HESP August 1, 2017

A father sits in a U-shape to have his baby daughter sitting on his chest and her head on his lap facing his face; she holds on to his thumbs tightly with her palms, and they smile at each other. In a Stanford Medicine video, Paul Kalanithi, a neurosurgeon, looks tired and weak. He gazes at his daughter’s eyes while everything beyond her eyes’ sparkle fades away. Diagnosed with terminal lung cancer at age thirty-six, he and his wife agreed to have a baby to fill his last days with joy instead of delving into depression. He writes to his daughter, “when you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world. Do not, I pray, discount that you filled a dying man’s days with a sated joy; a joy unknown to him in all his prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing”.[1] With death staring at him, Kalanithi writes his last words in a book When Breath Becomes Air, to share his answer to what makes his life worth living. He died while working on this book at age thirty-seven.

The book is a captivating poignant memoir for a compassionate person. Offering positivity and courage in facing death as a doctor and a patient, he writes, “I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness”.[2]

All his life, he pursued the answer to “what makes life worth living?” Striving for an answer, he earned degrees in literature, biology, history, and philosophy. He sees life as an intersection between literature and neuroscience, where literature forges the life of the mind, and neuroscience unravels how the brain structures life.


At the climax of his book, Kalanithi recognizes that life is just an “instant” and everybody will eventually die. Every person on earth is the author of his own life; the title of this life can be a person’s virtue, or a struggle, or what makes this person’s life worth living. With the time of his life quickly ticking away, Kalanithi focuses on his specific role in this life instead of trying to find an answer to a greater question. Kalanithi says that the most important value of his life is in the “doctor-patient relationship,” and he chooses it as a title for his life. “With severe brain damage, in these moments, I acted not, as I most often did, as death’s enemy, but as its ambassador. I had to help those families understand that the person they knew—the full, vital independent human—now lived only in the past and that I needed their input to understand what sort of future he or she would want: an easy death or to be strung between bags of fluids going in, others coming out, to persist despite being unable to struggle,”[3] he writes that when a patient with a severe head bleed comes in. He tries to remind the patient’s family that with the death can come as a peaceful letting go. Before operating on any patient’s brain, he says that his highest priority as a neurosurgeon is to understand his patient’s mind, identity, and what makes this patient’s life worth living.

Throughout the book, he emphasizes enriching an intimate small circle of friends and family. Therefore, “compassionate relationships” might have been a more fitting title for Kalanithi’s life, rather than restricting it to doctor-patient relationships, because of his care for his patients, family, and friends. “A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form,”[4] he writes to explain that his decision to study literature was motivated by his passion for how language brings people’s minds closer and deepens their relationship.

Kalanithi had a profound relationship with his wife, Lucy. By the time he suspected that he had cancer, his marriage was crumbling, and Lucy was thinking of moving out of their home. Because he loved her, he decided not to tell her that he had cancer so that she could live freely. On the other hand, she felt that he was hiding something from her and that was her problem. She told him, “I don’t want to learn about your worries by accident”. Because she loved him, she returned and asked him to not be distant from her. When he whispered, “I need you,” her answer was, “I will never leave you.” Adding to the charm of this marriage, while he was asking her to remarry after his death, she said she wanted to have a baby with him as if she is preserving his flesh and soul alive in a new body. [5]


Starkly demonstrating his power to see and to create positivity out of his dramatic illness, he writes that cancer saved his marriage. He describes his and Lucy’s trip to the sperm bank to freeze some of his tissues for after his death. Moreover, he writes that having a terminal illness can be a perfect gift for a doctor, and he gained energy from being with patients. “As a doctor, I had had some sense of what patients with life-changing illness faced—and it was exactly these moments I had wanted to explore with them. Should not terminal illness, then be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it?”[6] When he started his career as a neurosurgeon, he writes that he aimed to pursue death: to grasp it and see it eye-to-eye in order to guide his patients and their families with the weight of his human experience filled with sentiment and compassion. By being a patient himself, he experienced what his patients suffered, which added a new dimension to his medical experience. He sought not to be the doctor stereotype, preoccupied with empty formalism and disease treatment alone. It is inspiring to seek positivity aspects even in the terminal illness. Being religious helped him to accept death and deal with it with such positivity.

Atheism and religions

Involuntarily, Kalanithi’s memoir challenges atheism, Buddhism, and absurdism. Many other authors attempted to answer the same question: “What makes life worth living?” in various literary forms, some of them came up with answers that contradicted Kalanithi’s views. Albert Camus for example, an atheist himself, answers the question in The Stranger by saying that life is primarily about pleasure, while Terrance Rattigan approaches this question in Adventure Story by implying that life is about one’s actions and how he benefits the humanity, not necessarily one’s intentions or personal traits. On the other hand, the three heavenly religions refute Camus’s and Rattigan’s thoughts and say that life is merely a test and the one’s actions that are motivated by intentions, where good deeds eventually lead to paradise.

In the book, Kalanithi narrates his experience with atheism, and how he returned to Christianity. During his twenties, he lost himself in the realm of atheism for some time. Finally, he faced that problem of banishing not only God from the world but also love, hate, meaning and to believe that science is the arbiter of metaphysics. He says that science provides no basis for meaning; consequently, life itself does not have any meaning, and he finds that against his logic. Moreover, he writes that he finds a constant gap between science and passion as there is no system of thought can contain the fullness of a human experience. In fact, science describes only what is created in nature and tries to formulate a system for it, that the human brain can comprehend. Kalanithi dares the reader to think about such questions that might emerge in the reader’s mind: Who creates this nature? Who makes this system working correctly every nanosecond? Who controls our breath while asleep? Who controls the baby’s nutrients in a mommy’s womb? If there is no Creator, nor One God, then who is managing this world?! The sun-moon cycle is only enough proof that they are obeying The Almighty and The Sustainer (these are from Allah’s ninety-nine names).

