When Breath Becomes Air Study Guide

Paul Kalanithi was born in New York. His father was a doctor, and when he was ten years old his family (he was the middle of three brothers) moved to Kingman, Arizona. He graduated as the valedictorian of his high school and went on to graduate with a B.A. and M.A. in English Literature and a B.A. in Human Biology from Stanford University. He earned an M.Phil in History and Philosophy of Science and Medicine from the University of Cambridge before going to medical school. He attended medical school at Yale University and graduated cum laude. While at Yale, he also met his future wife, Lucy Goddard, and the two married shortly after graduating. Post-Yale, Kalanithi returned to Stanford for his residency training in neurological surgery and a postdoctoral fellowship in neuroscience. In May 2013, Kalanithi was diagnosed with stage IV metastatic lung cancer. After a round of successful treatment, he returned to work as a chief resident, but the following spring the disease relapsed and he underwent intensive chemotherapy. In July 2014, his daughter Cady was born, and he died the following year on March 9, 2015 at age 37. When Breath Becomes Air is Kalanithi’s only book and was a finalist for the Pulitzer Prize in Biography/Autobiography in 2017.

When Breath Becomes Air takes place largely within the present-day, and its personal nature detaches it from most historical events. It is worth noting two ways in which Kalanithi’s story builds on historical foundations, however. Kalanithi’s circumstance as a first-generation Indian-American born to immigrant parents was hardly unique, as in the 1980s and 1990s, Asians made up about half of the immigrants coming to America. Kalanithi’s experience mirrored the tales of many others: parents who worked hard, put a premium on education, and encouraged and supported their children as they strived for a better life than the one their parents had. Kalanithi describes himself as having just this same sort of attitude toward life; an attitude that he describes as spending all of his time “building potential.” The memoir also deals with cancer treatment, which, as Kalanithi acknowledges, is a constantly shifting field. Stage IV lung cancer was and remains a fatal illness, but one with emerging therapies that are for the first time providing years of life to those who have been diagnosed with it. The fact that these treatments are still in the process of being created, however, both offered hope and at the same time made Kalanithi less certain about his future and whether he could expect to live or to die.

Kalanithi’s love of literature is evident in When Breath Becomes Air, and throughout the novel he quotes T. S. Eliot’s The Waste Land in particular. He is greatly affected by its themes of meaninglessness, isolation, and the desperate quest for human connection. Additionally, Kalanithi refers to his experience reading Sherwin "Shep" Nuland’s 1995 book How We Die, one of the first books that confronted the topic of death head-on and fueled a national conversation about end-of-life decisions and reckonings. Beyond the literature that Kalanithi discusses, readers might see connections with The Bright Hour, a 2017 memoir by Nina Riggs about her own experience with breast cancer just prior to her death. This memoir has been widely compared to When Breath Becomes Air because of its discussions of meaning in life and death and its deep connection to literature. Riggs was a descendent of Ralph Waldo Emerson, and she finds solace in her ancestor's work as a means of understanding her own existence, just as Kalanithi does with Eliot and Whitman.