When Breath Becomes Air

by Paul Kalanithi

The trick, I discovered, was to read it aloud,

Why was I so authoritative in a surgeon’s coat but so meek in a patient’s gown?

She was upset because I’d promised her one life, and given her another.

“It’s very easy to be number one: find the guy who is number one, and score one point higher than he does.”

for every country fact that seemed preposterous, there was one that felt solid and true. Always check your shoes for scorpions, for example, seemed plain good sense.

Brave New World founded my nascent moral philosophy and became the subject of my college admissions essay, in which I argued that happiness was not the point of life.

However, it did make the throwaway assumption that the mind was simply the operation of the brain, an idea that struck me with force; it startled my naïve understanding of the world. Of course, it must be true—what were our brains doing, otherwise?

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

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.

A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form.

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.

but at least the ways in which he’d failed were illuminating.

because most English PhDs reacted to science, as he put it, “like apes to fire, with sheer terror.”

But hadn’t Whitman himself written that only the physician could truly understand “the Physiological-Spiritual Man”?

medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action.

The scalpel is so sharp it doesn’t so much cut the skin as unzip it, revealing the hidden and forbidden sinew beneath, and despite your preparation, you are caught unawares, ashamed and excited. Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feelings: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the mere tedium of academic exercise.

pathos

ba...

Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.

Cadavers reverse the polarity. The mannequins you pretend are real; the cadavers you pretend are fake. But

Prosopagnosia is a neurological disorder wherein one loses the ability to see faces. Pretty

I told this story as if to distance myself from it, but my kinship was undeniable.

(Students no longer had to bring their own bodies, for starters, as they did in the nineteenth century. And medical schools had discontinued their support of the practice of robbing graves to procure cadavers—that looting itself a vast improvement over murder, a means once common enough to warrant its own verb: burke, which the OED defines as “to kill secretly by suffocation or strangulation, or for the purpose of selling the victim’s body for dissection.”)

“You wouldn’t tell a patient the gory details of a surgery if that would make them not consent.”

In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.

Seeing the body as matter and mechanism is the flip side to easing the most profound human suffering.

“Let no man put asunder what God has joined,” the attending said. “At least, no more than temporarily. I like to leave things the way I found them—let’s sew it back

Putting lifestyle first is how you find a job—not a calling.)

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.

was not yet with patients in their pivotal moments, I was merely at those pivotal moments.

labile,

gurney,

inexorable.

formalism,

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

A tureen of tragedy was best allotted by the spoonful.

prognosis—

came to believe that it is irresponsible to be more precise than you can be accurate.

apse;

narthex

n...

ineluctable

He paused. “Paul,” he said, “do you think my life has meaning? Did I make the right choices?” It was stunning: even someone I considered a moral exemplar had these questions in the face of mortality.

A chief resident will advise a junior, “Learn to be fast now. You can learn to be good later.”

the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins.

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

The pain of failure had led me to understand that technical excellence was a moral requirement.

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. PART II Cease Not till Death

Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable.