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When Breath Becomes Air: Prologue

Updated: Jan 24, 2022



The prologue details the series of events and life changes that occurred before Kalanithi’s eventual diagnosis of cancer. The chapter begins with Kalanithi visiting his primary care physician and requesting some imaging tests to be ordered after experiencing severe back pain and unexplained weight loss. While Kalanithi suspected cancer, his X-ray results showed nothing abnormal, so both the author and his primary care physician attributed the symptoms to the stress of Kalanithi’s neurosurgery residency.

Kalanithi then describes the major career strides in his life thus far—his awards and accomplishments, as well as the many prestigious job prospects for after his residency. He explains that things were finally starting to settle down and that the life he and his wife, Lucy, had been waiting for was finally beginning to become a reality.

However, Kalanithi’s symptoms continued to worsen to the point where a diagnosis of cancer was becoming more and more likely. Kalanithi began to worry about his condition and refrained from confiding to his wife about his worries about cancer. Lucy was upset that he was not being transparent about his worries, and thus decided to not accompany Kalanithi on a yearly trip to see his family in order to organize her thoughts and feelings about the state of their marriage.

Before leaving for his trip, Kalanithi requested another chest X-ray. Kalanithi hoped that his debilitating back pain would subside during his vacation with some rest and relaxation, but that did not happen. It was during this vacation that Kalanithi physically verbalized his fear that he might have cancer. Once he came back from his trip, Kalanithi received a call from his PCP that the picture of his lungs from his chest X-ray appeared blurry—a sign that something was wrong.

Kalanithi shared the foreboding news with his wife “and the distance between [them] vanished.” The chapter ends with Kalanithi checking into a patient room in the hospital, one that he himself had made diagnoses in, gave good and bad news in, and treated patients in—except now he was a patient himself.

Family or Medicine? or Family and Medicine?


Family and medicine. No, not “family medicine” but family AND medicine. It’s a topic that’s discussed a lot when someone decides to dive head first into pursuing medical school with the hopes of becoming a doctor. The idea is a little outdated—a lot of discussion concerning these 2 topics seem to flutter around the idea that it’s either family OR medicine, not both. While I have no sources for this, the concern surrounding the decision to focus on family or medicine historically affects women more than men. Women were (are?) the stereotypical caregivers that are meant to focus on creating and sustaining a family, which forcefully pushed them out of medicine and made it a predominantly male career. Of course, gender equality has come a long way, and so the “family vs. medicine” debate now extends to men.

But really, why the debate between family and medicine in the first place? On some level, it makes sense. Premed students (not even medical students, let alone practicing physicians) are inundated with heavy and rigorous coursework that makes socialization outside of classes difficult. Medical school involves even more challenging coursework, clinical rotations, and the pressure of performing well enough to get matched into a program. This is followed by the notorious intern year and residency, filled with 12 to 14-hour work days (or more). Board exams are generally expected as well before one becomes an attending physician, and of course, the work doesn’t stop there.

In When Breath Becomes Air, although not explicitly stated, it’s heavily implied that Kalanithi struggles with balancing his responsibilities as a physician and his duties to his family. While there’s no doubt that he is an extremely accomplished physician, it’s also undeniable that these many achievements took enormous amounts of time, effort, and energy—time, effort, and energy that could have been at least partially devoted to his wife. Fortunately for Kalanithi, his wife is also a practicing physician who not only understands his pressure to perform, but is likely just as busy herself. However, solely “understanding” is not the same as accepting—and although Kalanithi was almost finished with his neurosurgery residency and “[they] were so close to the life together [they’d] always wanted,” sometimes “close” is already too late.

Fortunately, Kalanithi and his wife were able to heal some of the cracks in their strained relationship upon the grim report of Kalanithi’s chest X-ray imaging results. However, it does beg the question—how far would you be willing to go to pursue medicine or any other demanding career, at the expense of family and/or other responsibilities and joys of life? That is something you’d have to take a step back and evaluate for yourself. I’d like to emphasize strongly that this is not to say that I believe the debate is purely “family OR medicine;” I truly believe family AND medicine is possible. It just takes a lot of time, effort, and energy—on top of the inevitable mountain of professional responsibilities as well.

Pursuing medical school requires a large (yet unsurprising) amount of dedication—not just to academics and extracurricular activities, but also in maintaining your own mental and emotional health, as well as your social relationships. As you pursue medical school, here are a couple of things to think about or do before you make a decision:

  • How do you picture your professional life and your personal life, such as your social life and family life? How much time would you like to dedicate to your professional life and to your social/family life? List out your specific goals for your professional and personal life.

  • If you are interested in a specific specialty, think about the amount of time that you have to dedicate to that specialty. Don’t just consider the amount of time you would dedicate to it in a single workday, but also the number of years it would take to specialize in it (consider how long residency, fellowship, board exams, etc. would require).

  • If there are any healthcare professionals that you know (doctors, physician assistants, nurse practitioners, nurses, etc.), respectfully ask them about the amount of time they dedicate to their profession. If appropriate, respectfully ask them about the amount of time they dedicate to their personal life as well.

As we come towards the end of this post, I’d like to stress that choosing family over medicine, or even choosing a less-demanding specialty within medicine to dedicate time to your personal life, is not the “wrong” choice. As you’ll see in the next blog post, Kalanithi pursued opportunities that he found personal value in. For him, this eventually led him to medical school--but it doesn’t have to be medical school for you. Just as a final reminder:

Your profession does not define you—your values do.

See you next time!

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