When Breath Becomes Air by Paul Kalanithi: Study Guide & Literary Devices

Introduction

When Breath Becomes Air is a profound and touching memoir by Paul Kalanithi, a neurosurgeon at Stanford University who faced a life-changing diagnosis of stage IV lung cancer at the peak of his career and life. Published posthumously in 2016, this book delves into the essence of what makes life meaningful, exploring themes of life, death, and the pursuit of purpose with incredible depth and sensitivity. Kalanithi, who had always sought to understand where biology, morality, literature, and philosophy intersect, invites us on his journey to discover what truly matters in the face of mortality. This memoir is not just a tale of struggle; it’s an inspiring reflection on facing the inevitable with grace and a testament to the resilience of the human spirit. It belongs to the genres of biography, memoir, and non-fiction, touching hearts and provoking thoughts about our own lives and purposes. 📚💭✨

Contents

Plot Summary

When Breath Becomes Air begins with an introduction where Paul Kalanithi shares his love for literature and philosophy that leads him to pursue a career in neurosurgery and neuroscience, aiming to find where biology, morality, literature, and philosophy intersect.

Exposition — Paul’s journey starts with his upbringing in Arizona, a background filled with a passion for understanding human life’s meaning. This quest drives him through his education, leading to Yale for a Master’s in English Literature and eventually to Stanford for medical school.

Rising Action — As Kalanithi progresses in his career, excelling in neurosurgery, he faces severe back pain and weight loss, leading to the devastating diagnosis of stage IV lung cancer. This pivotal moment shifts his perspective from treating the dying to facing his mortality.

Climax — The climax unfolds as Paul grapples with his illness while continuing to work, seeking to understand death and life through the dual lenses of a doctor and a patient. He and his wife, Lucy, decide to have a child, embracing hope and future possibilities despite his uncertain future.

Falling Action — Paul’s health declines, and he is forced to confront the reality of his limited time. He reflects on what it means to live a meaningful life, how to leave a legacy, and the importance of his relationships, especially with his family and his newborn daughter, Cady.

Resolution — Paul Kalanithi dies at the age of 37, leaving behind his manuscript, which his wife, Lucy, completes. The book concludes with an epilogue by Lucy, offering a poignant and loving tribute to Paul’s life and their journey together. It’s a testament to Paul’s enduring quest to find meaning in life and death, leaving readers with profound insights into the human condition and the importance of facing mortality with grace and purpose.

When Breath Becomes Air serves as a moving exploration of life’s fragility and the search for meaning within it, providing a lasting legacy that continues to inspire and resonate with readers worldwide.

Character Analysis

Paul Kalanithi — Paul is both the author and the protagonist of the memoir, characterized by his deep introspection and quest for meaning in life and death. Trained as a neurosurgeon and a scholar of literature and philosophy, Paul’s diagnosis of lung cancer thrusts him into the patient’s role, challenging his understanding of life, identity, and mortality. His journey is marked by resilience, reflection, and a profound desire to find purpose amidst uncertainty.

Lucy Kalanithi — Lucy, Paul’s wife, is a constant presence of support and love throughout the narrative. She is a doctor herself, which allows her a unique understanding of Paul’s professional and personal struggles. Her strength, compassion, and dedication to their family, especially in pursuing the idea of having a child despite Paul’s prognosis, highlight her character’s depth and resilience.

Cady Kalanithi — Although Cady, the daughter of Paul and Lucy, only enters the story towards its end, her presence is significant. She represents hope, continuity, and the future, embodying Paul’s legacy and the embodiment of the love and aspirations he holds for the life he will not be able to witness.

Character	Personality Traits	Motivations	Development
Paul Kalanithi	Reflective, Resilient, Intellectual	To find meaning in life and death; to leave a lasting legacy	Transforms from a caregiver to a patient; deepens his understanding of life’s value
Lucy Kalanithi	Compassionate, Supportive, Strong-willed	To support Paul and ensure their family’s wellbeing; to honor Paul’s legacy	Grows in strength and resilience; becomes a voice for Paul’s story after his death
Cady Kalanithi	Represents Hope and Future	Embodiment of Paul and Lucy’s love and hopes	Symbolizes the continuity of life and legacy

This analysis reveals the depth of each character and their journey through the narrative, providing a lens through which we can explore themes of love, legacy, and the search for meaning amidst life’s most challenging moments.

Themes and Symbols

Mortality — The central theme of the memoir, mortality is explored through Paul’s diagnosis and his reflections on death. His journey from being a neurosurgeon to a patient foregrounds the inevitability of death and the importance of confronting it with dignity, grace, and purpose.

