Book Review Essay

The Ultimate Race Against Time

Johnna Gary


When Breath Becomes Air

Paul Kalanithi

Random House, 228 pp., 2016

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Adam Berry/Getty Images

Life is the ultimate race against time. Time pressures us with the way it impacts us in our everyday lives, constantly reminding us that we can never beat it. It holds a powerful strain on humans, forcing us to realize that, eventually, time runs out in life; the older we get the less time we have to cherish on Earth.


Life is precious. Life is valuable. Life is full of worth. Life is worth living. As humans, we all undergo an immense amount of stress that makes us sometimes ponder the question: What makes life worth living? Is it the love and devotion we express towards our loved ones? Work? Religion? Or, in some instances, nothing at all?

To have a meaningful life is to fill your days with great achievements and big moments, to “go for it”, and to reminisce and celebrate unforgettable moments[i]. It can be a struggle for many people to feel like they truly live a meaningful life. However, it can be recognized as a similar concept to returning to a sport after a serious injury: you must start with the basics. To be exact, you must start by being in the present[ii]. Really see people- look into their eyes and see them. This allows you to really focus on being in the present, and to take in the wonders of life. By noticing the empowering reality of what’s standing right in front of you, you can recognize that love is all around. Love is something that so many people crave and too many people take for granted. Everyone is lovable, and everyone deserves to be loved. Notice the love in the air. It’s everywhere, and it’s soothing.

In a recent study, Psychology Today[iii] posed many possible answers to the question of what makes life worth living. Abstract thought like this, while not an exact science, is the foundation of this question. While there is no definitive answer, many people suggested that at least one, if not all, applied to them: nothing, religion, happiness, and love.

Contrary to common belief, “nothing” was one of, if not the most, commonly repeated answers to evolve from this question. A select number of philosophers such as Nietzsche, Schopenhauer, and Benatar, have questioned whether life has any true, genuine meaning. They argued that some people are driven to suicide by depression and negative events in their lives. Fortunately, many people are able to find several reasons to value their lives, and in surveys[iv] most people report themselves as pretty happy. So, the total rejection of established laws and institutions (also known as nihilism) seems an improbable position for the good majority of people.

The next common response was religion. Some surveys[v] indicated that people rely on religion and spirituality in order to make their life a little more meaningful. For many, attending church on a regular basis provides a sense of satisfaction, a feeling that, no matter what life throws at you, you can always count on your faith to be there to cushion your fall. Counter arguments[vi]suggest that religious faith can be reassuring but cannot objectively tell you whether you should adhere to a certain form of religion. They also explain that faith cannot even tell you what version or category of, for example, Christianity you should practice. Religion can be hereditary, but most certainly is what speaks to you as a person. If one has a spiritual calling towards their faith, they earn the right to absorb what that faith has to offer, and if one of its many qualities is to make one’s life worth living, then so be it.

To be happy is to be content. To be happy is to be full of joy. To be happy is to be in good spirits, and to have a great deal of pleasure. Happiness was reported to be a popular vote in making life worth living. Psychological research[vii] has identified many ways in which people can increase the happiness in their lives. These suggestions include practicing mindfulness living (which is about living consciously and in the present moment) and getting sufficient quality sleep in order to live a happier life. As many of us are fully aware, lack of sleep causes a negative mood to envelop our everyday lives, and decreases our ability to be productive. Getting a good night’s sleep will lead to a happier life, and in fact can be a leading cause in the reason many of us struggle with happiness. However, happiness is usually the result of having a meaningful life, not what makes life worth living in itself. There are people whose lives are meaningful even though they may not be very happy. For example, an individual struggling with a challenging job while raising a special needs child will find every day of their lives to be filled with purpose, even if it lacks daily doses of happiness. On the other hand, happiness can be cheaply achieved from having minimal goals, access to drugs, or unlimited time for self-meditation. It’s essential to remember that you can have happiness without much meaning, and meaning without much happiness, but that happiness is not the exact meaning of life.

