The DO Book Club, April 2021: When Breath Becomes Air

Welcome back to The DO Book Club!

For April, Logan Carlyle, OMS II, of the Alabama College of Osteopathic Medicine, read When Breath Becomes Air by Paul Kalanithi, MD.

If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email Rose Raymond at rraymond@osteopathic.org.

Plot summary

In this memoir, Paul Kalanithi, MD, reflects on his life after receiving the news of his terminal lung cancer at age 36. He looks back over his childhood, college, and medical training experiences while spending the majority of his time reflecting on how his life has changed throughout his neurosurgery residency.

Dr. Kalanithi has the unique perspective of someone who spent a lot of time both treating patients and being one himself, and he uses it to offer guidance to physicians on understanding patients and giving diagnoses.

Growing up, Dr. Kalanithi was not at all interested in medicine. Several of his family members were doctors, and he noticed they were always away from their families in the hospital. While studying English literature at Stanford University, he became enamored with human meaning, and he saw the brain as the operating system that allowed for meaning to exist.

As he completed a master’s in English literature, he was left yearning to find the intersection of biology, mortality, literature, and philosophy. He decided to apply to medical school and was accepted into Yale’s program.

When Dr. Kalanithi was in medical school, he overheard a conversation between a pediatric neurosurgeon and the family of a young boy who had just been diagnosed with a brain tumor. This conversation made him realize that “neurosurgeons work in the crucible of identity,” in that they consider all options and outcomes to try to help find a balance between living longer and maintaining the ability to do what makes a longer life worth living.

He very somberly contemplates the various tradeoffs that may occur in a neurosurgeon’s office, such as trading a few more months of living for the ability to see or speak.

The true message of the book becomes more apparent after Dr. Kalanithi is diagnosed with lung cancer and begins to notice the vast differences between being a physician and a patient. He notes that many physicians approach patients more like a puzzle to be solved than like a human being needing comfort and understanding.

As Dr. Kalanithi reaches the end of his life, he fully completes the transformation from doctor to patient. He realizes that he would much rather devote the little energy he has remaining to his family.

In this transformation, he begins to appreciate the importance of maintaining patients’ quality of life. Many physicians base treatment plans off of past experiences or the newest research, but the most important aspect of the job is tailoring the treatment to help patients maintain a sense of meaning in their lives.

Dr. Kalanithi passed away at age 37 in 2015. This book was published posthumously the following year and was a finalist for the Pulitzer Prize.

Interesting tidbits for DOs

Osteopathic physicians are most known for their attention to patient-centered care and their view of the patient as a whole being. In fact, a common saying in the profession goes something like, “While many physicians treat the disease, we treat the patient.”

Dr. Kalanithi’s quote below truly exemplifies the way DOs approach medicine. Rather than sit across from the patient and tell them what is going to happen using terms that are new to them, we sit alongside them and guide them in their journey toward healing.

“There we were, doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now, was no more, and no less, than two people huddled together, as one faces the abyss.”

Notable quote

The quote below is about how we can help patients deal with life-altering diagnoses. After receiving a serious diagnosis, many patients feel that there are endless things they can no longer do and that their life may never go back to what they considered “normal.”

However, we need to help them realize that this does not mean their life is over, and part of our plan must involve allowing the patient to find new meaning in what they are able to do and protect that.

“Emma hadn’t given me back my old identity. She’d protected my ability to forge a new one.”

Takeaways

This book offers new ways to approach the doctor-patient relationship. Trained physicians have gone through years of schooling to learn many terms, processes, and procedures that the general public know little to nothing about.

Even as an almost fully trained neurosurgeon, Dr. Kalanithi felt lost as he attempted to research his own lung cancer. This underscores how many patients feel when they visit a doctor. We must do our best to help the patient make sense of their diagnosis rather than talk in only medical jargon and statistics.

Another key takeaway is about approaching life in terms of meaning. Dr. Kalanithi notes several times that medicine is not a field one should enter if they do not view it as a calling. I believe that is because he understands that it is often a difficult task to help patients find meaning in their most vulnerable times as we guide them through decisions about their future.

However, keeping meaning at top of mind when helping patients make wrenching choices about their future is the best thing we can do to try to ensure they maintain the best quality of life possible.

May’s book

For May, The DO Book Club will be reading Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande, MD. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore due to COVID-19, we recommend checking out eBook options.

As a reminder, if you read When Breath Becomes Air or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email rraymond@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, March 2021: The Pull of the Stars

The DO Book Club, February 2021: Womb With a View: Tales from the Delivery, Emergency and Operating Rooms