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When Breath Becomes Air Hardcover – January 12, 2016
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“Unmissable . . . Finishing this book and then forgetting about it is simply not an option.”—Janet Maslin, The New York Times
ONE OF THE BEST BOOKS OF THE YEAR: The New York Times Book Review, People, NPR, The Washington Post, Slate, Harper’s Bazaar, Time Out New York, Publishers Weekly, BookPage
At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.
What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.
Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. “I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything,” he wrote. “Seven words from Samuel Beckett began to repeat in my head: ‘I can’t go on. I’ll go on.’” When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.
Finalist for the PEN Center USA Literary Award in Creative Nonfiction and the Books for a Better Life Award in Inspirational Memoir
- Print length228 pages
- LanguageEnglish
- PublisherRandom House
- Publication dateJanuary 12, 2016
- Dimensions5.21 x 0.85 x 7.77 inches
- ISBN-10081298840X
- ISBN-13978-0812988406
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Editorial Reviews
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Review
“Paul Kalanithi’s memoir, When Breath Becomes Air, written as he faced a terminal cancer diagnosis, is inherently sad. But it’s an emotional investment well worth making: a moving and thoughtful memoir of family, medicine and literature. It is, despite its grim undertone, accidentally inspiring.”—The Washington Post
“Kalanithi uses the pages in this book to not only tell his story, but also share his ideas on how to approach death with grace and what it means to be fully alive.”—James Clear, #1 New York Times bestselling author of Atomic Habits
“Paul Kalanithi’s posthumous memoir, When Breath Becomes Air, possesses the gravity and wisdom of an ancient Greek tragedy. . . . The book brims with insightful reflections on mortality that are especially poignant coming from a trained physician familiar with what lies ahead. . . .”—The Boston Globe
“Devastating and spectacular . . . [Kalanithi] is so likeable, so relatable, and so humble, that you become immersed in his world and forget where it’s all heading.”—USA Today
“It’s [Kalanithi’s] unsentimental approach that makes When Breath Becomes Air so original—and so devastating. . . . Its only fault is that the book, like his life, ends much too early.”—Entertainment Weekly
“[When Breath Becomes Air] split my head open with its beauty.”—Cheryl Strayed
“Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.”—Atul Gawande
“Thanks to When Breath Becomes Air, those of us who never met Paul Kalanithi will both mourn his death and benefit from his life. This is one of a handful of books I consider to be a universal donor—I would recommend it to anyone, everyone.”—Ann Patchett
“Dr. Kalanithi describes, clearly and simply, and entirely without self-pity, his journey from innocent medical student to professionally detached and all-powerful neurosurgeon to helpless patient, dying from cancer. Every doctor should read this book—written by a member of our own tribe, it helps us understand and overcome the barriers we all erect between ourselves and our patients as soon as we are out of medical school.”—Henry Marsh, author of Do No Harm: Stories of Life, Death, and Brain Surgery
About the Author
Excerpt. © Reprinted by permission. All rights reserved.
In Perfect Health I Begin
The hand of the Lord was upon me, and carried me out in the spirit of the Lord, and set me down in the midst of the valley which was full of bones,
And caused me to pass by them round about: and, behold, there were very many in the open valley; and, lo, they were very dry.
And he said unto me, Son of man, can these bones live?
—Ezekiel 37:1–3, King James translation
I knew with certainty that I would never be a doctor. I stretched out in the sun, relaxing on a desert plateau just above our house. My uncle, a doctor, like so many of my relatives, had asked me earlier that day what I planned on doing for a career, now that I was heading off to college, and the question barely registered. If you had forced me to answer, I suppose I would have said a writer, but frankly, thoughts of any career at this point seemed absurd. I was leaving this small Arizona town in a few weeks, and I felt less like someone preparing to climb a career ladder than a buzzing electron about to achieve escape velocity, flinging out into a strange and sparkling universe.