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                                                                                                    Carolyn Gregoire/Huffington Post

Research taken from Huffington Post shows that, scientifically, it is important for people to make time for happiness. Whether it be to take a nap, meditate, or take a walk, people need to make time for their happiness. Eventually, improving one’s happiness will overall improve their quality of life.

Love[viii] is the final, and most appealing, answer to frequently occur from the question: What makes life worth living? Love includes friendships and family relationships as well as romantic ones. One can love people, places, animals, and their job, as well as the entertainment that all of these bring with. Work includes diverse, productive activities, such as community volunteering. Surveys and other psychological studies[ix] indicate that love, work, and the entertainment provided by each, do indeed enable people to have lives which they value. On a more technical level, neuroscience provides a deeper understanding of how the brain processes general needs for relatedness, autonomy, and competence that can be satisfied by the successful pursuit of love[x]. Such satisfaction yields happiness, but even the pursuit is enough to give life meaning.

At Yale University[xi] there is a course known as Life Worth Living in which there are two principles: First, the flourishing of our individual lives depends in part on our ability to ask and answer the question of what makes life worth living, and second, (in the globalizing, pluralistic world we live in today) that having leaders and citizens who are capable of articulating and deliberating about visions of a life worth living is a matter of paramount importance. At the personal level, ignorance towards big questions reveals itself in the unsettling experience of unexpectedly stopping short in the middle of routine activity. Not knowing why we should continue something adds to something larger than itself, a goal that gives “weight” to our lives. These experiences reveal the problem with pushing things aside (in this case the question of what makes life worth living) for the sake of focusing on the practical. There are various forces that shape our goals without us even remotely realizing it. Marketing and pop culture are the biggest outside factors that guide our lives for us in directions that we would normally want to resist[xii]. Over the years, life has become a series of consumer decisions based on our preferences on certain experiences, or a mad race for some vaguely-defined “success”.

In the memoir When Breath Becomes Air, the late Paul Kalanithi takes us on a journey through his battle with stage IV lung cancer. The beginning of the story provides us with the background on Kalanithi, things like how he fell in love with neurology, and the relationships he made over the course of his life, what was important to him as a doctor, husband, and eventual father, and what made his life worth living. Early in the book, Kalanithi states, “I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for it’s intertwining of life and death. I had thought that a life spent in the space between the two would grant me not merely a stage for compassionate action but an elevation of my own being: getting as far away from petty materialism, from self-important trivia, getting right there, to the heart of the matter, to truly life-and-death decisions and struggles… surely a kind of transcendence would be found there?”[xiii] He later explains that while being with patients in critical moments certainly had its emotional cost, it was also very rewarding. It was rewarding in the sense that he never spent a single minute of any day wondering why he did his work, or whether it was worth it. In his words, “the call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness.”[xiv] When operating on a patient’s brain, Kalanithi realized he must first try to fully understand his patient’s mind: their identity, values, what makes their life worth living, and what devastation makes it reasonable to let that life end. “The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”[xv]

When faced with the death of a close friend, (one of Kalanithi’s coworkers who had recently lost a patient), Paul Kalanithi truly began to understand mortality. It was then that he understood that death comes for all of us. That life is just a large countdown, with the time ticking out. He mentioned how he searched for a question to bring understanding to the horrible circumstance, that he could only imagine the overwhelming guilt that had lifted his friend up and off the building with which he had jumped. Particularly he says, “I wished, desperately, that I could’ve been walking with him out the door of the hospital that evening. I wished we could’ve commiserated as we used to. I wished I could have told Jeff what I had come to understand about life, and our chosen way of life, if only to hear his wise, clever counsel. Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it’s something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”[xvi] Paul Kalanithi refers many times to this experience as his way of looking death straight in the face. He tries to cope with the fact that in the end, death is going to win, by never taking life for granted and truly making the most out of his days.

