published in Seen & Unseen,
10 March 2026

link to Seen & Unseen article [1]

Paul Kalanithi’s memoir of dying sharpens how we see living

Ten years ago, in January 2016, neurosurgeon-writer Paul Kalanithi’s memoir was published. Just ten months after his death from lung cancer at the age of 37. Entitled When Breath Becomes Air it became a bestseller, spending 68 weeks on the New York Times list. Translated into 39 languages, it was a finalist for the 2017 Pulitzer Prize for biography and is described by a Daily Telegraph reviewer as at once extraordinary, remarkable, luminous, lyrical, intimate, insistent and profound - “Kalanithi had the mind of the polymath and the ear of a poet.” In his foreword for the book, Abraham Verghese, another physician turned writer, describes Kalanithi’s prose as unforgettable: ‘Out of his pen he was spinning gold.’

Death is much discussed in Kalanithi’s book. To begin, it is the death of his patients, rather than his own. He describes the “total deadness and total humanness” of his first slightly blue and bloated cadaver for dissection. As the years pass, he becomes accustomed to grappling with death, “like Jacob with the angel”, but is keenly aware of its power. “Our patients’ lives and identities may be in our hands,” he writes, “yet death always wins.” His duty, he affirms, is not to stave off death, or return patients to their old lives, but “to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence”. Spun gold that speaks much to me as a care home nurse. We too are surrounded by death and by disintegrated lives. Death does always win (the body), but we work with residents and families to traverse that terrain and find meaning in the moments that remain. When death comes, I too have been struck by the humanity of the corpse, it being absent yet unfathomably somehow still very present.

As much as he courageously confronts death, Kalanithi also questions life, restlessly searching for meaning in his memoir. As I read his words, I was struck time and again by the similarity of our stories. I was reminded of Bunyan’s Pilgrim’s Progress (which is quoted by Paul’s widow in the epilogue), where a spiritual journey common to most Christians is masterfully imagined, with scenes woven into the narrative including doubt, despair and distraction - pulling in the reader as they picture glimpses of their deepest self. For me, Kalanithi did the same, moving from a life which at first felt “like a linear sum of his choices”, to one in which, as I have found, “human action pales against superhuman forces”.

Meaning in messiness

Degrees in English literature and human biology left Kalanithi wondering what made life meaningful; forays into philosophy felt ‘dry as a bone’ and he was aware that he was missing the weight and messiness of real human life. Sensing that human relationships undergirded life’s meaning, he worked as chef on a summer camp, turning down a more academic role in primate research – choosing, in his words, to experience meaning rather than study it. This decision surprised his tutors, and brought to mind my own experience decades before, when I was completing my DPhil viva in physiology. 

It was as the three-hour oral interrogation came to a close that one of my examiners expressed dismay at my decision to qualify as a nurse rather than to continue in academia at Oxford. The turning point for me had been an evening walk in the passage that separates Somerville College where I studied, from the old Radcliffe Infirmary, where I would later work as a student nurse. Piercing my soul was a glimpse into a geriatric ward, where life in all its fullness, frailty, and futility seemed to exist, worlds apart from my microscope. Like Kalanithi, I wanted a deeper experience of life, to see through the eyes of others as well as my own. It has taught me much about meaning.

Captivated by creation

Whilst on that summer camp, Kalanithi was lost in wonder, love and praise as he surveyed the skies, in stunningly beautiful prose that deserves to be read in full.

“We would sit and watch as the first hint of sunlight, a light tinge of day blue, would leak out of the eastern horizon, slowly erasing the stars….Craning your head back, you could see the day’s blue darken halfway across the sky, and to the west, the night remained yet unconquered – pitch black, stars in full glimmer, the moon still pinned in the sky. To the east, the full light of day beamed toward you; to the west night reigned with no hint of surrender. No philosopher can explain the sublime better than this, standing between day and night. It was as if this were the moment God said, “Let there be light!”

Contemplating his speck-like existence against the immensity of the universe, Kalanithi took my breath away - and my mind back to a moment when I too had been awed by creation, on a summer holiday, as the only passenger awake on a coach as it silently made its way through majestic mountains at daybreak. I answered with silence.

I had already caught a glimpse of the Creator in a small dark room during my research. As I sat, for years, in total darkness watching fluorescently-labelled single heart cells beat under a microscope, I was mesmerised by the miracle, wondering at its meaning.

Touched by tragedy

Breath became air, prematurely, for a colleague of Kalanithi’s, lost to suicide. It happened just as Kalanithi reached the pinnacle of his medical training, and was winning awards, and receiving job interest. I too lost a dear friend to a road traffic accident, just as we both completed our Oxford studies. My husband lives with spinal cord injury after a car crash; my mother gave her breath to my lungs when she resuscitated me after a seizure.

Breath is denied to embryos discarded or frozen in the name of IVF treatment. My husband and I adopted embryos in 2008. The treatment failed and, as well as empty arms, the Blood Transfusion Service suggest that I may be stained [2] much deeper within. Paul and Lucy Kalanithi also faced infertility and wrestled with the thought that creating life in IVF, necessarily involved allowing death too.

For Kalanithi, his own cancer diagnosis felt as if someone had just firebombed the path forward. “Death,” he writes, “so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable.” He’s lost in a featureless wasteland of his own mortality, searching for a vocabulary to make sense of death, saying simply that “the fact of death is unsettling, yet there is no other way to live”. He draws on words from the preacher of Ecclesiastes, where money and status and all the vanities of life are of so little interest, a chasing after the wind.

Surrender

After a “sojourn in ironclad atheism”, Kalanithi describes a return to the central values of Christianity [3] – sacrifice, redemption and forgiveness because he found them so compelling. To banish God, he writes, means also to banish love, hate and meaning. His last recorded spoken words in the book are - “I’m ready”.

Surrender is an emerging area in popular psychology [4] as experts realise, “We spend enormous energy trying to shape outcomes, force situations, or avoid uncertainty. But the truth is, life has its own rhythm — and peace comes when we learn to dance with it”.

Victorian art critic John Ruskin saw God as the creator of life’s rhythm, urging us to “learn the tune” to the symphony of our lives. “If we look up,” he wrote, “God Himself will beat the time for us. With the eye on Him, we shall strike the next note full and clear.” 

Specifically, he writes on not being dismayed at rests in music, and interruptions in life – something that Kalanithi experienced so starkly. “There is no music in a rest, but there is the making of music in it. In our whole life-melody the music is broken off here and there by ‘rests’, and we foolishly think we have come to the end of the tune. God sends a time of forced leisure, sickness, disappointed plans, frustrated efforts, and makes a sudden pause in the choral hymn of our lives, and we lament that our voices must be silent, and our part missing in the music which ever goes up to the ear of the Creator.”

In a voice broken neither by illness nor by death itself, this book tells of a life interrupted in the most brutal way, and encourages the reader to look up during the discord, letting our tragedies, and God’s revealed beauty, turn our eyes to Him.