On When Breath Becomes Air

How I learned about the book

I don’t exactly remember when it was. MSG friends and I were waiting to get a table for dinner at Sushi Plus in Redwood City. I probably have finished a book recently, and was asking for a book recommendation. Jungi mentioned that he had read a book called “When Breath Becomes Air”. He said it was about a neurosurgeon getting diagnosed with cancer and his journey with it. I didn’t read the book at the time, but for some reason, the name of the book stuck with me, even though it was one short discussion. Recently, with Covid-19, my work-life balance has worsened and my exhausted self was spending a lot of time watching YouTube before going to bed. I picked up this book to fight that habit. Although I am still watching YouTube a lot, I really enjoyed reading through the book.


Paul Kalanithi was a rising star in the Stanford Neurosurgery Department. It was his final year as a resident when he got diagnosed with lung cancer. The cancer changed his life completely from what he thought his life would be. The book is an autobiography by Paul Kalanithi reflecting through his life trajectory. In my opinion, this book is really about death and the transformation of his relationship with it.

Death as philosophical subject

In the first part of the book, death is something that is an interesting subject to him. He wants to get a better understanding of the meaning of life, and he wants to approach his search with science. With these interests, neurosurgeon was a natural path for him to get a deeper understanding into cognition, life, and death.

Death as an observer

After he became a resident in Stanford Neurosurgery Department, his experience with death changes. It no longer is just an academic subject. He is arguably the most close observer of death. People with severe brain conditions come to him as a patient and he has to make a call of which procedure to be applied. He is the one who needs to guide the patient throughout the journey, sometimes to cure and sometimes to the end. He is the one who needs to explain the patient’s condition to their family. He is the one who needs to make a call on when to stop the medical treatment.

Death as a subject

His diagnosis with lung cancer transforms his relationship with death. He is no longer an observer of it. He now is the subject of the arrival of death.



Throughout the book, the biggest impression was that he was brave when confronted with death. Before the diagnosis, he was a hard working, prominent neurosurgeon. There were a number of best offers lined up for him, waiting for a less than a year left graduation. Although it is clear that he was frustrated by the sudden change in his course of life, he is not put into defeat. He keeps on living. He goes back to being a resident and puts in hours caring for patients. He works with his wife to plan for the family. He writes this book. There are many cases where fear influences my decision. Fear, without being analyzed where it is coming from, impacts the behavior to land in a sub-optimal place, not fully in and not fully out, somewhere in the middle. My impression of Paul was that he doesn’t let his emotion suffer from the negativity of fear. Rather, he does risk management and just executes on it. I should try analyzing the fear, make a risk management plan, execute on the plan, and live on.

Work Life Balance

Paul was a workaholic. He had put in a crazy amount of work hours to achieve his goals. However, his work ethic put his relationship with his wife in jeopardy and I see this as one factor to the cause of cancer. This part struck me a bit since I have been feeling the pressure to perform and putting long hours to work myself. At the end of the day, I feel like I am growing so I think those efforts pay off, but sometimes I question myself, “can my body/mind handle this long term?”, “would I be able to keep a healthy relationship with my loved ones?”. I still don’t have a good action plan to improve this. The book reminded me that this is something important that I should keep thinking about.

What do I want to do

Another thing that I thought was interesting was the question of “What do I want to do with life?” Often people say that the answer to this question becomes clearer upon a death bed although the question becomes more like “What should I have done with life?” Paul’s story puts a different angle to this question. He knows that the death is near but doesn’t know how near. There was a paragraph that he thinks about what he should do if there is a week left vs a few months vs a few years. Throughout the story, his thoughts change over his journey. It was an interesting thought exercise to think about that question. At the same time, it was interesting that the answer to that question doesn’t become clear even near death. I guess the takeaway is to execute with full earnestness to my answer at any moment without fearing the answer to change. It will change, but journey to the previous answer is not worthless as long as I put my best toward it.

Written on July 5, 2020