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When Breath becomes air
When Breath Becomes Air written by Paul Kalanithi, first published in Vintage in 2017. This book talks about the life of the neurosurgeon Paul Kalanithi, who was diagnosed with terminal lung cancer in his last years of residency training. The two medical issues from this book that I will discuss are lung cancer and neurosurgery.
Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs; usually in the cells that line the air passages (Medical News Today, 2016). These abnormal cells develop and grow to form tumors. Lung cancer is the leading cause of cancer-related mortality worldwide. Eighty to ninety percent of lung cancer cases occur in smokers (Duruisseaux and Esteller, 2018). Some of the risk factors include age, gender, genetics, ethnicity/race, and environmental risks.
There are two types of lung cancer, non-small cell lung cancer, and small cell lung cancer. Non-small cell lung cancer (NSCLC) accounts for 80% of lung cancers, while small cell lung cancer accounts for the remaining 20% (Medical News Today, 2016). There is a wide range of symptoms that lung cancer can present itself as, some of which are coughing, chest pain, back pain, shoulder pain, difficulty swallowing and breathing, coughing up blood, weight loss, fatigue, and general weakness. The most common imaging techniques used to diagnose lung cancer include chest X-rays, bronchoscopy, CT scans, MRI scans, and PET scans. However, extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose lung cancer (Medical News Today, 2016).
The next step would be to determine the stage of lung cancer; this is usually done by a cancer staging method called the TNM system. In non-small cell lung cancer there are five stages with increasing severity. However, in small cell lung cancer, there are only two stages, limited, where the tumor exist in one lung and nearby lymph nodes, and extensive, where the tumor has infected both lungs as well as other organs in the body.
Neurosurgery is the other medical issue discussed in When Breath Becomes Air. It is the medical specialty concerned with the diagnosis and treatment of patients with injury to, or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body (School of Medicine Neurological Surgery). Therefore a neurosurgeon treats diseases and disorders such as brain and other CNS tumors, cerebrovascular disorders, epilepsy, facial pain, head injuries, movement disorders, pediatric neurosurgical disorders, peripheral nerve problems, pituitary disease, spinal disease and injuries, Parkinson’s disease, stroke, as well as less familiar ones such as frontotemporal dementiasurgical.
One of the most rigorous training programs that exist in medicine is Neurosurgery residence (Pan and Mocco, 2018). Neurosurgeons will usually spend approximately 6-8 years in residency training. Overall it takes about 14 years to become a fully qualified and practicing neurosurgeon. It is a field which comes with a great deal of responsibility and requires intense dedication to detail from the neurosurgeon, therefore can take a mental, emotional, and physical toll on the person.
Women in the field of neurosurgery are a minority. The field of neurosurgery is mainly male-dominated. In 2008, 5.9% of practicing neurosurgeons and 10% of neurosurgical residents were women (Corley and Williamson, 2018). There have been some suggestions to the causes of this, some of which are gender inequities in regard to salaries, academic promotion, and achieving leadership positions within the specialty (ReachMD). But with time, this is slightly starting to change.
In conclusion, the book When Breath Becomes Air discussed two very serious and severe medical issues. They were lung cancer and the study of neurosurgery, both very physically and emotionally demanding and draining. In the book, it describes how these two medical issues can affect not only the person himself but everyone around him as well, from parents to family members, friends and colleagues. These two issues can completely change a person’s life. Lung cancer will dramatically affect and alter a person daily routine. There will be many visits to the hospital for all the required treatments as well as any unexpected complications. While for a neurosurgeon it will mainly affect his social life, this is his relationships with the people around him outside of work. Although only two out of the many medical or scientific issues, were discussed in the book, it has raised my awareness of the responsibilities and difficulties both a patient and a physician may experience.

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