When Breath Becomes Air

by Paul Kalanithi

If the unexamined life was not worth living, was the unlived life worth examining?

In other words, I could either study meaning or I could experience it.

No philosopher can explain the sublime better than this, standing between day and

night. It was as if this were the moment God said, “Let there be light!” You

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.

Only later would I realize that our trip had added a new dimension to my understanding of the fact that brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.

There must be a way, I thought, that the language of life as experienced—of passion, of hunger, of love—bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats.

“the Physiological-Spiritual Man.”

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

literature. But it would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.

where I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them.

exercise. Everything teeters between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito.

On that first day, you simply could not deny the humanity of the corpse.

in the end, becomes less a violation of the sacred and more something that interferes with happy hour, and that realization discomfits.

Somehow, I had to believe, I would gain not only knowledge but wisdom,

At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living.

Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant

The idea was overwhelming and intoxicating: perhaps I, too, could join the ranks of these polymaths who strode into the densest thicket of emotional, scientific, and spiritual problems and found, or carved, ways out.

Before he became delirious, he looked up at me and said, “It’s not fair—I’ve been diluting my drinks with water.”

The twilight existence of unconscious metabolism becomes an unbearable burden, usually left to an institution, where the family, unable to attain closure, visits with increasing rarity, until the inevitable fatal bedsore or pneumonia sets in. Some insist on this life and embrace its possibility, eyes open. But many do not, or cannot, and the neurosurgeon must learn to adjudicate.

I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking.

intertwining of brain and consciousness as for its intertwinin...

I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun.

I wondered if, in my brief time as a physician, I had made more moral slides than strides.

I feared I was on the way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focused on the rote treatment of disease—and utterly missing the larger human significance.

acted not, as I most often did, as death’s enemy, but as its ambassador. I had to help those families understand that the

wondering why I did this work, or whether it was worth it.

The implications of writing signals into the brain, or “neuromodulation,”

able to control neural firing would conceivably allow treatment of a host of currently untreatable or intractable neurological and psychiatric

If boredom is, as Heidegger argued, the awareness of time passing, then surgery felt like the opposite:

felt to me as if the individual strands of biology, morality, life, and death were finally beginning to weave themselves into, if not a perfect moral system, a coherent worldview and a sense of my place in it.

It felt less like an epiphany—a piercing burst of light, illuminating What Really Matters—and more like someone had just firebombed the path forward.

Death, so familiar to me in my work, was now paying a personal visit.

Could we divide the curve into existential sections, from “defeated” to “pessimistic” to “realistic” to “hopeful” to “delusional”?

Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting

She had done what I had challenged myself to do as a doctor years earlier: accepted mortal responsibility for my soul and returned me to a point where I could return to myself. I

The problem, however, eventually became evident: to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning—to consider a world that is self-evidently not the world we live in.

In other words, existential claims have no weight; all knowledge is scientific knowledge.

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.

Looking out over the expanse ahead I saw not an empty wasteland but something simpler: a blank page on which I would go on.

When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.

What happened to Paul was tragic, but he was not a tragedy.