When Breath Becomes Air: Discussion Questions & Activities

We’ve put together discussion questions for When Breath Becomes Air by Paul Kalanithi that you can use with a book club, a class at school, or a team at work. We include sample answers, book club activities that will help you get more out of what you’ve read, and recommendations for more reading if you like this book.

Book Synopsis

When Breath Becomes Air is a profound memoir by Paul Kalanithi, a neurosurgeon who was diagnosed with stage IV lung cancer at age 36, just as he was completing his medical training. The book chronicles his journey from doctor to patient, exploring his transformation from someone who treated the dying to someone facing his own mortality. Kalanithi had spent years studying literature and philosophy before pursuing medicine—driven by questions about what makes life meaningful—and his dual background uniquely positioned him to examine death and meaning with both clinical precision and literary grace.

Throughout the memoir, Kalanithi grapples with profound questions: What makes life worth living when faced with death? How do you continue forward when the future you’d planned disappears? He writes about his relationship with his wife Lucy, their decision to have a child despite his diagnosis, and his struggle to find purpose and identity as his body fails him. The book, completed in his final months and published posthumously in 2016, offers a beautiful meditation on mortality, the patient-physician relationship, and the search for meaning in the face of death. It’s ultimately about living fully in the time we have—however long or short that might be.

Read Shortform’s comprehensive guide to this book.

When Breath Becomes Air Discussion Questions & Sample Answers

Along with discussion questions for When Breath Becomes Air, we include sample answers you can use as prompts.

