CONTENT ANALYSIS

(WHEN BREATH BECOMES AIR- Dr.Paul Kalanithi)

Naziya Zaina Naufal

MSc. Psychology (1st Sem)

 When Breath Becomes Air talks about a neurosurgeon’s life and him coming to terms

with his own impending death due a terminal illness. Dr. Paul Kalanithi can be seen as a

passionate student and physician who deeply ponders about the meaning and purpose of life.

He studied English and Biology at Stanford and then went on to attend the Yale School of

Medicine. He felt the need to explore the physical characteristics in a human being in order to

understand the meaning of life that English Literature provided. He can be seen as

unwavering and focused throughout his course and later in his residency. He chose to

specialize in neurosurgery as it deals with the functions of brain and in turn decides the

identity and behaviour of a human being.

In the first part of the book, he explains about how he becomes accustomed to seeing

death to a point where he and his colleague shares inside jokes about patients’ prognoses. But

at one point one of his friends passes away in an accident and his moral consciousness is

rekindled. He tries to look past patients as paperworks and starts inculcating compassion and

kindness. He talks about how he learns the importance of judgement and decision making as

it had the power to make or break a person, especially in his field. He tries to understand the

unique characteristics that makes a person’s life meaningful and considers it while taking

important decisions in treatment.

It was at the tail end of his residency that he was diagnosed with Stage IV Lung

Cancer. This totally caught him off guard and he struggles to come to terms with this fact. He

mentions at one point that before he was diagnosed he didn’t know when he was going to die,

and after diagnosing too, he didn’t know how much time he had left. The feeling was similar

but at the same time totally different. He seemed frustrated that he could not plan anything

for a longer stretch as he did not know whether he would be alive by then. He shifts his focus

to what is truly important in his life and focuses on leaving his mark in this world.
 This in itself is a huge lesson for the readers. The fact that a long life is not promised

to anyone but however death is a promised deal. We work to build a life but never think of a

world after our death. At several instances in the book, for example, like the time they discuss

about having a child, Dr. Kalanithi can be seen to be thinking of a time when he ceases to

exist. Infact, the book itself is a product of such vision.

From a psychological point of view, his life can be read along the lines of Abraham

Maslow’s self-actualization theory. He constantly tries to derive meaning and purpose at

every walk of his life and neurosurgery itself becomes his way of striving for self-

actualization unknowingly. After getting diagnosed he moves on to other needs of his life

other than neurosurgery, which includes having a child and writing a book, which he had kept

off for later.

He himself talks about the stages of grief in the book, noting that he experienced all

the stages in a backward manner with acceptance at the beginning and denial at the end. We

can find Sullivan’s concept of interpersonal relationships also in the book. His family and

wife support him in all ways to help him settle in to his new life. They decide to have a child

in the hope that it might bring immense joy during their trying times. These are all examples

of the impact that meaningful relations can have on a person’s life.

He passed away at the age of 37 which means he was still in the transition period

between young adulthood and middle adulthood when he was diagnosed. If we take Erikson’s

Psychosocial theory, we can see that he was in Stage 7, which is Generativity vs Stagnation

which roughly occurs around the age 40. He worked hard to contribute to the world and to

make his mark, which was to write a book and conduct researches in neuroscience. However

with his impending death, conducting researches were not an option since it required around

a time frame of 20 years. Their newborn child and the book that he wrote in his final years is
considered as something that will affirm his existence long after he is gone. The second part

of the book ends with a message for his daughter, informing her that she brought the greatest

joy in his life during his last days. The book ends with an epilogue by his wife that talks

about his final days surrounding his death. She says he always wished to die with integrity.

He opts out of ventilator and chooses “comfort care” towards the end. The fact that he was a

neurosurgeon helped him to see all the upcoming events beforehand while at the same time

he experienced the uncertain feelings of a patient too. He tells goodbye to his family and tells

them that he was ready to die. We can say that he resolved the conflict in stage 7 and moved

on to stage 8 well before reaching old age. Apparently he resolved the crisis at that stage too

before his death.

Death makes everything different. It makes our long term plans futile and leaves us to

assess our lives and wonder whether we lived well. A meaningful life is of utmost

importance, and everything that a human does is infact a race to achieve clarity and meaning

in their life. Everything that we do in our life revolves around making our days worthwhile.

‘When Breath Becomes Air’ talks about this concept right from its title which means that our

physical body takes meaning only when we have identity and consciousness. Just like air

becomes breath when we breathe. And our breath becomes air when we die. The book is not

gloomy and dark as expected of someone facing death but on the other hand, it is practical

and helps one to live life while we have the chance. It urges us to not just exist but to make

our lives and deaths meaningful and impactful. The fact that people still read his book and

still mourns his death is a proof of Dr. Paul Kalanithi’s impact in this world. What might

have ended as a personal loss feels like a collective loss because of his first and final book.
 We all are dying. In one way or the other. The fact that we attach death to an illness or

an accident is what makes us forget this fact. But in reality, we all are dying as much as we

are living. The struggle lies in coming to terms with it and to accept the fact that one day, the

world will function without us.