When Breath Becomes Air

by Paul Kalanithi

I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.

brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.

Where did biology, morality, literature, and philosophy intersect?

What makes life meaningful enough to go on living?

it

is irresponsible to be more precise than you can be accurate.

meanings of patient, after all, is “one who endures hardship without complaint.”)

You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

If the weight of mortality does not grow

lighter, does it at least get more familiar?

life wasn’t about avoiding suffering.

defining characteristic of the organism is striving.

The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.

“Denial → Anger → Bargaining → Depression → Acceptance” cliché—but

Science is based on reproducibility and manufactured objectivity. As strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable.

Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.

Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them, where, as at the end of that Sunday’s reading, the sower and reaper can rejoice together. For here the saying is verified that “One sows and another reaps.” I sent you to reap what you have not worked for; others have done the work, and you are sharing the fruits of their work.

If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: the days have shortened considerably.

that life was lived in the first twenty years and the remainder was just reflection.

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past.

The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after wind, indeed. Yet

the urgency of racing against time, of having important things to say.

Dying in one’s fourth decade is unusual now, but dying is

His strength was defined by ambition and effort, but also by softness, the opposite of bitterness.

“Always the seer is a sayer,” Emerson wrote.

“Somehow his dream is told; somehow he publishes it with solemn joy.”

one trick to managing a terminal illness is to be deeply in love—to be vulnerable, kind, generous, grateful.

trick to managing a terminal illness is to be deeply in love—to be vulnerable, kind, generous, grateful.

“I will share your joy and sorrow / Till we’ve seen this journey through.”

have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love. Relying on his own strength and the support of his family and community, Paul faced each stage of his illness with grace—not with bravado or a misguided faith that he would “overcome” or “beat” cancer but with an authenticity that allowed him to grieve the loss of the future he had planned and forge a new one.

He let himself be open and vulnerable, let himself be comforted.

Parallel to this story are the love and warmth and spaciousness and radical permission that surrounded him.

We all inhabit different selves in space and time.

frail but never weak.

allowed him to live with hope, with that delicate alchemy of agency and opportunity that he writes about so eloquently, until the very end.

“We shall rise insensibly, and reach the tops of the everlasting hills, where the winds are cool and the sight is glorious.”

the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this.

“Bereavement is not the truncation of married love,”

one of its regular phases—like the honeymoon. What we want is to live our marriage well and faithfully through that phase too.”

“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

“Who would true valour see, / Let him come hither…/ Then

fancies fly away, / He’ll fear not what men say, / He’ll labour night and day / To be a pilgrim.”