Search for Meaning — Paul’s quest to understand the essence of life and what makes it worth living drives the narrative. His background in literature and philosophy, combined with his medical career and personal experiences, frame his exploration of meaning in the face of mortality.

Role of Medicine — Medicine is portrayed not just as a science but as an art that intersects with morality, empathy, and the human condition. Paul’s perspectives as both a doctor and a patient highlight the complexities and responsibilities of medical professionals in dealing with life, death, and ethical dilemmas.

Family and Love — The memoir underscores the importance of relationships and love as fundamental to human experience. Paul’s relationship with his wife, Lucy, and the birth of their daughter, Cady, illuminate love’s power to provide hope and meaning in the most challenging times.

Legacy — Legacy is a recurrent theme, with Paul contemplating what he will leave behind, both professionally and personally. His memoir itself becomes a part of his legacy, offering insights and reflections on life and death to readers.

Symbols:

The Clock — Represents the constant presence of time and its passage, serving as a reminder of Paul’s dwindling time and the urgency to find meaning and purpose in his remaining days.

The Operating Room — Symbolizes the intersection of life and death where Paul spent much of his career. It stands as a metaphor for the delicate balance between saving lives and facing the limits of what medicine can do.

Books and Literature — Reflect Paul’s lifelong passion for literature and philosophy, serving as tools for exploration and understanding of life’s deeper meanings and complexities.

These themes and symbols intertwine to enrich the narrative, offering profound insights into the human experience, the pursuit of meaning, and the acceptance of mortality as an integral part of life.

Style and Tone

Paul Kalanithi’s “When Breath Becomes Air” is characterized by a distinctive writing style and tone that contribute significantly to the memoir’s impact and emotional depth.

Reflective and Philosophical — Kalanithi’s background in literature and philosophy permeates his writing, lending a reflective and introspective quality to his narrative. This style invites readers to ponder alongside him the profound questions of life, death, and meaning.
Lyrical and Poetic — The prose is often lyrical, with a poetic sensibility that captures the beauty and tragedy of human existence. Kalanithi’s ability to articulate complex emotions and experiences in eloquent language enriches the reader’s engagement with the text.
Honest and Raw — There’s a striking honesty in Kalanithi’s account of his journey with cancer, his fears, and his hopes. The tone is candid, sometimes brutally so, as he confronts the realities of his condition and the limitations of medicine and human life.
Hopeful and Inspiring — Despite the book’s exploration of death and mortality, the tone is not despairing but infused with hope and a quest for meaning. Kalanithi’s resilience and determination to live a meaningful life, even as he faces the end, inspire optimism and courage.
Educational and Insightful — Through reflections on his medical career and patient experiences, Kalanithi offers insightful perspectives on the practice of medicine, the doctor-patient relationship, and the ethical complexities of healthcare. The narrative serves as an educational journey, shedding light on aspects of neurosurgery and oncology, as well as the broader human condition.

The combination of these stylistic and tonal elements makes “When Breath Becomes Air” a compelling read that resonates on multiple levels, engaging the mind and heart alike in a profound exploration of life’s most pressing questions.

Literary Devices used in When Breath Becomes Air

Metaphor — Kalanithi frequently uses metaphors to draw parallels between his experiences and broader themes of life and death. For example, he likens the brain surgery process to navigating a complex map, symbolizing his journey through cancer.
Imagery — Vivid imagery is utilized to paint a detailed picture of his experiences, both in the operating room and in his personal life. Descriptions of surgical procedures, the physical manifestations of his illness, and moments of personal significance are rendered with precision and sensory detail.
Personification — Kalanithi personifies elements of his experience, such as cancer, to illustrate his battle with the disease. This device helps to externalize his internal struggles and make them more relatable to readers.
Juxtaposition — The author juxtaposes his life as a neurosurgeon with his life as a patient, creating a stark contrast that highlights the fragility of human existence and the sudden shifts in perspective that can occur.
Flashback — Kalanithi employs flashbacks to provide context to his current situation, reflecting on his life’s journey, the decisions he made, and the events that led him to where he is. These flashbacks enrich the narrative, offering deeper insight into his character and motivations.
Foreshadowing — Early in the memoir, subtle hints foreshadow Kalanithi’s diagnosis and the challenges that lie ahead. This literary device adds a layer of tension and anticipation for the reader.
Allusion — References to literary works, philosophical ideas, and medical texts abound, creating a rich tapestry that connects his personal story with wider cultural and intellectual themes.
Irony — The irony of a neurosurgeon facing a terminal brain condition is not lost on Kalanithi or the reader. This situational irony adds depth to the narrative, highlighting the unpredictability of life and the common fate shared by all humans, regardless of their knowledge or abilities.
Symbolism — Various symbols, such as the scalpel and the cancer cells, represent larger concepts of life, death, healing, and disease. These symbols serve to abstractly convey complex emotions and themes.
Parallelism — Kalanithi draws parallels between his experiences and broader existential questions, using his personal journey as a lens through which to explore universal themes of life, meaning, and mortality.

