When Breath Becomes Air Review

9.5 Gut-Wrenchingly Beautiful

I sat half-sleepily on my couch after a day’s work, holding the light blue cover book in my hand, and was ready to doze off any moment. There isn’t any photo in between the pages like many other memoirs and instead it is loaded with thousands of long, baffling medical terms.


The pages turned so effortlessly and before I knew it, I long passed the time I normally sleep. Paul had a captivating story to tell.

“What happened to Paul was tragic, but he was not a tragedy.”

Paul was a talented and hardworking young doctor. It was during his early years in a camping trip, he found his true calling in life. He shared the stories of a care center where patients suffered from various degrees of mental disability. Initially families were visiting frequently but eventually, the patients were all abandoned. Paul determined to make a difference.

Paul had some of the most prestigious universities under his belt: Stanford, Cambridge and Yale. Upon graduation, instead of choosing one of the easy avenues to lead a successful life (and good money), he embarked on another seven-year training to becoming a resident neurosurgeon. During the first half volume of the book, he recounted the stories of being a doctor: on anatomy studies, the constant reminder to pay due respect to dead bodies, the sudden death of a healthy old women who was just admitted with a minor ailment and the patient who in pain could only shout out numbers due to a brain operation. Paul was working under punitive hours and pressures. For preterm babies, is it better to have a cessation and risk organ failures or to wait for another couple of crucial days so the organ can be developed but risk stillborn? For a brain tumor at a delicate area, is it better to have a highly complex operation which with just one millimeter of difference, the patient will turn to a temperamental eating monster or just wait for the tumor to grow and cause nerve system to breakdown? During a hectic evening shift whose medicine can be delayed and who requires immediate attention? The motorist hustled in ICU with half of his brain out of skull, was he worth saving and turn into a vegetative state or better leave him dying? Save a life or let it go might one of the easy ones he had to deal with. Soon, Paul had to make the decision, not as a doctor but as a terminal disease patient.

During the second half of the book, cancer striped him down to the most important things in his life: operation table and writing. First there was denial. He was aware of all the symptoms but he and his doctor refused to reach the obvious conclusion. Then there was frustration. He was about to finish his training and jobs were lined up for him with multiple folds increase in pay. He wanted to become a neurosurgeon and a neuroscientist. He planned a wonderful family life with sunshine and golden beach. The mired CT scan of his own lung changed everything. Then there was hope. For a while, his cancer cells were under control, he even managed to do operation again with an aching back. He opted for the treatment that would be least damaging to his nerve system so he could still have steady hands and clear vision.

As a patient, he found it hard to let go the doctor’s hat. He wanted to dictate what medicine is used in his chemotherapy, he was furious that a young doctor denied his medicine which he thought was a mistake. He lay helplessly on the operation table with intermittent consciousness while a group of doctors stumbled to deliver a consistent treatment. He was anxious, vulnerable, and with an anesthetically muffled anger.

At the end, all means of combating cancer failed. Medicine was no longer effective, chemotherapy was destroying him. He lost weight to a point he could see his bones clearly under his thin layer of flesh. As his lung failed, he was to be put on an intubation, a life supporting system which could possibly let him live a bit longer. But he deemed that was not how he wanted to live a meaningful life. He chose morphine.

Paul had gifted hand to deliver the most complex operation and an equally gifted mind to deliver powerful words. With all this plethora of excruciating details under the sharp scalpels, interwined self-talks and gripping storytelling, his eloquent writing flowed gracefully. A short yet riveting read that will linger at the back of your mind for long. It is a story about mortality, which we all have to face it one day. All the dreams, ambitions, to-do lists change dramatically with varying length of remaining life span. The insignificant ones were all swept away and only the truly important ones remain. Yet, very few had the courage and wisdom to pursue the true meaning of life.

‘Life is not about avoiding suffering; it is about creating meaning.”


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