When Breath Becomes Air summary

After months of grueling medical school applications, Kalanithi finally landed a spot at the Yale School of Medicine. It was in the anatomy lab that he found himself confronted with the realities of life and death.

As a part of his course work, he spent innumerable hours dissecting cadavers, slicing through skin and tissue and sawing through bone. While the medical students would keep the faces of these dead bodies covered and remained unaware of their names, Kalanithi was still very much moved by their humanity. One day, while opening up the stomach of a cadaver, he found a couple of undigested pills – a sign to him of life even within the dead.

During his fourth year of medical school, Kalanithi made the decision to specialize in neurosurgery. He knew this choice was far from easy, but the field was beckoning him. So, following his graduation, he began a residency at Stanford, where he would train for the next seven years.

It wasn’t long before he found himself working under the pressure of real responsibility, a situation he had only gotten glimpses of during medical school. One day a young boy named Matthew came in with a headache. An examination showed he had a substantial brain tumor, and it was Kalanithi’s responsibility to decide on a course of action.

During the second year of his residency Kalanithi was put on call, which meant that in an emergency, he would be the first to arrive. Luckily, the responsibility he was beginning to shoulder increased in proportion to his skill level. But now, more than ever, it was up to him to call the shots and to decide whether someone would or should be saved.

On one occasion a patient was rushed into the operating room with severe brain trauma. The team saved him, but the patient permanently lost the ability to speak or eat by himself. Nothing could be done to save his brain, and he would be forced to spend the rest of his life institutionalized. So, while the patient still had a pulse, Kalanithi wasn’t sure whether saving his life was the right thing to do.

While in his fourth year of residency, Kalanithi received training in a field outside his specialization. He began work in a neuroscience lab at Stanford where he began studying to be a neuroscientist – a specialist who studies the nervous system, including the anatomy and biochemistry of neurons and their networks.

As you might imagine, being both a neurosurgeon and neuroscientist was simultaneously highly prestigious and difficult. Kalanithi also took a different route to his peers; while many neuroscientists in the lab were studying technologies that could help, for instance, a paralyzed person operate a computer or robotic leg with her mind, Kalanithi wanted to study the reverse of this.

Kalanithi made mistakes, but he also excelled. Despite the incredible pressure he was under, his hard work paid off.

His residency was drawing to a close. He’d hurdled all the obstacles in his way and performed all the operations required of him. He’d even received prestigious awards and the respect of the senior doctors with whom he worked.

If you knew your time on earth was going to be cut dramatically short, how would you spend your remaining days?

It’s one of the toughest questions imaginable, and during his treatment, Kalanithi had no clue how to proceed with his life and career. In discussions with his doctor, Emma, to whom he felt very close, he talked about how disturbing it was not to know how much time he had left.

On 4 July 2014, Kalanithi’s daughter, Elizabeth Acadia, also known as Cady, was born. While Kalanithi survived long enough to see her birth, he was in a severely weakened state.

When Lucy went into labor, Kalanithi was debilitated, having been in and out of the hospital. Despite a brief and temporary recovery, he weighed next to nothing and had to lie on a cot in the delivery room, unable to stand as Lucy gave birth.

Eight months after Lucy gave birth to Cady, Kalanithi was rushed to the emergency room with breathing difficulties. He would never recover.

Once in the hospital, Kalanithi was put on breathing support, but knew this was a temporary solution only. After discussing treatment options, he asked to be taken off life support, aware that if he’d opted to go on a ventilator, he might never come off it. Kalanithi concluded that as the time he had left was losing its meaning, there was little point in keeping his heart beating.