NY, excruciating pain, returned home early to chest X-rays results. May 2013, diagnosed with metastatic stage IV non-small-cell EGFR-positive lung cancer.

The book describes childhood, a love of literature, and a quest for meaning. PK looked in literature for meaning, but decided that the most intense understanding of mind and mortality would be found through neurosurgery and research. Accomplished resident surgeon, did some surgery during illness, but could not finish an operation and transitioned to chemotherapy.

Fractions of a millimeter count in neurosurgery - a tiny slip and a tumor removal yields aphasia or locked-in syndrome. Hours ridiculous, stress enormous (fellow resident suicided).

Kaplan-Meier survival curves. PI3K mutation. Sperm bank before chemotherapy. EGFR treatable with Tarceva. 18 weeks after diagnosis and treatment, returned to neurosurgery, fantasized about 20 year research and surgery career, then writing.

The book is artfully incomplete; PK did not live long enough to polish it, but wrote enough, so segments are rearranged and wife Lucy wrote the epilogue. Very powerful and emotionally engaging writing.