When Breath Becomes Air

by Paul Kalanithi

In the ensuing days, it spread exponentially. (I’m an infectious diseases specialist, so please forgive me for not using the word viral as a metaphor.)

LOL as a virologist, I get it XD

In a world of asynchronous communication, where we are so often buried in our screens, our gaze rooted to the rectangular objects buzzing in our hands, our attention consumed by ephemera, stop and experience this dialogue with my young departed colleague, now ageless and extant in memory.

Okay this hits

Listen to Paul. In the silences between his words, listen to what you have to say back. Therein lies his message. I got it. I hope you experience it, too. It is a gift.

Keeps hitting. What a Foreward.

And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.

This hits me deeply with all the uncertainty in science right now. It is nowhere near the same. But my heart feels it

For fun, when my friends and I discovered a wolf spider’s nest, we’d drop an ant onto its outer limits and watch as its entangled escape attempts sent quivers down the silk strands, into the spider’s dark central hole, anticipating that fatal moment when the spider would burst from its hollows and seize the doomed ant in its mandibles.

Boys Bugs and Men vibes here. Just saying.

We are never so wise as when we live in this moment.

Deep shit from english PhD friends

You would think that the first time you cut up a dead person, you’d feel a bit funny about it. Strangely, though, everything feels normal.

Can confirm

The first birth I witnessed was also the first death.

Well that escalated quickly

could only think of Samuel Beckett, the metaphors that, in those twins, reached their terminal limit: “One day we were born, one day we shall die, the same day, the same second….Birth astride of a grave, the light gleams an instant, then it’s night once more.” I had stood next to “the grave digger” with his “forceps.” What had these lives amounted to?

Fuck man.

A match flickers but does not light.

Wow.

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

Brb going to cry

How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

I can't not think of my brothers. It's impossible for me not to

A pathologist, dying of pneumonia, wheezing her death rattle before heading down to be autopsied—her final trip to the pathology lab, where she had spent so many years of her life.

Chills. The circular nature of life and death

Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinging to the same raft, caught in the same tide.

"Drowning,even in blood" Slaps so hard

Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.

Poetry in prose

V was not like other scientists I knew. He was soft-spoken and cared deeply about people and the clinical mission, and he often confessed to me that he wished he’d been a surgeon himself. Science, I had come to learn, is as political, competitive, and fierce a career as you can find, full of the temptation to find easy paths.

I feel a little offended but I can also understand that these people do exist

Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

This hits

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.

Felt

a paralytic uncertainty loomed: Who would I be, going forward, and for how long?

Reminds me of the chorus in Turbulance by ATEEZ. "At the end of this road, where should we be? What should we become, in what form?"

Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.

Fucking snaps. Until I actually die, I'm still alive. Hotdamn.

“Or even the beginning of the end. This is just the end of the beginning.”

More ATEEZ references

“Look,” he continued, “if you weren’t you, we wouldn’t even be having this conversation. I’d just stop the drug and make you prove it causes all this pain.”

BIG BRAD ENERGY. FUCK THIS GUY AND HIS ARROGANCE

Some days, I simply persist.

The horrors persist but so do I

That message is simple: 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.

Brb crying

PAUL DIED ON MONDAY, March 9, 2015, surrounded by his family, in a hospital bed roughly two hundred yards from the labor and delivery ward where our daughter, Cady, had entered the world eight months before.

Rip. March 9, a sad day to many

He didn’t write anything that day. The manuscript for this book was only partially finished, and Paul now knew that he was unlikely to complete it—unlikely to have the stamina, the clarity, the time.

Crushing

Paul on a gurney this time, his parents close behind us, he turned toward me and whispered, “This might be how it ends.” “I’m here with you,” I said.

Okay actually tearing up

He looked at me, his dark eyes alert above the nose bridge of the BiPAP mask, and said clearly, his voice soft but unwavering, “I’m ready.” Ready, he meant, to remove the breathing support, to start morphine, to die.

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During the precious minutes after Paul’s decision, we all expressed our love and respect. Tears glistened in Paul’s eyes. He expressed gratitude to his parents. He asked us to ensure that his manuscript be published in some form. He told me a last time that he loved me.

Literal tears

He spent much of his life wrestling with the question of how to live a meaningful life, and his book explores that essential territory. “Always the seer is a sayer,” Emerson wrote. “Somehow his dream is told; somehow he publishes it with solemn joy.” Writing this book was a chance for this courageous seer to be a sayer, to teach us to face death with integrity.

Still openly crying

At home in bed a few weeks before he died, I asked him, “Can you breathe okay with my head on your chest like this?” His answer was “It’s the only way I know how to breathe.” That Paul and I formed part of the deep meaning of each other’s lives is one of the greatest blessings that has ever come to me.

STOP I CANT TAKE ANY MORE CRYING IN PUBLIC

Indeed, the version of Paul I miss most, more even than the robust, dazzling version with whom I first fell in love, is the beautiful, focused man he was in his last year, the Paul who wrote this book—frail but never weak.

Well I had stopped but now I am crying again

what Paul saw and what I now carry deep in my bones, too: the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this. What happened to Paul was tragic, but he was not a tragedy.

Tears

Two days after Paul died, I wrote a journal entry addressed to Cady: “When someone dies, people tend to say great things about him. Please know that all the wonderful things people are saying now about your dad are true. He really was that good and that brave.”

Stooop i cant take iittt