When Breath Becomes Air

Use this activity to engage all types of learners, while requiring that they refer to and incorporate details from the text over the course of the activity.

“The Power of Language”

In this activity, students will select and analyze a series of passages of Paul Kalanithi’s writing that best express his ability to use language in effective and poetic ways to communicate his message.

In Part 1, Section 2, Kalanithi writes, “I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion.” Later, in Part 1, Section 9, he reiterates his strong feelings on communicating: “After someone suffers a head trauma or a stroke, the destruction of these areas often restrains the surgeon’s impulse to save a life: What kind of life exists without language?”

Reflect on the ways in which Kalanithi uses language in the composition of his memoir. How does his passion for effective language show in his own writing? How do writing elements such as word choice, poetic devices, tone, style, and other literary techniques help to convey emotion, theme, and meaning?

• Select 3-5 narrative passages that best express Kalanithi’s ability to use language in effective and poetic ways. Choose your selections from a variety of places in the text.
• In your notes or a reading journal, draw a chart with rows for each passage and columns for analysis of each.
• After noting or citing the passage in your chart, analyze each passage by these criteria:

o Column 1: Poetic/Literary devices. Note the use of any metaphorical language, figurative language (such as sensory imagery), and sound devices (like alliteration or onomatopoeia) in the passage. Explain the literal meaning; note the impact on the reader.

o Column 2: Theme. Note the strongest theme connection to the passage. How does the passage help to develop the theme, or to connect the theme to surrounding events in the text?

o Column 3: Reader impact. Note ways in which the passage impacts the reading experience: Does word choice or tone change or affect the mood? Does sentence length, syntax, or construction affect the reading pace?

After analyzing the passages you selected, share one with a small group or the class and summarize, based on your notes, how the language of the passage contributes to Kalanithi’s overall message.

Teaching Suggestion: It may be helpful to review or provide a refresher list of key literary and poetry devices with definitions and examples. For an activity that focuses on oral communication skills, students might offer 1-2 passages aloud along with brief analytical comments. Additional comments or other viewpoints might be contributed by other readers, in the format of Socratic discussion. In this alternative activity, it might be helpful to list the suggested “columns” on the board for quick reference.

Differentiation Suggestion: For an approach or extension that focuses on additional poetry analysis and creative writing, students might summarize the strongest idea of a passage in their own words, then communicate that idea in a short free verse or micro poem. 

Use these essay questions as writing and critical thinking exercises for all levels of writers, and to build their literary analysis skills by requiring textual references throughout the essay.

Differentiation Suggestion: For English learners or struggling writers, strategies that work well include graphic organizers, sentence frames or starters, group work, or oral responses.

Scaffolded Essay Questions

Student Prompt: Write a short (1-3 paragraph) response using one of the bulleted outlines below. Cite details from the text over the course of your response that serve as examples and support.

1. In Part 1, Section 4, Paul presents the following question: “What makes life meaningful enough to go on living?”

• How does When Breath Becomes Air offer an answer to that question? (topic sentence)
• Analyze and discuss in at least 3 points how the memoir grapples with what makes a meaningful life and how it derives an answer. Cite direct quotes from the memoir to support your thoughts.
• In your concluding sentences, briefly explain how the quote above connects to the theme of The Meaning of Death and/or The Future.

2. When Breath Becomes Air is divided into two parts: Part 1 explores Paul’s early life, education, residence, and diagnosis. Part 2 focuses on Paul’s battle with cancer.

• How does Paul’s choice to organize his memoir into these two parts impact the messages Paul explores in the text? (topic sentence)
• Analyze and discuss the relationship between Part 1 and Part 2. Consider not only the distinctions between the parts but also the ways in which they supplement each other and work together to create meaning and convey Paul’s messages. Cite direct evidence from each part to support your points.
• In your concluding sentences, consider how the book’s organization helps develop a particular theme or themes.

Full Essay Assignments

Student Prompt: Write a structured and well-developed essay. Include a thesis statement, at least three main points supported by text details, and a conclusion.

1. Consider the role of the Epilogue in the memoir. How does the Epilogue, written by Lucy, interact with Paul’s own words? In what ways does the Epilogue supplement Paul’s thoughts and experiences as told by him, and/or in what ways does it emphasize the fact that Paul’s life, and his writing, was cut short? Analyze how this text structure helps develop one of the unit’s main themes. As you compose your essay, include citations from both the Epilogue and the main text to strengthen your thoughts.

