When Breath Becomes Air

by Paul Kalanithi

Out of his pen he was spinning gold.

She made me read 1984 when I was ten years old; I was scandalized by the sex, but it also instilled in me a deep love of, and care for, language.

Books became my closest confidants, finely ground lenses providing new views of the world.

Literature provided a rich account of human meaning; the brain, then, was the machinery that somehow enabled it. It seemed like magic.

What makes human life meaningful?

Nabokov, for his awareness of how our suffering can make us callous to the obvious suffering of another.

Conrad, for his hypertuned sense of how miscommunication between people can so profoundly impact their lives.

Literature not only illuminated another’s experience, it provided, I believed, the richest ma...

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

brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.

Yet the best-informed people—doctors—almost never donated their bodies. How informed were the donors, then?

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

It was the thought of your mother, your father, your grandparents being hacked to pieces by wisecracking twenty-two-year-old medical students.

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

feared I was on the way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focused on the rote treatment of disease—and utterly missing the larger human significance.

volition

The armament varies, from prayer to wealth to herbs to stem cells.

hardness always seems brittle, unrealistic optimism the only alternative to crushing despair. In any case, in the immediacy of surgery, a warlike attitude fit.

Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.

Yet openness to human relationality also carried a price.

The call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness.

The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt.

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

The most rigorous and prestigious path is that of the neurosurgeon-neuroscientist.

It was stunning: even someone I considered a moral exemplar had these questions in the face of mortality.

The funny thing about time in the OR, whether you race frenetically or proceed steadily, is that you have no sense of it passing.

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

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.

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.

The man who loved hiking, camping, and running, who expressed his love through gigantic hugs, who threw his giggling niece high in the air—that was a man I no longer was. At best, I could aim to be him again.

Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death, to rebuild my old life—or perhaps find a new one.

As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know. It’s like falling in love or having a kid. You don’t appreciate the mounds of paperwork that come along with it, or the little things.

Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving.

the easiest death wasn’t necessarily the best.

Even in having children in this new life, death played its part.

the future that was no longer mine: early career awards, promotions, new houses.

death? What better way to understand it than to live

The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language.

You might not make it, but it’s not crazy.”

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.

Death may be a one-time event, but living with terminal illness is a process.

amicably,

“The disease looks stable, maybe even slightly shrinking.”

Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly

reducing the amount you can squeeze into a day.

Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line.

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after wind, indeed.

There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.

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.