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“When Breath becomes Air” by Paul Kalanithi

 

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Published: January 12, 2016

Pages:228

 

 

 

This brief memoir is interposed between a foreword by Abraham Verghese, the brilliant author of “Cutting for Stone” and an epilogue by author’s wife, Lucy Kalanithi.  It is a beautiful, heartrending, deeply philosophical piece by an accomplished young man who dedicated heart and mind to his work and study in neurosurgery.  He discovers that he has terminal lung cancer at the age of 36, just before completing his grueling neurosurgical residency and embarking on the career he has worked so hard to attain.   The book is very thoughtful and reflective in nature, especially upon the meaning of life.  It made me wonder if the author was truly always so interested in finding the meaning of life, or if only when told of this terminal diagnosis, that reflection back on  his life made this search so apparent.  As one nears death, what is most important, becomes glaringly more obvious, and Paul Kalanithi describes this so well.

Abraham Verghese speaks in the foreword of how he had met Paul in person several times before his death, but it was not until he read his book that he felt  he really knew him.  I too, felt like I got to know Paul through this book.  He is very open and honest about himself, his sickness, his relationships, and struggles and triumphs throughout the process of dealing with cancer.

I find it interesting that Paul did not always think he wanted to be a physician, but rather thought he might be a writer.  He may not have realized his full potential as neurosurgeon and professor, but he surely achieved his goal to be a writer.  He has left behind a beautiful book that will be read for many years to come.  It will be of great interest to those with life-threatening disease, their family members, and really everyone, because we will all be in those shoes at some point.  He has also left behind a wonderful gift of himself to his daughter.  She will not remember her time with him, but she will be able to know him through this book and well as through the memories that I’m sure his close relations will share with her.  Aside from writing and even delving back into neurosurgery residency at one point, he spent the last years of his life following his diagnosis, building closer bonds with his family, and the love there was overflowing.

Aside from being an important read for anyone facing a life-threatening illness themselves or loving someone who is, I think it is a very important read for all medical professionals.  It puts a face behind a patient, who is clearly able to articulate the thoughts and feelings of being a patient in our medical system.  It emphasizes and highlights the importance of the physician-patient relationship.

I give this memoir images for it’s thought provoking, beautiful prose, as well as for writing it’s way through a death with utmost dignity.  He strengthens his belief systems, forges stronger relationships with family and loved ones, and finds greater meaning in life once he is given this terminal diagnosis.

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Stanford University neurosurgeon Paul Kalanithi savors a moment with his daughter, Cady, earlier this year. Kalanithi, who had never smoked, was diagnosed with lung cancer in 2013. He died March 9 at the age of 37. Illustrates SURGEON-ESSAY (category l), by Paul Kalanithi , special to The Washington Post. Moved Friday, March 13, 2015. (MUST CREDIT: By Mark Hanlon/ Stanford University)
(MUST CREDIT: By Mark Hanlon/ Stanford University)

Discussion Questions:

  1.  What do you think is the meaning of life?  What makes life meaningful?  Are these two questions different?
  2. Paul says in his book, Darwin and Nietzsche agree that the defining characteristic of live is striving.  Do you agree?
  3. Why do think doctors sometimes lose sight of the doctor-patient relationship?
  4. How does terminal illness change Paul’s identity?
  5. If you were to die tomorrow, what meaning would your life have?
  6. Jeff kills himself because of a bad outcome.  Do you think we put too much responsibility upon physicians?
  7. Do you think the long hours that residents work is a good thing?  How does it affect the doctor-patient relationship and the quality of care?
  8. How do you think physicians are treated differently when treated for illnesses than people unknown to physicians?  Do you think there is a difference in the care they would receive?
  9. Lucy asks Paul at one point, “What are you most afraid of?”  He answers that it is leaving her.  What would you be most afraid of?
  10. How did you feel about Paul and Lucy’s decision to have a baby?
  11. What does “death with integrity” mean to you?

Paul Kalanithi’s website

New York Times Review

Discussion Questions by Random House

“The Nightingale” by Kristin Hannah

 

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Published:  February 3, 2015

Pages:  440

Awards:  Goodreads Choice Award for Historical Fiction (2015)

 

 

This WW2 historical fiction novel was a slow starter for me, however the character development and historical background were so beautifully and masterfully laid out that I was compulsively reading toward the end.  In fact, I was on a plane with tears streaming down my face for the last 15% of the novel.  My 5 year old son asked me what the words were in the book that were making me cry.  How could I even begin to explain!???

This is a heart-rending novel, full of love and compassion, contrasted by war.  The quote that starts the book off and is really the theme weaving itself throughout the novel within each of the characters and their relationship to each other is, “In love we find out who we want to be; in war we find out who we are.”  The main plot of this novel pivots on the relationship between two sisters and their different manners of resisting and/or complying with the German occupation of France during WW2.  Their understanding of war grows and helps them to better understand their father and his mistreatment of them when they were younger.

I have not read Kristin Hannah’s other books, but have heard that they are considered more of the “romance” and “chic-lit” genres.  I was somewhat skeptical at the outset of this novel that this might be the same as she is very descriptive in her writing, however, I grew to love and linger on her descriptions of items, people, and geography with such detail.  She describes aromas, tastes, feelings, and an array of other senses so vividly that I as the reader, felt fully transplanted while reading.  But, I also felt that there was a shift in her writing style from pre-war to wartime.  The writing was much more “flowery” in the pre-war era and during wartime things moved more quickly.

Kristin Hannah handled the relationships within the book masterfully.  I love how beautifully she describes the the bonds between sisters, between lovers, between mother and child.  The love, mistrust, abandonment, terror, and so many feelings are so vivid and intense in this book.

This novel goes in and out of present day for the narrator (1995) in America on the Oregon Coast to a third-person narrating 1939 and through WW2 in France.  It is unclear until the end of the book which sister the narrator actually is, Vianne or Isabelle.

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This map depicts the occupied and free zones which were spoke of in the book.  Both Vianne and Isabelle are in the Loire Valley during the early part of German military occupation.  Isabelle leaves Vianne to move to Paris and become part of the french resistance and ultimately “The Nightingale” helping to take downed pilots to safety across the Pyrenees, via Tours to Spain.  Vianne’s initial instinct is to protect her child and cooperate, but ultimately resists the French by helping Jewish children to safety.  The book highlights the role of women in WW2.

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My overall rating: images  I absolutely loved it!!! Amazing!  Moving!  Deeply absorbing!  A book that stays with you long after you’ve finished it!

Discussion Questions:

  1.  Why is Isabelle’s title “The Nightingale”?  Is it because nightingales sing mostly at night?  Is there another reason?
  2. How does the book’s opening statement relate to characters in the book?   “In love we find out who we want to be; in war we find out who we are.”  How does this play out with Vianne and Isabelle’s father; Vianne; Isabelle; the German officers billeting at Vianne’s house; Antoine?
  3. How does this book compare with other WW2 historical fiction novels taking place in France?  Some examples include “All the Light We Cannot See” by Anthony Doerr and “Life after Life” by Kate Atkinson.  Do you have a favorite WW2 historical fiction novel?
  4. Did you find yourself identifying with one sister more than the other?  Did you find yourself admiring one sister more than the other?  Who did you expect to be the narrator at the end?
  5. If you’ve read other Kristin Hannah books, how does this book compare with her other books?
  6. Do you think France felt shame at it’s role in complying with the German occupation and enforcing internment of Jews in camps after the war?

Discussion Guide from Kristin Hannah’s website

Review by USA Today