2. Analyze the development of the theme of The Patient-Doctor Dichotomy. As a surgeon with terminal cancer, Paul exists in the worlds of both patient and doctor. How does Paul navigate these dual identities? In what ways does Paul’s medical background help him make sense of his cancer, and in what ways might his experience as a doctor complicate it? How do Paul and Emma work together as not only doctor and patient but as colleagues, and how does their relationship evolve throughout Paul’s illness? As you compose your essay, cite direct evidence from the text to strengthen your points of discussion.

Multiple Choice and Long Answer Questions create ideal opportunities for whole-text review, exams, or summative assessments.

Multiple Choice

1. What was Paul’s mother most anxious about upon the family’s move to Arizona?

A) Rattlesnakes

B) Her children’s futures

C) The weather

D) Feeling isolated

2. What poem most profoundly impacted Paul in the first half of his undergraduate experience?

A) T. S. Eliot’s “The Waste Land”

B) Walt Whitman’s “Song of Myself”

C) Emily Dickinson’s “If I Could Not Stop For Death”

D) John Donne’s “Death Be Not Proud”

3. In Part 1, Section 4, what is emphasized by describing the premature twins as looking “like tiny birds fallen too soon from a nest?”

A) Their not-yet-opened eyes

B) Their small size

C) Their under-development

D) Their resemblance to each other

4. Which of the following ideas best describes Paul’s experience as a medical student observing the interaction between the surgeon and the patient Claire’s parents?

A) Confusing

B) Worrying

C) Frustrating

D) Clarifying

5. Which of the following passages best shows how proximity to death impacted Paul and his fellow surgical residents?

A) “But some days, like a humid muggy day, it had a suffocating weight of its own.”

B) “As residents, we were working as much as one hundred hours a week.”

C) “As my skills increased, so too did my responsibility.”

D) “As an intern in the first year of residency, one is little more than a paper pusher against a backdrop of life and death.”

6. The phrase used in Part 1, Section 7, “one who endures hardship without complaint,” is an early meaning of which of the following words?

A) Surgeon

B) Supporter

C) Patient

D) Nurse

7. Which literary device is shown in the following passage from Part 1, Section 9: “I could only imagine the overwhelming guilt, like a tidal wave, that had lifted him up and off that building.”

A) Personification

B) Allusion

C) Symbolism

D) Simile

8. Which of the following best defines the word “monolithic” as used in the following sentence from Part 2, Section 3: “The monolithic uncertainty of my future was deadening; everywhere I turned, the shadow of death obscured the meaning of any action.”

A) Immovable

B) Impermanent

C) Miniscule

D) Frightening

9. Which word from the following passage from Part 2, Section 5 best explains the meaning of the word “hubris” as used in the quote: “My own hubris as a surgeon stood naked to me now: as much as I focused on my responsibility and power over patients’ lives, it was a best a temporary responsibility, a fleeting power.”

A) Naked

B) Responsibility

C) Temporary

D) Power

10. Which of the following best describes the focus on Part 2, Section 6, when Paul’s parents come to visit?

A) The difficulties of returning to work as a surgeon

B) The relationship between science and religion

C) The role that literature plays in Paul’s worldview

D) The ways in which chronic illness impact marriage

11. What best describes Paul’s initial reaction to seeing the new tumor on his last CT scan of the residency?

A) Angry

B) Scared

C) Unmoved

D) Indifferent

12. Which of the following best explains the context for this passage in Part 2, Section 7: “The morning passed, and I scrubbed for my last case. Suddenly the moment felt enormous.”

A) Paul wonders if this will be his last surgery because of the new tumor.

B) Paul is nervous because the surgery is particularly complicated.

C) Paul is anxious because he is feeling weak and exhausted.

D) Paul has been reflecting on the intersection between surgery and spirituality.

13. What best describes the tone of Part 2, Section 7, when Paul receives his last CT scan of the residency and goes to work the following day?

A) Angry

B) Bitter

C) Sorrowful

D) Optimistic

14. What best describes Paul’s interaction with the resident as they discuss the resident’s decision to take Paul off Tarceva?

A) Reasonable

B) Argumentative

C) Compassionate

D) Collaborative

15. What best describes the tone of the Epilogue, as Lucy reflects on Paul’s life, illness, and death?

A) Heartbroken

B) Despondent

C) Resigned

D) Admiring

Long Answer

Compose a response of 2-3 sentences, incorporating text details to support your response.

1. What is the story of Mrs. Lee and her husband, and what purpose does this anecdote serve in the bigger narrative?

2. What does Paul begin to understand about the role of a surgeon in a patient’s recovery, and how does he apply this to his own patient/surgeon relationship with Emma?