These literary devices are skillfully woven into the fabric of Kalanithi’s narrative, enhancing the memoir’s emotional resonance and intellectual depth.

Literary Devices Examples

Let’s explore examples and explanations for each of the top 10 literary devices used in “When Breath Becomes Air” by Paul Kalanithi.

Metaphor

Brain Surgery as Navigating a Complex Map

Example: Comparing the intricate work of neurosurgery to navigating a detailed map highlights the precision, skill, and critical decisions involved in the process.
Explanation: This metaphor emphasizes the complexity and delicacy of neurosurgery, underscoring the challenges Kalanithi faced in his profession and how they mirror his journey through illness.

Imagery

Vivid Description of Surgical Procedures

Example: Detailed accounts of surgeries provide a clear, sensory-rich picture of the operating room, allowing readers to visualize the scene vividly.
Explanation: The use of imagery here immerses the reader in the tactile and visual aspects of neurosurgery, enhancing the narrative’s realism and emotional impact.

Personification

Cancer as an Adversary

Example: Describing cancer as an entity with which he is battling personifies the disease, making his struggle against it more tangible.
Explanation: This personification externalizes his fight against cancer, framing it as a conflict against a discernible enemy, which adds dramatic tension to his narrative.

Juxtaposition

Life as a Surgeon vs. Life as a Patient

Example: Kalanithi’s transition from a confident surgeon to a vulnerable patient starkly contrasts these two roles.
Explanation: Juxtaposing these experiences highlights the fragility of life and the swift changes in identity and perspective illness can bring.

Flashback

Reflections on Past Decisions and Life Events

Example: Kalanithi recounts his journey from literature student to neurosurgeon, providing context for his current situation.
Explanation: These flashbacks offer depth to his character, showing how past experiences shape his understanding of his illness and approach to life.

Foreshadowing

Subtle Hints at Future Diagnosis

Example: Early references to fatigue and back pain hint at his later cancer diagnosis.
Explanation: This foreshadowing builds suspense and prepares the reader for the emotional and physical journey ahead.

Allusion

References to Literature and Philosophy

Example: Kalanithi frequently cites works of literature and philosophy that have influenced his thinking.
Explanation: These allusions connect his personal experiences to broader intellectual traditions, enriching the narrative’s depth.

Irony

A Neurosurgeon Facing a Brain Condition

Example: The irony of a neurosurgeon diagnosed with lung cancer that eventually affects the brain.
Explanation: This situational irony underscores the unpredictability of life and the vulnerability that unites us all, regardless of our knowledge or expertise.

Symbolism

The Scalpel and Cancer Cells

Example: The scalpel symbolizes the role of the healer, while the cancer cells represent disease and mortality.
Explanation: Together, they embody the dualities of life and death, health and illness, and the fine line between saving and losing a life.

Parallelism

Personal Experience as a Reflection of Existential Questions

Example: Kalanithi’s journey mirrors broader questions about the meaning of life, the nature of suffering, and the inevitability of death.
Explanation: This parallelism draws a connection between the individual and the universal, suggesting that personal experiences can offer insights into life’s most profound questions.

These examples demonstrate how Paul Kalanithi employs literary devices to enhance the narrative power of “When Breath Becomes Air,” offering readers a deeply moving and intellectually stimulating exploration of life, death, and meaning.

When Breath Becomes Air – FAQs

Q: What motivated Paul Kalanithi to write “When Breath Becomes Air”?
A: Paul Kalanithi was motivated by his unique position at the intersection of life and death — both as a neurosurgeon and as a patient facing terminal cancer. He wanted to explore and share his journey of confronting mortality, finding meaning amidst uncertainty, and understanding the essence of life through the lens of both medicine and literature.

Q: How does Kalanithi’s background in literature and philosophy influence the book?
A: His background significantly shapes the memoir, infusing it with a deep philosophical insight and literary quality. He draws upon his extensive reading and understanding of classical texts to explore themes of mortality, identity, and the search for meaning, making the book not just a memoir but a profound meditation on life.