1. What does the title “When Breath Becomes Air” mean to you, and why do you think Kalanithi chose it?
   • Sample answer: I think it’s about that moment when something we take completely for granted—breathing, being alive—suddenly becomes insubstantial, like it could just disappear into nothing. It’s poetic but also kind of haunting. Paul was so aware that his breath (his life) was slipping away, becoming as intangible as air itself. The title really captures that liminal space between life and death that he was living in.
2. How did Kalanithi’s background in literature and philosophy shape the way he approached both medicine and his illness?
   • Sample answer: I found it fascinating how he wasn’t just a typical doctor. He’d spent all that time reading the great books and thinking about life and meaning before ever going to med school. I think it made him see patients as whole people with stories, not just bodies to fix. And when he himself got sick, he had this whole vocabulary and framework for thinking about suffering and meaning that a lot of people just don’t have. It’s probably why he could write so beautifully about something so difficult.
3. Paul writes about the relationship between patients and doctors. How did his perspective on this relationship change when he became a patient himself?
   • Sample answer: It was such a shift for him. As a doctor, he had all this power and knowledge, and he was the one delivering the news and making decisions. But as a patient, he was suddenly vulnerable and dependent, and he realized how much patients need their doctors to be honest but also compassionate. He talks about how some doctors couldn’t look him in the eye or would be too clinical, and you could tell that really hurt. It gave him so much more empathy.
4. Why do you think Paul and Lucy decided to have a baby after his diagnosis?
   • Sample answer: On one hand, it seems irresponsible and even selfish. On the other hand, it could be seen as a profound act of hope and defiance. They weren’t going to let cancer steal their future entirely. Paul wanted to create something that would last beyond him, and Lucy wanted a piece of him to hold onto. It was about choosing life and meaning even in the face of death.
5. How does Kalanithi define what makes life meaningful?
   • Sample answer: He seems to say it’s not about how long you live but about engagement—being present with the people you love, doing work that matters, creating something. Even when he couldn’t operate anymore, he found meaning in writing this book and being a father to Cady. I don’t think he ever pins down one single definition, but it’s clear that, for him, meaning came from connection and contribution, not from some abstract achievement or extending life at all costs.
6. What role does identity play in the book, particularly Paul’s identity as a doctor?
   • Sample answer: Oh, this was huge for him. Being a neurosurgeon wasn’t just his job—it was who he was. So, when the cancer made it impossible for him to operate, he had this real crisis: If he wasn’t a surgeon, who was he? I think a lot of us define ourselves by our work, so this really resonated with me. He had to figure out how to be Paul without being Dr. Kalanithi, and that’s part of why writing became so important to him.
7. How does Kalanithi approach the concept of hope throughout his illness?
   • Sample answer: It’s complicated, right? He talks about false hope versus real hope and how doctors sometimes give patients unrealistic expectations. But he also needed hope to keep going. I think he tried to balance being realistic about his prognosis with staying open to possibility. He didn’t want false promises, but he also didn’t want to give up. That scene where his doctor finally gives him real numbers about his prognosis—you can feel his relief at having honest information, even though it’s terrible news.
8. What did you think about Paul’s return to surgery after his diagnosis?
   • Sample answer: I had mixed feelings about it. Part of me admired his determination and thought it was beautiful that he wanted to keep doing what he loved. But part of me also wondered if he was in denial or pushing himself too hard. Looking back, though, I think it was his way of reclaiming some normalcy and purpose. He needed to know if he could still be that person, still do that work. It wasn’t about proving anything to anyone else; it was about proving it to himself.
9. How does the book handle the tension between prolonging life and maintaining quality of life?
   • Sample answer: This is one of the central questions, isn’t it? Paul sees this from both sides—as an oncologist choosing treatments and as a patient receiving them. I think he shows how there’s no one right answer. He wanted to live long enough to meet his daughter and write his book, but he didn’t want to be so debilitated that he couldn’t be present. The part where he decides to stop treatment was heartbreaking but also felt like he was taking back control of his own death.
10. What’s the significance of Paul’s relationship with his wife Lucy throughout the book?
    • Sample answer: Their relationship is really the emotional core of the book for me. Lucy was his partner, his caregiver, his fellow parent, and eventually his widow—all while dealing with her own grief. Paul is honest about how the illness strained their marriage, which I appreciated. They’re not perfect, but their love is so evident. The fact that she wrote the epilogue and has continued his legacy says everything about their bond. I can’t imagine her strength.
11. How does Kalanithi address the question of whether his life and death have meaning?
    • Sample answer: I think the very act of writing the book is his answer. He’s saying that even a short life can have profound meaning if you live it fully and leave something behind. He doesn’t get to raise his daughter or finish his career—but, through the book, he’s touched millions of people and changed how we think about death and meaning. That seems pretty meaningful to me. He’s not looking for some grand cosmic purpose; he’s creating meaning through his relationships and his words.
12. What surprised you most about the book?
    • Sample answer: Honestly, how beautiful the writing was. I expected it to be sad and maybe informative, but I didn’t expect it to be so lyrical and philosophical. Paul could have just told his story, but instead he created this meditation on mortality that’s almost spiritual. Also, I was surprised by how much he continued doing—going back to work, having a baby, writing. I think I assumed terminal illness meant just giving up, but he showed that you can live fully even while dying.
13. How does the book explore the limits of medicine?
    • Sample answer: Paul is really honest about what medicine can and can’t do. He talks about how we’ve gotten so good at prolonging life that we sometimes lose sight of why we’re doing it. There’s that powerful idea that doctors should help patients live the life they want to live, not just keep them alive at all costs. He shows how medicine is amazing but also limited: It couldn’t save him, and, at a certain point, more treatment would have just made his remaining time worse.
14. What do you think about the epilogue written by Lucy?
    • Sample answer: It destroyed me. Reading Paul’s words, you’re so in his perspective that you almost forget he’s gone. Then Lucy’s epilogue brings you crashing back to reality. She fills in those final days that Paul couldn’t write about, and you feel the full weight of the loss. But she also shows his legacy—their daughter Cady, the book, the impact he had. It’s the perfect ending even though it’s so sad, because it shows that life goes on after loss.
15. How does Kalanithi’s neurosurgery work inform his understanding of consciousness, self, and mortality?
    • Sample answer: This was fascinating to me. He literally operated on the part of the body that makes us who we are—the brain. He’d seen how a tumor or an injury could completely change someone’s personality or abilities, which made him think deeply about what makes us “us.” Is it just neurons and chemistry, or something more? When he got sick, he was facing the destruction of his own brain, his own consciousness. I think his neurosurgery background made mortality both more concrete and more mysterious to him.
16. What does the book suggest about the importance of talking honestly about death?
    • Sample answer: Paul makes it really clear that our culture’s avoidance of talking about death does more harm than good. He wanted honest conversations with his doctors, even when the news was terrible. He wanted to have real talks with Lucy about what would happen. I think he’s arguing that we should normalize these conversations because death is inevitable, and avoiding it just leaves people unprepared and anxious. The book itself is a model for how to talk about death with honesty and grace.
17. How did reading this book change your perspective on your own life or mortality?
    • Sample answer: It definitely made me think about how I’m spending my time and whether I’m doing what really matters to me. Paul didn’t get the long life he expected, and it made me realize that none of us knows how much time we have. I’ve been putting off certain things, waiting for the “right time,” and this book made me question that. It’s a cliché, but it really did make me want to live more intentionally. I also feel less afraid of death somehow, which is strange for a book about dying.
18. What role does faith or spirituality play in the book?
    • Sample answer: It’s interesting because Paul doesn’t come to any definitive religious conclusions. He explores faith and questions it, especially as death approaches. He wasn’t raised particularly religious, but he seems open to something beyond pure materialism. I appreciated that he didn’t give easy answers or have a convenient deathbed conversion. His spirituality seems more philosophical than religious—concerned with meaning and connection rather than doctrine. It felt very honest.
19. How effective is the book’s structure, moving from his early life through his illness?
    • Sample answer: I thought it worked really well. Starting with his childhood and his decision to become a doctor gave context for everything that came later. You understand why medicine meant so much to him and why losing it was so devastating. The chronological structure also means you experience his diagnosis almost as a shock, the way he did. And ending where he physically couldn’t write anymore, and then Lucy finishing the story—that was powerful. The structure mirrors his life: complete and then suddenly cut short.
20. If you could ask Paul Kalanithi one question, what would it be?
    • Sample answer: I think I’d ask him if writing the book gave him peace. He was so focused on leaving a legacy and finding meaning, and I’d want to know if getting his thoughts down—knowing this book would exist after him—brought him comfort in those final days. Did it feel like enough? Did it accomplish what he hoped? I imagine it did, given how much effort he put into it even when he was so sick, but I’d love to hear him reflect on that.

