When Breath Becomes Air

by Paul Kalanithi

“How Long Have I Got Left?” in The New York Times,

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it was a love and empathy for those who suffered, for what they endured and what he might bring to bear.

see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.

“I need you,” I whispered. “I will never leave you,” she said.

Having people there for you in your dark moments.....gives alittle hope

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

Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection.

I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them.

How We Die,

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Maybe Beckett’s Pozzo is right. Maybe life is merely an “instant,” too brief to consider.

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

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?

As a resident, my highest ideal was not saving lives—everyone dies eventually—but guiding a patient or family to an understanding of death or illness.

had met her in a space where she was a person, instead of a problem to be solved.

Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it.

“do you think my life has meaning? Did I make the right choices?”

Neurosurgery requires a commitment to one’s own excellence and a commitment to another’s identity.

Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms.

Even if you are perfect, the world isn’t.

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

My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close.

I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.

It occurred to me that my relationship with statistics changed as soon as I became one.

Getting too deeply into statistics is like trying to quench a thirst with salty water.

The angst of facing mortality has no remedy in probability.

If the weight of mortality does not grow lighter, does it at least get more familiar?

I was starting to see death as both doctor and patient.

I had passed from the subject to the direct object of every sentence of my life.

life wasn’t about avoiding suffering.

We would carry on living, instead of dying.

I’ll go on.

“I can’t go on. I’ll go on.”

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.

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.

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.

“We all have a notion of what it means to be good, and we can’t live up to it all the time.”

it cannot be doubted that each of us can see only a part of the picture.

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.

Doctors, it turns out, need hope, too.

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

I plod, I ponder. Some days, I simply persist.

Graham Greene once said that life was lived in the first twenty years and the remainder was just reflection.

Words have a longevity I do not.

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.

“I want everyone to know that even if I don’t see them, I love them. I cherish their friendship, and one more glass of Ardbeg won’t change that.”

he turned toward me and whispered, “This might be how it ends.” “I’m here with you,” I said.

“Always the seer is a sayer,”

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.”

Such simple moments swelled with grace and beauty, and even luck, if such a concept can be said to exist at all.

we did feel lucky, grateful—for family,

frail but never weak.