I lay there in the dirt, awash in sunlight and memory, feeling the shrinking size of this town of fifteen thousand, six hundred miles from my new college dormitory at Stanford and all its promise.
I knew medicine only by its absence—specifically, the absence of a father growing up, one who went to work before dawn and returned in the dark to a plate of reheated dinner. When I was ten, my father had moved us—three boys, ages fourteen, ten, and eight—from Bronxville, New York, a compact, affluent suburb just north of Manhattan, to Kingman, Arizona, in a desert valley ringed by two mountain ranges, known primarily to the outside world as a place to get gas en route to somewhere else. He was drawn by the sun, by the cost of living—how else would he pay for his sons to attend the colleges he aspired to?—and by the opportunity to establish a regional cardiology practice of his own. His unyielding dedication to his patients soon made him a respected member of the community. When we did see him, late at night or on weekends, he was an amalgam of sweet affections and austere diktats, hugs and kisses mixed with stony pronouncements: “It’s very easy to be number one: find the guy who is number one, and score one point higher than he does.” He had reached some compromise in his mind that fatherhood could be distilled; short, concentrated (but sincere) bursts of high intensity could equal . . . whatever it was that other fathers did. All I knew was, if that was the price of medicine, it was simply too high.
From my desert plateau, I could see our house, just beyond the city limits, at the base of the Cerbat Mountains, amid red-rock desert speckled with mesquite, tumbleweeds, and paddle-shaped cacti. Out here, dust devils swirled up from nothing, blurring your vision, then disappeared. Spaces stretched on, then fell away into the distance. Our two dogs, Max and Nip, never grew tired of the freedom. Every day, they’d venture forth and bring home some new desert treasure: the leg of a deer, unfinished bits of jackrabbit to eat later, the sun-bleached skull of a horse, the jawbone of a coyote.
My friends and I loved the freedom, too, and we spent our afternoons exploring, walking, scavenging for bones and rare desert creeks. Having spent my previous years in a lightly forested suburb in the Northeast, with a tree-lined main street and a candy store, I found the wild, windy desert alien and alluring. On my first trek alone, as a ten-year-old, I discovered an old irrigation grate. I pried it open with my fingers, lifted it up, and there, a few inches from my face, were three white silken webs, and in each, marching along on spindled legs, was a glistening black bulbous body, bearing in its shine the dreaded blood-red hourglass. Near to each spider a pale, pulsating sac breathed with the imminent birth of countless more black widows. Horror let the grate crash shut. I stumbled back. The horror came in a mix of “country facts” (Nothing is more deadly than the bite of the black widow spider) and the inhuman posture and the black shine and the red hourglass. I had nightmares for years.
The desert offered a pantheon of terrors: tarantulas, wolf spiders, fiddlebacks, bark scorpions, whip scorpions, centipedes, diamondbacks, sidewinders, Mojave greens. Eventually we grew familiar, even comfortable, with these creatures. For fun, when my friends and I discovered a wolf spider’s nest, we’d drop an ant onto its outer limits and watch as its entangled escape attempts sent quivers down the silk strands, into the spider’s dark central hole, anticipating that fatal moment when the spider would burst from its hollows and seize the doomed ant in its mandibles. “Country facts” became my term for the rural cousin of the urban legend. As I first learned them, country facts granted fairy powers to desert creatures, making, say, the Gila monster no less an actual monster than the Gorgon. Only after living out in the desert for a while did we realize that some country facts, like the existence of the jackalope, had been deliberately created to confuse city folk and amuse the locals. I once spent an hour convincing a group of exchange students from Berlin that, yes, there was a particular species of coyote that lived inside cacti and could leap ten yards to attack its prey (like, well, unsuspecting Germans). Yet no one precisely knew where the truth lay amid the whirling sand; for every country fact that seemed preposterous, there was one that felt solid and true. Always check your shoes for scorpions, for example, seemed plain good sense.
