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“All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private.” (When Breath Becomes Air Quotes)
Paul Kalanithi
When Breath Becomes Air
“Any major illness transforms a patient’s – really, an entire family’s – life. But brain diseases have the additional strangeness of the esoteric.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“As an intern in the first year of residency, one is little more than a paper pusher against a backdrop of life and death – though, even then, the workload is enormous.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.”
Paul Kalanithi
When Breath Becomes Air
“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?”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“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. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.”
Paul Kalanithi
When Breath Becomes Air
“Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escort them into the world, and then back out.”
Paul Kalanithi
When Breath Becomes Air
“Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinging to the same raft, caught in the same tide.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“How little do doctors understand the hells through which we put patients.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of the living. We are never so wise as when we live in the moment.”
Paul Kalanithi
When Breath Becomes Air
“I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. 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.”
Paul Kalanithi
When Breath Becomes Air
“I was compelled by neurosurgery, with its unforgiving call to perfection. Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: neurosurgery, ICU medicine, neurology, radiology. Not only would I have to train my mind and hands, I realized; I’d have to train my eyes, and perhaps other organs as well. The idea was overwhelming and intoxicating: perhaps I, too, could join the ranks of these polymaths who strode into the densest thicket of emotional, scientific, and spiritual problems and found, or carved, ways out.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“If the unexamined life was not worth living, was the unlived life worth examining?”
Paul Kalanithi
When Breath Becomes Air
“Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job — not a calling.”
Paul Kalanithi
When Breath Becomes Air
“Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.”
Paul Kalanithi
When Breath Becomes Air
“Moral duty has weight, things that have weight have gravity, and so the duty to bear mortal responsibility pulled me back into the operating room.”
Paul Kalanithi
When Breath Becomes Air
“Moral speculation was puny compared to moral action.”
Paul Kalanithi
When Breath Becomes Air
“Our patients’ lives 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.”
Paul Kalanithi
When Breath Becomes Air
“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. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“Science, I had come to learn, is as political, competitive, and fierce a career as you can find, full of the temptation to find easy paths.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“The defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes.”
Paul Kalanithi
When Breath Becomes Air
“The funny thing about time in the OR, whether you race frenetically or proceed steadily, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, then surgery felt like the opposite: the intense focus made the arms of the clock seem arbitrarily placed. Two hours could feel like a minute. Once the final stitch was placed and the wound was dressed, normal time suddenly restarted. You could almost hear an audible whoosh.”
Paul Kalanithi
When Breath Becomes Air
“The pain of failure had led me to understand that technical excellence was a moral requirement. Good intentions were not enough, not when so much depended on my skills, when the difference between tragedy and triumph was defined by one or two millimeters.”
Paul Kalanithi
When Breath Becomes Air
“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”
Paul Kalanithi
When Breath Becomes Air
“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. That’s not to say that if you believe in meaning, you must also believe in God. It is to say, though, that if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn’t have any. In other words, existential claims have no weight; all knowledge is scientific knowledge.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“We shall rise insensibly, and reach the tops of the everlasting hills, where the winds are cool and the sight is glorious.”
Paul Kalanithi
When Breath Becomes Air
“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.”
Paul Kalanithi
When Breath Becomes Air
“When there’s no place for the scalpel, words are the surgeon’s only tool.”
Paul Kalanithi
When Breath Becomes Air
“While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves.”
Paul Kalanithi
When Breath Becomes Air
“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
Paul Kalanithi
When Breath Becomes Air
