When Breath Becomes Air

by Paul Kalanithi

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

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

And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise. Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation.

Any major illness transforms a patient’s—really, an entire family’s—life.

Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it’s something that happens to you and those around you.

If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live. —Michel de Montaigne, “That to Study Philosophy Is to Learn to Die”

I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced.

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.