When Breath Becomes Air

By: Paul Kalanithi

At sixteen, I nearly died from a mosquito bite that resulted in this profound realization of time's value and the fragility of life. No event echoes louder through my days. Yet, I still often get caught up in trivial and lose sight of the remarkable opportunity of being. Reading When Breath Becomes Air is like going through that realization for the first time all over again.

The book's written by cancer-ridden neurosurgeon Paul Kalanithi, a gifted thinker and wordsmith dying as the medical career he put a decade of devoted preparation into is about to begin. It's a gift, wholeheartedly cast back to the living, from a dying man.

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Throughout college, my monastic, scholarly study of human meaning would conflict with my urge to forge and strengthen human relationships that formed that meaning. If the unexamined life was not worth living, was the unlived life worth examining?
— Paul Kalanithi
I spent the next year in classrooms in the English countryside, where I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them. Stepping back, I realize that I was confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue serious biological philosophy. Moral speculation was puny compared to moral action.
— Paul Kalanithi
Indeed this is how 99% 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
Had the confirmation of my fears—the CT scan, in the lab results, both showing not merely cancer but a body overwhelmed, nearing death—released me from the duty to serve, from my duty to patients, to neurosurgery, to the pursuit of goodness? Yes, I thought, and therein was the paradox: like a runner crossing the finish line only to collapse, without that duty to care for the ill pushing me forward, I became an invalid.
— Paul Kalanithi
“Don’t you think saying goodbye to your child will make your death more painful?” “Wouldn’t it be great if it did?” I said. Lucy and I both felt that life wasn’t about avoiding suffering. Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes. After so many years of living with death, I’d come to understand that the easiest death wasn’t necessarily the best.
— Paul Kalanithi
During the pastor’s scripture reading, I suddenly found myself chuckling. It featured a frustrated Jesus whose metaphorical language receives little interpretation from his followers.
— Paul Kalanithi
We build scientific theories to organize and manipulate the world, to reduce phenomena to manageable units. Science is based upon reproducibility and manufactured objectivity. As strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable. 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
In the end, it cannot be doubted that each of us can see only a part of the picture. The doctor sees one, the patient sees another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth. Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and is still never complete. And Truth comes somewhere above all of them.
— Paul Kalanithi
… two people huddled together, as one faces the abyss.
— Paul Kalanithi
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 in life, flattens out into a perpetual present. Money, status, all the vanities the preacher Ecclesiastes described hold so little interest: a chasing after wind, indeed.
— Paul Kalanithi

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