Living A Meaningful Life To The Very Last Breath

One of our Diploma students at the Viktor Frankl Centre - Jen - has started a Logotherapy Book and Film Group. The first book she chose 'When Breath Becomes Air' is a memoir of a young neurosurgeon who faces a terminal cancer diagnosis. For Jen, this book is deeply personal. I include her story here, and the overview and questions she shared with the group.

I am incredibly grateful for her honesty, courage and tenacity. Here are her thoughts:

I chose When Breath Becomes Air as our first book because it’s the one that most deeply resonated with my own recent life experience. Like Paul Kalanithi, I am living with terminal cancer. And like him, I’ve had to face the sudden loss of a life I had very carefully built: a career I loved, plans I’d made, an identity I had invested in. Reading Paul’s reflections — his wrestle with mortality and meaning — I often felt as though I were reading my own thoughts written by someone else. It’s rare to feel that seen in such a profoundly isolating experience as dying.

For those who might not have read or finished the book, it’s Paul’s memoir — written in the time between his diagnosis and his death — about what it meant to him to live fully when he knew his time was short. He was a neurosurgeon and a philosopher, which meant that he had spent his life dealing with people's brains and big questions. And suddenly he found himself forced to inhabit both from the inside.

What struck me most wasn’t his courage and quiet strength, but his insistence that life’s meaning doesn’t dissolve in the face of death — that it might, in fact, sharpen. Frankl wrote that meaning can be found in three ways: through what we create, what we experience, and the attitude we take toward the suffering we cannot change. When Breath Becomes Air touches all three, but especially that last one — the freedom to choose one’s attitude, even when it may seem like everything we hold dear is being taken from us.

I’m not a Logotherapist — I start my training in January — and I know some of you attending are far more experienced in this field. But I hope this session can be a meeting place between the personal, the philosophical and the psychological. A place where we can reflect not just on Paul’s story, but on our own lives through his, asking: what gives life meaning? How do we face limitation, loss, and mortality — our own and others’ — without losing sight of that meaning?

So, as we begin, I invite us to hold both lenses: Paul’s and our own. To listen for where his words resonate or challenge, and to see where his search for meaning might illuminate something about our own.

When Breath Becomes Air

Overview

When Breath Becomes Air is the memoir of Dr. Paul Kalanithi, a neurosurgeon diagnosed with stage IV lung cancer at the age of 36. The book traces his life from childhood through his medical career and into his experience of terminal illness. It concludes with an epilogue written by his wife, Dr. Lucy Kalanithi.

Lucy Kalanithi Reflecting On Her Journey With Paul And Beyond

Structure

The book is divided into two main parts:

1. “In Perfect Health I Begin” – Paul’s early life, education, and medical training.

2. “Cease Not Till Death” – his diagnosis, treatment, and final period of life.

Part One: Early Life, Education, and Medicine

• Paul grew up in Kingman, Arizona, in a family that valued both academic achievement and literature.

• He studied English literature and human biology at Stanford University, later completing a master’s degree in English literature, and a master's degree in history and philosophy of science and medicine.

• Unsatisfied with literature alone, he pursued medicine to understand human life at its most fundamental level.

• He attended medical school at Yale, where he met his future wife, Lucy.

• Paul chose neurosurgery for its combination of science, technical skill, and proximity to questions about the mind and identity.

• He became a highly accomplished neurosurgical resident at Stanford, nearing the end of his training when he developed symptoms such as weight loss and back pain.

• Scans revealed stage IV lung cancer, abruptly changing the course of his life and career.

Part Two: Diagnosis, Illness, and the End of Life

• After diagnosis, Paul underwent treatment including targeted therapy, with periods of improvement and decline.

• His relationship with Lucy strengthened as they navigated his illness together.

• Paul debated whether to return to neurosurgery; after some improvement, he resumed operating for several months.

• As his health declined again, he stopped working and focused on writing the memoir.

• Paul and Lucy decided to have a child despite his prognosis; their daughter, Cady, was born during this period.

• Paul continued writing as his condition worsened, addressing his final reflections to his daughter.

Lucy Kalanithi’s Epilogue

Lucy describes Paul’s final decline and last days in hospital. She recounts his commitment to writing despite physical deterioration and offers closure by reflecting on his final moments and the completion of the manuscript.

Major Themes

• Mortality: Paul’s confrontation with terminal illness after years spent treating patients facing life limiting conditions.

• Identity: The impact of illness on his sense of self as a doctor, husband, father, and individual.

• Medicine: Observations on medical training, decision making, patient care, and the emotional realities of neurosurgery.

• Uncertainty and choice: Decisions about treatment, work, family, and future under an unpredictable prognosis.

• Family and relationships: How Paul and Lucy’s relationship evolves, and the significance of their decision to have a child.

Discussion Questions:

1. Opening Reflections

• What was your initial reaction to reading a book about mortality?

• Was there a line or moment that stayed with you after reading?

2. Meaning and Limitation

• Frankl suggests that meaning exists even (or especially) within suffering. How do you see Paul enacting or resisting this idea?

• Paul writes about the loss of the future he imagined. What does his response reveal about how meaning shifts when life’s structure changes?

• Have there been moments in your own life where limitation reshaped your sense of purpose or direction?

3. Identity, Vocation, and Being

• What does Paul’s transition from doctor to patient show about the relationship between what we do and who we are?

• How might we distinguish meaning that comes from doing (work, achievement) from meaning that comes from being (presence, relationship)?

• When identity feels stripped away, what resources — inner or outer — help us rebuild meaning?

4. Facing Death

• How does Paul model a 'good' or meaningful death, if such a thing exists?

• What would a meaningful death look like for you, to the extent you feel comfortable reflecting on that?

• How does confronting death help clarify what is essential to a meaningful life?

5. Freedom and Attitude

• Where do you see Paul exercising the freedom to choose his attitude?

• Are there moments where that freedom seems to waver? What does that reveal about realistic limitations in suffering?

• How do we hold compassion for ourselves or others when choosing one’s attitude feels difficult or impossible?

6. Meaning Beyond the Individual

• What does Paul’s decision to have a child near the end of his life say about legacy and meaning beyond the self?

• How do love and relationships create or deepen meaning when time is short?

• How does sharing one’s story — as Paul does, and as we do in groups like this — become an act of meaning-making?

7. Closing Reflections

• After reading this book, what feels clearer about your own sense of meaning or purpose?

• What one question about meaning do you want to carry with you after today?