When I was sixteen, I was supposed to drive my younger brother, Jeevan, to school. One morning, as usual, I was running late, and as Jeevan was standing impatiently in the foyer, yelling that he didn’t want to get detention again because of my tardiness, so could I please hurry the hell up, I raced down the stairs, threw open the front door . . . and nearly stepped on a snoozing six-foot rattlesnake. It was another country fact that if you killed a rattlesnake on your doorstep, its mate and offspring would come and make a permanent nest there, like Grendel’s mother seeking her revenge. So Jeevan and I drew straws: the lucky one grabbed a shovel, the unlucky one a pair of thick gardening gloves and a pillowcase, and through a seriocomic dance, we managed to get the snake into the pillowcase. Then, like an Olympic hammer thrower, I hurled the whole out into the desert, with plans to retrieve the pillowcase later that afternoon, so as not to get in trouble with our mother.
Of our many childhood mysteries, chief among them was not why our father decided to bring his family to the desert town of Kingman, Arizona, which we grew to cherish, but how he ever convinced my mother to join him there. They had eloped, in love, across the world, from southern India to New York City (he a Christian, she a Hindu, their marriage was condemned on both sides, and led to years of familial rifts—my mother’s mother never acknowledged my name, Paul, instead insisting I be called by my middle name, Sudhir) to Arizona, where my mother was forced to confront an intractable mortal fear of snakes. Even the smallest, cutest, most harmless red racer would send her screaming into the house, where she’d lock the doors and arm herself with the nearest large, sharp implement—rake, cleaver, ax.
Product details
- Publisher : Random House; 1st edition (January 12, 2016)
- Language : English
- Hardcover : 228 pages
- ISBN-10 : 081298840X
- ISBN-13 : 978-0812988406
- Item Weight : 11.2 ounces
- Dimensions : 5.21 x 0.85 x 7.77 inches
- Best Sellers Rank: #894 in Books (See Top 100 in Books)
- #2 in Sociology of Death (Books)
- #2 in Medical Professional Biographies
- #47 in Memoirs (Books)
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About the authors
PAUL KALANITHI was a neurosurgeon and writer. He graduated from Stanford with a B.A. and M.A. in English literature and a B.A. in human biology. He earned an M.Phil in the history and philosophy of science and medicine from Cambridge and graduated cum laude from the Yale School of Medicine, where he was inducted into the Alpha Omega Alpha national medical honor society. He returned to Stanford to complete his residency training in neurological surgery and a postdoctoral fellowship in neuroscience, and received the American Academy of Neurological Surgery's highest award for resident research. He died in March 2015. He is survived by his family, including his wife Lucy, and their daughter Elizabeth Acadia.
ABRAHAM VERGHESE is the Linda R. Meier and Joan F. Lane Provostial Professor and Vice Chair of Medicine, Stanford University School of Medicine. He sees patients, teaches students, and writes.
From 1990 to 1991, Abraham Verghese attended the Iowa Writers' Workshop at The University of Iowa, where he obtained a Master of Fine Arts degree.
His first book, MY OWN COUNTRY, about AIDS in rural Tennessee, was a finalist for the National Book Critics Circle Award for 1994 and was made into a movie directed by Mira Nair and starring Naveen Andrews, Marisa Tomei, Glenne Headley and others.
His second book, THE TENNIS PARTNER, was a New York Times notable book and a national bestseller.
His third book, CUTTING FOR STONE was an epic love story, medical story and family saga. It appeared in hardback in 2009, and is in its 9th printing and is being translated into 16 languages. It is a Vintage paperback and was on the New York Times bestseller list for over 110 weeks at this writing.
His latest novel, THE COVENANT OF WATER, is forthcoming from Grove Press (May 2, 2023).
Verghese has honorary degrees from five universities and has published extensively in the medical literature, and his writing has appeared in The New Yorker, Sports Illustrated, The Atlantic Monthly, Esquire, Granta, The New York Times Magazine, The Wall Street Journal, and elsewhere. He is an elected member of the National Academy of Medicine and the American Academy of Arts & Sciences. He was awarded the National Humanities Medal by President Obama in 2016.