Q: What role does Kalanithi’s family play in the memoir?
A: Kalanithi’s family, particularly his wife Lucy and their daughter Cady, play a central role in the memoir. They represent his support system, his reasons for hope, and his legacy. The narrative delves into his relationships with them, highlighting the power of love and the importance of family in facing life’s greatest challenges.

Q: How does “When Breath Becomes Air” contribute to the conversation about doctor-patient relationships?
A: The memoir offers a unique perspective on the doctor-patient relationship by presenting Kalanithi’s experiences on both sides of the equation. It emphasizes empathy, communication, and understanding as foundational elements of medical care, suggesting that recognizing the shared humanity between doctor and patient can lead to more compassionate and effective healthcare.

Q: Can “When Breath Becomes Air” be considered a guide for dealing with terminal illness?
A: While not a guide in the traditional sense, the memoir provides valuable insights into the emotional and existential aspects of facing a terminal illness. Kalanithi’s reflections on his journey offer readers a framework for contemplating their mortality and finding meaning in the face of death, making it a powerful resource for patients, families, and caregivers.

Q: What is the significance of the title “When Breath Becomes Air”?
A: The title reflects the ephemeral nature of life, capturing the moment of transition between life and death — when the physical act of breathing ceases and the essence of a person’s being merges with the world around them. It symbolizes the fragility of existence and the search for meaning within that fragility.

Q: How has “When Breath Becomes Air” impacted readers and the medical community?
A: The memoir has had a profound impact on both readers and the medical community by offering a deeply personal view of confronting mortality and the search for meaning. It has sparked conversations about the nature of life and death, the role of doctors in addressing the emotional and existential concerns of patients, and the importance of empathy in medical practice.

Quiz

Questions	A	B	C	D	Correct Answer
What motivated Paul Kalanithi to pursue a career in neurosurgery and write “When Breath Becomes Air”?	His interest in philosophy and literature	A desire to earn a high income	Pressure from his family	An early fascination with the mechanics of the human brain	A
What is the central theme of “When Breath Becomes Air”?	The advancements in neurosurgery	The exploration of different cultures	The confrontation with mortality and search for meaning	Tips for aspiring medical professionals	C
How does Kalanithi’s diagnosis change his perspective on life and death?	It has minimal impact on his views	It deepens his empathy for patients and appreciation for life	It makes him resentful and bitter	It leads him to abandon medicine	B
What role does Lucy Kalanithi play in the memoir?	She is mentioned briefly as Paul’s colleague	She is a central figure, providing support and insight into Paul’s journey	She is the antagonist of the story	She is a secondary character with little influence on Paul’s decisions	B
What symbolizes the fragility of life in the memoir?	The operating room	A ticking clock	The scalpel	Cancer cells	D
What literary device does Kalanithi frequently use to describe his experiences and reflections?	Hyperbole	Metaphor	Onomatopoeia	Simile	B
How does the memoir contribute to the conversation about doctor-patient relationships?	By criticizing modern medical practices	By highlighting the financial aspects of healthcare	By emphasizing empathy and shared humanity	By focusing on the technological advancements in treatment	C
What significance does the title “When Breath Becomes Air” hold?	It signifies the completion of a successful surgery	It symbolizes the transition from life to death	It represents a new beginning	It is a metaphor for academic achievement	B

This quiz covers various aspects of “When Breath Becomes Air,” from its themes and motivations to literary devices and the significance of its title, providing a comprehensive understanding of the memoir.

Exercise

Read the following paragraph from “When Breath Becomes Air” and identify the literary devices used. Write down your answers and compare them with the key provided below.

“Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving. As a doctor, I had observed the phenomenon of life struggling to survive in the face of death, but as a patient now facing death myself, this struggle had become personal. My understanding of the organism’s struggle shifted from a clinical observation to an existential reality. It was as if I had crossed over from the realm of the theoretical to the real, a traveler who finally faces the terrain he has studied long in maps.”

Answers:

Metaphor — The comparison of life’s struggle with striving, as observed by Darwin and Nietzsche, serves as a metaphor for the human condition.
Personification — Describing life as “struggling to survive” personifies it, giving life human qualities of determination and resistance.
Juxtaposition — The author juxtaposes his roles as a doctor and a patient to highlight how his perspective on life and death shifts.
Allusion — References to Darwin and Nietzsche allude to their philosophical and scientific ideas about life and survival, enriching the narrative with broader intellectual contexts.
Imagery — The description of the existential struggle provides vivid imagery that helps the reader visualize and feel the profoundness of the author’s experience.
Shift — There is a noticeable shift in perspective from a clinical to a personal understanding of life’s struggle, marked by the transition in the author’s role from an observer to a participant.