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WHEN BREATH BECOMES AIR by Paul Kalanithi. New York: Random House, 2016. Hardcover, 228 pages, $33.00 CDN. Reviewed by Edwin Buettner

Occasionally one comes across a book that defies the typical genre categories. When Breath Becomes Air is a memoir, a spiritual diary, an account of medical education, a glimpse into the realities of brain surgery, and a testament of personal faith. It is brilliantly crafted by an author writing within the crucible of terminal illness. By the second page of the prologue, the reader is already privy to the author’s devastating diagnosis of a rapidly spreading cancer. As an intimate and deeply personal account of meaning in life and death, it invites the reader to enter into that most fundamental of questions.

There is a singular uniqueness in Dr. Kalanithi’s path to becoming a highly competent neurosurgeon. As a youth he was determined not to go into medicine despite the urgings of his physician father. His interests lay in the exploration of the existential question: what is the nature and purpose of humanity? An early passion for the power and beauty of words, led to Kalanithi’s earning a graduate degree in English. Curiously, he also pursued studies in biology, for he sensed that “. . . the language of life as experience — of passion, of hunger, of love — (must bear) some relationship . . . to the language of neurons, digestive tracts, and heartbeats.”

Aside from a few pages near the end of the book, there is little direct reference to what many might consider “religious” themes. Yet, in the pages leading up to that point, Kalanithi’s reflections continuously point toward a transcendent dimension of life, despite any direct reference to a deity. It was during a lenten church service that he receives a key insight: science by itself could never quench his own and the universal spiritual thirst: “. . . to make science the arbiter (of ultimate meaning) is to banish not only God from the world, but also love, hate, meaning . . . a world that is self-evidently not the world we live in.” One senses that his strivings and struggles had been but a preparation for this confession of faith.

Kalanithi’s journey brings to mind Israel’s 40 years of wandering in the desert. Like Moses, Kalanithi is shown a land “flowing with milk and honey” only to find that he may not take up residence. The scriptural reading for that lenten service was the parable of the sower, which for Kalanithi becomes a metaphor for the hope that his life, despite its shortness, will bear fruit beyond the grave. He sees that though he may not participate in the harvest, ultimately “. . . the sower and the reaper can rejoice together.”

Of necessity, Kalanithi draws heavily on his experiences in the study and practice of medicine. Yet, the book draws its power from Paul Kalanithi the human being whose work as a doctor always gave priority to the person-to-person connection with patients (without compromising the “moral requirement” technical excellence). It is during his final days that he comes to recognize the ultimate shared poverty of the doctor-patient relationship: “. . . two people huddled together.” Paradoxically, it is from these ashes that the reader may draw hope, even joy.