His writing, both non-fiction and fiction, has to do with his view of medicine as a passionate and romantic pursuit; he sees the bedside skill and ritual of examining the patient as critical, cost saving, time-honored and necessary, though it is threatened in this technological age. He coined the term the 'iPatient' to describe the phenomenon of the virtual patient in the computer becoming the object of attention to the detriment of the real patient in the bed. His is an important voice for humanism in medicine and for anticipating the unwanted consequences of new technologies before they are introduced.
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At age 36, in the last year of his neurosurgery residency, Paul Kalanithi discovered he had stage IV lung cancer. For the next 22 months, he and his wife Lucy, an internal medicine physician, awoke each day focused on living, not “living until...” When Breath Becomes Air was written largely because Dr. Kalanithi had the soul of a poet and turning to words to express any experience in life was as instinctive to him as breathing itself. His intent was that his story could aid in the healing of others and that one day his own daughter would read it and get a sense of the father she would never remember.
The book’s format, like the author’s writing style, is simple, straightforward, eloquent, and unflinchingly honest – Prologue, Part I and Part II. In the prologue, Paul describes the first step in his diagnosis, getting x-rays for his recurring severe chest pain. It was 15 months prior to the end of his residency. He could see the light at the end of the long 10-year tunnel of preparation for his work in neurosurgery. There would be wonderful opportunities to practice as well as conduct research, offer of a professorship, a huge increase in income, a new home and starting a family with Lucy. The x-rays were fine, he was told. But he had lost weight and the pain was not letting up in severity. He began researching incidence of cancer in his age group. Things with Lucy were strained at that time, partly because he was not sharing his concerns about his condition. She decided against going with him on a vacation with old friends in order to sort out her own feelings about their relationship. He came home in severe pain after just a couple of days. She picked him up from the airport. After he told her about his symptoms and his self-diagnosis, she took him to the hospital that night where a neurosurgeon friend admitted him.
Most of Part 1, In Perfect Health I Begin, describes life prior to the diagnosis, obviously back to his childhood. Both of his parents were immigrants from India, his father a Christian and his mother Hindu. Both families disowned them for many years. They moved their own family of three sons from Bronxville, New York to Kingman so Paul’s father could establish a cardiology practice, which he did very successfully. Paul’s mother had been trained as a physiologist in India before eloping with Paul’s father when she was 23. Her own father had defied the traditions of 1960s rural India and insisted that his daughter be educated and trained for a profession. She was horrified to discover that Kingman’s school district was among the lowest performing in the entire country. Her eldest son had been educated in Westchester County, New York schools, where graduates were assured of admission to the nation’s most prestigious universities. He had been accepted at Stanford before the move to Kingman. What would happen to 10-year-old Paul and his 6-year-old brother Jeevan? Instead of wringing her hands, Mrs. Kalanithi threw herself into supplementing her sons’ educations and improving that of all the children in the area. She gave Paul a reading list intended for college prep students and at age ten he read 1984, followed by many other modern and traditional classics. He discovered a love for words as an expression of the human spirit. His mom got elected to the school board and worked with teachers and others to transform the school district. After a few years their 30+% dropout rate was greatly reduced and graduates were getting accepted at universities of their choice.
No doubt Paul was born with that poetic soul, but it was his mother’s guidance that led him to read the literary giants who nourished that soul. It was his parents’ examples of excellence in their own lives, their faith, and service to their community, in this strange land that they made their own, that formed Paul’s desire and need to serve.
In When Breath Becomes Air, he writes of vocation, a term you rarely hear people use these days. A thousand years ago when I was growing up, vocation was ubiquitous. We were told time and again that discerning our vocation was one of our prime responsibilities as human beings. It was our reason for being here, what we were called to do in service to humankind. Teaching, medicine, religious ministry, musicianship, military, etc. By knowing our natural talents we could know our vocation.