Answering what makes life worth living juxtaposes Camus’s The Stranger with Kalanithi’s memoir. The Stranger demonstrates the absurdism of this world through the story of an indifferent man. He was accused of murder after an apathetic attendance to his mother’s funeral.[7] With Kalanithi’s diligence, and seeking what makes life meaningful until the last day of his life stands in contrast with such nihilism. Because this life has a meaning, every human has a role in this life before going to the hereafter. At the beginning of his life, Kalanithi learned that “life is not about happiness,” and he argued this concept in his admission paper to college.[8] Therefore, whenever he had time or energy, he spent it on a useful cause or duty. He embraced his destiny with peace and content, not outrage, or despair, or depression, or giving up: “Knowing that even if I’m dying, until I actually die, I am still living”.[9] Kalanithi’s life is an outstanding example that stands in contrast to atheism where people should spend their lives in temporary pleasures.

Leaving an impact on human life and engraving one’s name in history, Terence Rattigan’s Adventure Story explores the same question of life worth living through Alexander the Great’s life. In this book, Alexander the Great finds the life worth living in conquering the world and uniting it. He struggles with the fact that he will be remembered by what he did, not by who he was. Rattigan argues that by saying that what he did, made him who he was. In this philosophical play, Rattigan wants to emphasize the fact that actions create identity, not vice versa, and that actions are what makes the person’s life worthy regardless of his beliefs and intention.

In between the two extremes of Camus and Kalanithi, and Rattigan in between, religions answer the question: What makes life worth living? The heavenly religions: Judaism, Christianity, and Islam believe in the hereafter and hence an understanding that striving and good intentions and subsequently good actions are key to pleasing the creator; therefore, the answer is exactly the same while Buddhism offers a different answer as its adherent do not believe in a day of judgment. The three heavenly religions are common about striving and doing good actions with the intention to please God. In other words, the identity, motives, and virtues of a person lie in his heart and must be reflected in his actions. However, good actions do not necessarily translate to being a good person. For example, someone might donate a big sum of money for a good cause: the action is good, but not enough an indication of being a kind-hearted person. Behind the action, the motive is mysterious, maybe that person donated the money to be elected to power or fame. At the end, only the creator, God, can judge between people, on the day of judgment, for He alone can see through their intentions. Apart from their different practices and notions of divinity, they all agree on helping other people, through development and education. The intention of such actions should be purely devoted to God, The One. Therefore, there are two life aspects to a meaningful life: one’s relationship with others and one’s relationship to God: the more pious, the higher rank, he will be in paradise.

While in Buddhism, it is just about ending the suffering. At the end of his life, Kalanithi learned that “life is not about avoiding suffering” when he courageously decided along with his wife to have a baby while facing the prospect of death. Moreover, if the soul is in an endless cycle of death and living without being judged one day, then all Kalanithi’s and his patients’ suffering would be to no avail: a notion Kalanithi and many others may consider unfathomable.

There are many universal existential questions that seem alike, while they are different: What makes life worth living? What is a good life? What is a happy life? How do we measure a life? And finally, what is a successful life? These are all important questions, that some Ivy League universities devote entire classes to tackle them from both theological and philosophical stand points. Interestingly, Yale offers a course with the same title of this article: What makes life worth living? Finally, the only common fact is that life equals time.


Time is one’s only real treasure; no one should waste time. Kalanithi guides readers to find one’s values and maybe write them in a similar book. Tackling the dilemma of time and one’s role in life was genuinely inspiring. When his doctor, Emma, asked him to figure out what he valued most, he did not know what he wanted or how to think five years ahead. Hence, he resolved himself to doing anything and everything he could do, to not waste any of his few precious time, Kalanithi returned to the operating room, decided to become a father, and authored a book. He finds new definitions to time through struggling. Mortality means the cessation of time, and he feels that time is more like space. He writes, “My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spent time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?”[10] Clocks are irrelevant to him.

The final answer

Kalanithi’s When Breath Becomes Air is a deep book where he pours his heart on paper. He ponders about life, death, and his discoveries of what makes life worth living. No one can stay the same after reading it. “Days are long. Years are short,” time is the real investment of one’s life.[11] Each one is free to leave their fingerprint on others’ souls and extend their lives through the lives of others or to choose not to touch any one’s existence as if he walked on sand, and the water waves erase his existence. Usually, people see the other person differently than the person would see himself. Therefore, it is essential that one judges himself and questions himself: what makes his life worth living? what has he contributed to others? Moreover, it is an interesting exercise that everyone tries to put a title to his life as it might reveal the most salient aspects of their lives. Asking people for their honest opinions about his personality will help as the one sees himself differently from how the people see him. The final answer to what makes this life worth living is how close the one is to God, how pious he is, and ensuring that his actions and his intentions are for God’s sake only.

[1] Kalanithi, Paul. When Breath Becomes Air
[7]Camus, Albert. The Stranger


This Essay was submitted for the class Reviewing the arts, by Jeremy C. Fox


About the author:

Engy Fouda is an author, freelance engineer, and journalist. Pursuing master’s degree in journalism at the Harvard Extension School and the Team Leader for Momken Group (Engineering for the Blind), Egypt Scholars Inc. She lives in NY and is originally from Egypt.

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