Book Club Activities for This Book

Discussing When Breath Becomes Air can be just the beginning! Use these activities to get even more out of the book and create unforgettable experiences.

Activity 1: Mapping Your Own Meaning

Paul Kalanithi spent years exploring what makes life meaningful, first through literature and philosophy, then through medicine, and finally through confronting his own mortality. This individual reflection exercise invites you to chart your own understanding of meaning.

1. Draw a timeline of your life, and mark the moments that felt most meaningful to you—not necessarily the happiest moments, but the ones that felt most significant or full of purpose.
2. For each moment, write a few sentences about why it mattered.
3. Looking at these moments collectively, identify any patterns or themes. What were you doing? Who were you with? What values were you expressing?
4. Write a paragraph about what you want the next meaningful chapter of your life to look like. Paul didn’t get to write all the chapters he planned, which serves as a reminder to actively create meaning rather than wait for it.

This exercise can be particularly powerful to share in a group setting, with members discussing what surprised them about their own patterns.

Activity 2: The Patient-Doctor Dialogue

Paul writes extensively about the communication gaps between doctors and patients and how crucial honest, compassionate conversations are in medical care. This group role-playing activity helps explore these dynamics.

1. Pair up, and assign roles: One person is a doctor who needs to deliver serious news (a cancer diagnosis, a poor prognosis, limited treatment options), and the other is the patient. Spend five minutes having this conversation.
2. Switch roles, and try again with a different scenario.
3. Come together as a full group to discuss:
   • How did it feel to deliver bad news?
   • How did it feel to receive it?
   • What made the conversation easier or harder?
   • What did you need from the other person that you did or didn’t get?
   • Paul emphasizes that patients need honesty but also hope and humanity—discuss how to balance these.