Paul had many talents and interests, complicating his vocation decision. He studied both English literature and human biology in college. “I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Also a man of deep spirituality, Paul reflected, “Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.” The intersection of science and morality was of prime interest to Paul.
The rest of Part I describes how Paul came to see medicine and then neurosurgery as his vocation. He forthrightly deals with the idealism of medical students and residents and how that idealism is dimmed or completely snuffed out by the realities of giving medical care to other human beings. His explanation of cadaver dissection and why physicians and their families do not donate their own bodies to medical science is eye opening. “Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.” This is the kind of honesty displayed throughout the entire book. He writes of his own loss of idealism and how the recognition of that affected his own self-image as well as his job performance. “I wondered if, in my brief time as a physician, I had made more moral slides than strides.”
That earlier mentioned phrase, “the messiness and weight of real human life” describes this book. The author has given the world not a mere recollection of events or achievements, but has laid bare his soul, exposing the very marrow of his being. This book should be read by every premed student in the world before they commit to a decade or more of study and relentless hard work.
In Part II , Cease Not till Death, the author details the diagnosis, the immediate aftermath, the determination to emphasize living not dying, the quest to conceive a child, and the agony involved in treatment. I think Part II should be experienced by each reader. Most readers will find it extremely compelling and very personal. It is the nitty gritty of this man’s inner being. Lucy, his wife, wrote an eloquent epilogue further detailing Paul’s experience while writing this book, the support they received from colleagues, friends, family, and others after his death on March 9, 2015.
I found this book soul wrenching, but also witty, uplifting and hopeful. Without preaching, he reveals some deep flaws in the way we do health care and the price that not just patients but the care providers sometimes pay. In our war with cancer, it won a battle here by taking this remarkable man so early. He would have touched hundreds of students and thousands of patients with the professorship that would have been his. But When Breath Becomes Air is sure to touch millions of us. Cady Kalanithi will one day be able to read for herself just who her father really was.
Rating: 4.50/5.0.
Long story short: this is not an uplifting read and is laudable only in that it made me literally cry. Unfortunately, most people will most likely remember this book solely for its emotional strength and less for the arguments with which Kalanithi struggled to answer.
I would not recommend this book to any causal reader on its own. Perhaps as part of a course of study or other such intentional read, Otherwise I can only assume this book has received such high accolades on the strength of the emotional impact alone. To be fair, this is the first book I have ever read that made me literally cry, and I do not say this as hyperbole. I literally cried for nearly an hour, despite foreknowledge of the ending, as I slogged through the epilogue.
Kalanithi is a troubling author and the book is troubled for it. Though it isn't patently obvious, and no one would set forth to write themselves as the villain in their own memoir, I would not call Kalanithi a good person. So before I explicate that thought let me say that he is evidently, and demonstrably, intelligent as his various degrees and awards would attest. Yet his writing is of merely good quality for most of the book, though it is not by far the worst I have ever read. This results in a somewhat conversational retelling of his life, interspersed with the occasional medical jargon, that centers around an obsession with death and the meaning of life. All of this combined with some genuinely interesting philosophical examinations drove me to read the whole book in two sittings (though were it not for life circumstances it could easily have been one).
The real issue begins with the fact that the narrative follows a pattern in which he will tell of something ostensibly happy followed by something dramatically more depressing or horrifying. At one point he speaks of the life of a surgeon as being "between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito" (pg 44 Kindle edition near location 508). I suspect his writing pattern was an attempt to emulate this feeling within readers, though perhaps that is going a step too far. What this functionally results in is that often he does not, or perhaps will not, account for nor explain certain statements that, given the philosophical nature of his work, require explication. He speaks of moral implications but then never explores said issues; he has none of the contemplative introspection I would expect but rather only entangles his recollections with rhetoric. Not only that, but there are a few small instances wherein he either implies or does something morally dubious that then taint his arguments.
