When Breath Becomes Air

by Paul Kalanithi

(Alexander Pope: “A little learning is a dangerous thing; / Drink deep, or taste not the Pierian spring.”)

“On our list of things to worry about,” I said, with a laugh, “I think that’s in the bottom quartile.”

What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find on her own. 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.

“Don’t you get it?” she said, taking my hand in hers. “If we’re the best at this, that means it doesn’t get better than this.” If the

prognosis,

They tell me that this happens to everybody, but even after eleven years in medicine, I had never known.

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

I felt trapped inside a reversed Christmas carol:

meaning

cogitate

prognostication:

Death may be a one-time event, but living with terminal illness is a process. It struck me that I had traversed the five stages of grief—the “Denial → Anger → Bargaining → Depression → Acceptance” cliché—but I had done it all backward.

There is no proof of God; therefore, it is unreasonable to believe in God.

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.

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.

The favorite quote of many an atheist, from the Nobel Prize–winning French biologist Jacques Monod, belies this revelatory aspect: “The ancient covenant is in pieces; man at last knows that he is alone in the unfeeling immensity of the universe, out of which he emerged only by chance.”

There is a tension in the Bible between justice and mercy, between the Old Testament and the New Testament. And the New Testament says you can never be good enough: goodness is the thing, and you can never live up to it. The main message of Jesus, I believed, is that mercy trumps justice every time.

but the basic reality of human life stands compellingly against blind determinism.

In medicine, this is known as the WICOS problem: Who Is the Captain Of the Ship?

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

finitude.

pluperfect

“The good news is I’ve already outlived two Brontës, Keats, and Stephen Crane. The bad news is that I haven’t written anything.”