Like his patients, Kalanithi had to face his mortality and try to understand what made his life worth living. Torn between being a doctor and being a patient, delving into a medical science and turning back to literature for answers, Paul Kalanithi struggled to rebuild his old life, or even find a new one. Kalanithi argues that as a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know. “It’s like falling in love or having a kid. You don’t appreciate the mounds of paperwork that come along with it, or the little things. When you get an IV placed, for example, you can actually taste the salt when they start infusing it. They tell me that this happens to everybody, but even after eleven years in medicine, I had never known.”[xvii] One of the most important things that Kalanithi learned throughout his experience of facing death was that the hard part of illness is that your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. You may decide you want to spend your time working as (in his case) a neurosurgeon, but a few months later, you may feel differently.

He said it best, “Death may be a one-time event, but living with a terminal illness is a process.”[xviii] Throughout his battle with cancer, Paul Kalanithi lived each day to the fullest. With his newly born daughter, he was able to make his days a little brighter and a little less dark, turning against his terminal illness to live in the moment with his precious, Elizabeth Acadia (Cady). Paul’s decision not to avoid death epitomizes a determination with which we don’t celebrate enough in our death-avoidance culture. His strength was defined by desire and strength, as well as gentleness. He spent the majority of his life tussling with the question of how to live a meaningful live, and his book discovers that indispensable place. Relying on his own strength and the support of his friends, family, and community, Paul Kalanithi faced each stage of his illness with poise, with the vigor that allowed him to lament the loss of the future he had prearranged and create a new one. In the final words of When Breath Becomes Air, Paul Kalanithi’s now widowed wife, Lucy, reflects on his life and expresses the thought that the book is a new way for Paul to help others now that he is gone. She surfaces the idea that for much of Paul’s life he wondered about death and whether he could face it with integrity. She now knows, the answer is yes. Indeed, he faced his life with much integrity.

Death is a horrid, dreadful conception that overwhelms everyone, eventually consuming them whether they like it or not. Being able to cope with mortality and not entirely avoid it, allows the average person to live a life with no regrets; to make their life worth living. To look death in the eyes and appreciate that you will never conquer it, eliminates the theory of making your life more meaningful after hearing that you have a certain amount of time to live. Don’t wait to take risks after finding out that you have four months to live. Take risks now, in the moment. The cliché “you only live once” is true. You only get one shot at life; make the most of it while you can because you never know when your time will run out.


[i] Swenson, Becky. “What Makes Life Worth Living: Create Tiny Epic Moments.” Tiny Buddha. Tiny Buddha, 2013. Web. 01 May 2016.

[ii] Swenson, Becky. Paragraph 7.

[iii] Thagard, Paul. “What Makes Life Worth Living? Love, Work, and Play” Psychology Today. Psychology Today, 25 Feb 2010. Web. 01 May 2016.

[iv] Thagard, Paul. Paragraph 2.

[v] Thagard, Paul. Paragraph 3.

[vi] Thagard, Paul. Paragraph 3.

[vii] Poh, Michael. “8 Scientifically Proven Ways to Increase Your Happiness.” HongKiai. HongKiai: Technology Design Inspiration, 2014. Web. 02 May 2016.

[viii] Thagard, Paul. Paragraph 5.

[ix] Thagard, Paul. Paragraph 5.

[x] Thagard, Paul. Paragraph 5.

[xi] Volf, M., & McAnnally-Linz R. “What Makes Life Worth Living? Take a Moment to Ask.” Huffington Post. Huffington Post, 25 Aug 2014. Web. 05 May 2016.

[xii] Volf, M., & McAnnally-Linz R. Paragraph 4.

[xiii] Kalanithi, Paul. (2016). When Breath Becomes Air. New York: Random House. Page 81.

[xiv] Kalanithi, Paul. Page 98.

[xv] Kalanithi, Paul. Page 98.

[xvi] Kalanithi, Paul. Page 114-115.

[xvii] Kalanithi, Paul. Page 140.

[xviii] Kalanithi, Paul. Page 160.