A friend of mine said, " I feel enriched but also much emptier. This was by far the most profoundly troubling work I've read yet". Not only do I agree with that sentiment generally, but I also can't say I'm any better for having read it. Ultimately, I fear that the visceral emotional impact will far outweigh any of the more interesting arguments of this book. That for me, at least, is the real tragedy of this book.
Top reviews from other countries
This book deeply touched me on an emotional and what some would call a spiritual level. While I am not spiritual, I cannot deny the spirit of this man, who lived, loved, triumphed and accepted his fate with courage and strength, even as cancer weakened him physiologically.
Paul died very near my own age. I struggle to find meaning in life, especially as I see others die around me every year. I also grapple with my own impending end which could come any moment, future or present. I began to question everything as I've aged. I fear perhaps I have made the wrong choices in life. I question what it is all for. Being an atheist is a blessing and a curse, for it gives life at times a hollow definition. We live to die. Most of us spend the majority of our lives dying, or declining until our last day. This does not have to be a sad thing though. This book has revealed to me that there is another way in which to die. That is, to live... until death.
From the bottom of my heart I am thankful to Paul, for this book, and to Lucy for her epilogue, for her kind words which will touch my own spirit, my core being, until the end. It will forever remind me that our fate may not always be what we want it to be but our lives are what we will make of them. We will all die, some sooner, some later. This is a fact. While we live to die this does not mean we cannot also live to live, to live life appreciatively.
While I do not share the expansive and loving family Paul did and while I feel at times vastly alone in this world, I have learned the deep lessons of this book. I have no one to truly comfort me in my sorrows as I grind through life. This book, these words, are my comfort. Alone we embrace, this philosophy and I. I am not dying such as Paul was. I am merely dying as life would naturally have it, as we all are, until something decides to speed this natural process up, like a cancer or some other malignance. I merely suffer the physiological strife that comes with working on a farm in rural Nova Scotia. I toil so others may not. Someone must till the soil, grow the food, harvest from life to give life. Though I often feel I should be doing more.
My English degree hangs on a wall, a banner of achievement, yet a reminder of failure. I relate to Paul in that, like him, I want to help others. After all, there is no better feeling than having consoled or counselled another. I have often had the dream of using words to ease the pain of suffering. Paul has awakened me to the fallacy of how I see that piece of paper in the negative. Perhaps I will do no more than I have. Some do nothing. Some live and die, forgotten to the winds of time. The important thing is to understand that life is a treasure. It is a thing to be cherished, this consciousness, this awareness, our ability to think and see and question and comprehend. To compel or be compelled is to live. Whether alone or in the company of loved ones, we should hold dear this thing we call life. Find your happiness where you can. Be it within the pages of a book such as this or in the company of others, seek it and embrace it, for a life lived happily is to truly live. Whether short or long, alone or otherwise, we need not despair the eventuality of our end. Smile, my fellows, for were we not alive, we would not know what it is to live.
Thank you Paul. Thank you Lucy. You have both, in death, and life, warmed my heart beyond what other words have elsewhere been able.
Kalanithi's eloquent prose beautifully captures the essence of his journey, navigating the realms of medicine, philosophy, and literature. The narrative weaves between his experiences as a doctor and a patient, creating a powerful narrative that is both intellectually stimulating and emotionally resonant.
As he grapples with his own mortality, Kalanithi invites readers to contemplate the universal questions of existence. The book delves into the fragility of life, the significance of our choices, and the search for purpose in the face of inevitable death.
The raw honesty and vulnerability displayed by the author make "When Breath Becomes Air" a profoundly human story. It transcends the confines of a traditional memoir, touching on themes that resonate universally. Kalanithi's introspective exploration of love, identity, and the meaning of a life well-lived leaves an enduring impact, prompting readers to reflect on their own lives and values.
In essence, "When Breath Becomes Air" is not just a book; it's a testament to the beauty and fragility of the human experience. It is a poignant reminder that in confronting mortality, we find the essence of what it truly means to live