This activity can lead to meaningful conversations about how we’ve experienced medical care ourselves, how we might advocate for better communication, and how we might support loved ones facing serious illness.

Activity 3: A Letter to Your Future Self or Loved Ones

One of the most poignant aspects of the book is Paul’s awareness that his daughter Cady would grow up without him and his desire to leave something of himself behind—which he did through this memoir. This writing exercise asks you to create your own legacy document.

Spend 30 to 45 minutes writing a letter either to your future self (to be opened during a difficult time) or to loved ones (expressing what you’d want them to know if you couldn’t tell them yourself). You might share your values, lessons you’ve learned, hopes you have for them, or what has made your life meaningful. Paul’s book reminds us that we don’t need to be facing death to think about what we want to say and what we want to leave behind.

If doing this as a group activity, you don’t need to share the actual contents of your letters; these can remain private. Instead, reconvene to discuss the experience of writing:

• What was difficult about it?
• What felt important to capture?
• How did it change your perspective on your life right now?

Some participants might choose to actually give or save these letters; others will find the exercise itself valuable regardless of what they do with the finished product.

If You Like When Breath Becomes Air

If you want to read more books like When Breath Becomes Air, check out these titles:

• Being Mortal: Medicine and What Matters in the End—This book by Atul Gawande is a natural companion to When Breath Becomes Air. Gawande, a surgeon and writer, explores how modern medicine often fails patients at the end of life by prioritizing survival over well-being. Like Kalanithi, Gawande examines the medical system from the inside, drawing on his experiences with patients and his own father’s terminal illness. He asks many of the same questions Paul grappled with: How do we balance extending life with maintaining quality of life? What conversations should doctors and families be having about death? What does a “good death” look like? While Kalanithi’s book is a personal memoir, Gawande’s is more of a medical and social analysis, but both authors share a commitment to honest, compassionate end-of-life care—and both write with exceptional clarity and humanity. Readers who appreciated Kalanithi’s insights into the doctor-patient relationship and the limits of medicine will find Gawande’s perspective equally valuable and thought-provoking.
  • Shortform’s comprehensive guide to this book
  • Discussion questions and activities for this book
• The Bright Hour: A Memoir of Living and Dying—Nina Riggs was a poet and writer who was diagnosed with terminal breast cancer at age 37, and her memoir chronicles her final years with extraordinary grace, honesty, and even humor. Like Kalanithi, Riggs was a young parent facing death far too soon, and she writes beautifully about marriage, motherhood, and finding joy even while dying. Her literary sensibility and philosophical bent will resonate with readers who loved Paul’s writing style; she weaves in poetry, references to her ancestor Ralph Waldo Emerson, and reflections on nature and time. The book is deeply sad but also life-affirming, full of small moments of beauty and connection. What makes it particularly compelling as a follow-up to When Breath Becomes Air is that Riggs actually read that book during her own illness and reflects on it in her memoir, creating a kind of dialogue between the two writers about mortality and meaning.
• The Year of Magical Thinking—While this classic memoir approaches death from a different angle—Joan Didion writes about the sudden loss of her husband John Gregory Dunne rather than her own terminal illness—it shares When Breath Becomes Air‘s brave examination of grief, loss, and how we make sense of mortality. Didion is one of America’s greatest prose stylists, and she brings her precise, analytical mind to bear on the irrational experience of grief, exploring how we cope (or fail to cope) when someone we love dies. The book examines marriage, memory, and the stories we tell ourselves to survive devastating loss. Readers who appreciated Kalanithi’s literary approach to difficult subject matter and his intellectual honesty will find Didion’s meditation on death equally powerful. Her book also has insight into the experience of the surviving spouse (which Lucy Kalanithi hints at in her epilogue), making it a meaningful way to consider the other side of Paul’s story.

Discuss More Books

Shortform has discussion questions for scores of books. Take a look!