“I FLIPPED THROUGH THE CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.” – Excerpt, “When Breath Becomes Air”

At 36 years old, Paul was diagnosed with a metastatic lung cancer. He lost 30 pounds, suffered from back pains and fatigue never left him alone. Paul, instead of treating patients, was being treated as a patient.

Among adults with lung cancer in England, the one year net survival (2014 data) for males is highest when diagnosed at stage I (81%), and lowest when diagnosed at stage IV (15%)  (Bannister & Broggio, 2016). Paul was at stage IV.

As Paul said: “I found myself the sheep, lost and confused”. Death was coming for him and it was coming fast. The cancer was quickly depriving him of the ability to carry out routine daily tasks.

As Paul experienced, a common effect of cancer is functional impairment in which the patients require assistance. 61% of people caring for someone with cancer experience some kind of impact on their lives as a result of caring, though very few receive a formal carer’s assessment and seek for assistance (National Health Service, 2015). The NHS has in place care and support systems that make services available to anyone in need (https://www.nhs.uk/conditions/social-care-and-support/).

Fortunately Paul and Lucy’s families were a source of strength and comfort. They helped the couple as Paul underwent treatment and as they brought a child into this world.

Paul’s days were spent at medical appointments with Emma, his oncologist, to discuss treatment options; at cognitive therapy to help with the psychological impacts of cancer; and at physical therapy to maintain or regain strength.

Cancer adversely affects patients’ quality of life. The World Health Organisation (WHO) developed the WHOQOL-100 which produces scores relating to quality of life (e.g. positive feelings, social support), scores relating to larger domains (e.g. psychological, social relationships) and a score relating to overall quality of life and general health. It aids the assessment of a patient’s well-being during treatment, indicating the effectiveness of various treatment methods (World Health Organisation, 1997).

Paul had many ups and downs in his treatment. After returning to work during the brief period, Paul left surgery for good and focused on chemotherapy. His condition deteriorated, with dehydration, kidney failure and occasional loss of consciousness. Only a week later was Paul discharged, in a condition that was not that much improved. It was likely better for Paul to stay comfortably at home.

Lucy gave birth to their daughter, Cady, with Paul, as fragile as he was, by her side. Paul was fortunate to have seen the birth of Cady, and the first few months of her life.

As Paul explained, time was a double-edged sword for him. Though each day meant a day further from his last relapse, it also meant a day closer to his next relapse and ultimate death. The third-line drug treatments began to fail and Paul rapidly declined. He was unable to continue writing and Lucy completed the book with an epilogue.

On 9th March 2015, Paul lost his fight against cancer, surrounded by his loved ones. He felt he was ready – his breathing support was removed and morphine was administered.

“When breath becomes air” is a short yet powerful memoir. Paul wrote bravely about his mortality. He embraced death when it came and robbed him of the many other opportunities to make a difference in the lives of people as a neurosurgeon. He lived the remaining days of his life, doing what mattered most to him and making the best of what he could.

As a psychology student, it is inspiring to read about the strength and courage that Paul and his family had in order to face a losing battle. I can hardly imagine what it is like to have life cut short at such a young age. In the European Union countries, life expectancy can be as high as 80 years old and above (French Institute for Demographic Studies, 2017). The goals and ambitions we have set would have to be re-evaluated in light of a reduced life span, compounded by the fact that the disease could cause disabilities, both physically and mentally. It really tests us on how we interpret the meaning of life no matter how cruelly it treats us.

I would recommend this book to anyone looking for an unforgettable read.

Note: This book review focuses on Part 2 of Paul’s memoir, on his life after cancer diagnosis. Part 1 focuses more on the life of Paul before his diagnosis.

This review was written by Carolyn Keh and edited by Emma Keoy. Both of them are members of the Bugle team. 


Bannister, N., & Broggio, J. (2016). Cancer survival by stage at diagnosis for England (experimental statistics): Adults diagnosed 2012, 2013 and 2014 and followed up to 2015. Office for National Statistics.

French Institute for Demographic Studies. Life expectancy at birth. Retrieved January 25, 2018, from Institut National D’Etudes Demographiques: https://www.ined.fr/en/everything_about_population/data/europe-developed-countries/life-expectancy

National Health Service. (2015). Psychological support for people living with cancer Commissioning guidance for cancer care in London . London Mental Health Strategic Clinical Network, London.

World Health Organisation. (1997). WHOQOL:Measuring Quality of Life. Division of mental health and prevention of substance abuse . Geneva: World Health Organisation.

Source of picture: http://cinemalover.blog/2017/10/19/when-breath-becomes-air/