When Breath Becomes Air By Paul Kalanithi and Lab Girl by Hope Jahren
Reviewed by Wendy Beth Jackelow

The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Association of Medical Illustrators (AMI).

When Breath Becomes Air

Initially it seemed fitting to pair the late Paul Kalanithi’s beautiful and haunting memoir, When Breath Becomes Air, with Atul Gawande’s insightful book about end of life care, Being Mortal. Both books, written by doctors, discuss the physician-patient relationship and how to improve treatment of terminally ill patients. Sadly, Dr. Kalanithi, a neurosurgeon and neuroscientist, lived the whole scenario from both sides of the table, first as a doctor and then as a patient. My whole focus completely turned around, however, after reading <cite>Lab Girl</cite> by Hope Jahren, a geobiologist and professor at the University of Hawaii. Both she and Paul Kalanithi shared a passion for their work in the sciences as well as a deep love of literature that resulted in two of the best books I have ever read about pursuing a meaningful life in the face of adversity.

In the Epilogue of When Breath Becomes Air, Dr. Kalanithi’s wife, Lucy, says that what happened to her husband “was tragic, but he was not a tragedy.” This is a profound book by a thoughtful and brilliant man about living life in a way that has meaning. His childhood in a small Arizona town was filled with desert landscape and a school district that was the least educated in America according to the Census. Kalanithi’s mother was determined to remedy that with a book list she devised to make sure her sons were as competently schooled as any child in America. Eschewing the path into medicine that his father took, Paul studied English literature and biology at Stanford earning a BA and then an MA in English literature.

His quest for a meaningful life led him to consider the connection between thoughts and language—the foundation of human relationships—and the physical processes of the brain, neurons and body. It became clear to him that the only area of study that bridged the two was medicine. At Yale School of Medicine, he decided to specialize in neurosurgery which “seemed to present the most challenging and direct confrontation with meaning, identity, and death.” Back at Stanford for his residency and scientific training in neuroscience, Dr. Kalanithi proved himself to be a talented surgeon and gifted researcher. His work gave him the ability to help others at critical moments when they needed it most using his surgical skills and his empathy to help them through their uncertainty and fear.

There is a beautiful passage in the book where he describes choosing summer work at a camp over work at a lab during college in order to experience life instead of studying it. The staff has slept outside on a mountain peak and at sunrise, he observes the blue sky to the east and the darkness and stars to the west. It was neither day nor night, but somewhere in between. Kalanithi’s book deals with these transitional places between life and death, experience and study, mind and body, sickness and health. His illness denied his patients a wonderful doctor and surgeon but it allowed him to write his story so we could all benefit from his knowledge, humanity and compassion.

When Breath Becomes Air

Hope Jahren’s Lab Girl recounts her life in science interspersed with interesting and informative chapters about the life of plants, her specialty. Each botanical chapter relates directly to her development as a geobiologist and gives insight into her work and her struggles to achieve recognition in the male dominated realm of academia. Her story is at times raucously hilarious and then serious and somber. The path to becoming a bona fide scientist was strewn with sexism, constant financial worry and ceaseless work.

As a child in rural Minnesota Hope is free to roam in her father’s lab—her after hours playground—at the community college where he teachers physics and earth science. Her mother, who is completing a college correspondence course to obtain the college degree she had to forgo many years before, fosters in her a love of literature. Like Paul Kalanithi, she began studying literature in college only to be drawn to science because it involved actually doing things and answering questions. She had never seen a female scientist, but knew her questioning and curious nature was well suited to the work.

As a new graduate school teaching assistant at Berkeley, she meets Bill, a quirky undergraduate who stands out on a field trip because he is wearing jeans and a leather jacket while working in the searing heat. He is as smart as he is peculiar and they forge a friendship as outsiders devoted to science. When she graduates with her PhD and is offered a job as an assistant professor at Georgia Tech, she asks Bill to come along and help build her new lab. Their partnership in the lab and their ongoing friendship gives her the stability and sense of belonging she needs to fuel her research. Her lab is the place where she can be herself.

Dr. Jahren writes about the moment when she truly became a scientist. It was late one night and she made a discovery for her PhD research that only she knew about—a scientific secret until she shared it with others. She also describes when one of her early research projects fails so terribly that she is convinced it is sign that her “future career was unraveling.” This setback leads to a breakthrough where she concludes “that experiments are not about getting the world to do what you it to do.” From then on she would study plants from the inside out— from the perspective of a plant. It was a novel idea that paved the way for her future work. It also led to a senior scientist standing on a chair and heckling her during her presentation at a scientific conference.

The book recounts these events and misadventures during her career with a cheerful cynicism, always allowing the reader to be part of the inside joke. During an excursion to the attraction, Monkey Jungle (“Where humans are caged and monkeys run wild!”), Bill hilariously comes face to face with his twin and they realize that they are “all just monkeys working in a monkey house.” A field trip to Ireland results in all their samples being discarded at the airport since they did not have a permit to take them from the country. There are setbacks, but also paths forward as Hope and Bill continue their research.

As her work is considered “curiosity driven research” which does not yield a useful product for material gain, the grant money Dr. Jahren can obtain (mainly from the National Science Foundation) is a very small piece of the pie. Her university pays her salary, but she has to procure the rest, including Bill’s income, as well as anything the lab needs in supplies, student researchers or travel. “The life of an academic scientist is ruled by her three-year budget,” she says. Sometimes her lab takes on outside work for income that allows her to have enough money to pursue her own research. She and Bill work around the clock at times to make ends meet and to make progress with their own experiments. At one point Bill was living in his van and when that arrangement became too unbearable, set up a bed and dresser behind a desk in the lab. It is not an easy path, but it is what a scientist must do to survive today.

Along the way, we learn of Hope’s battle with manic depression, how she met her husband after she was hired at Johns Hopkins, the birth of her son and her growth as a respected scientist. She builds a life for herself that she never expected—one of meaningful work, a loving family and a loyal friend and lab partner that all mesh together to create a bridge to future discoveries both personal and scientific.