When Breath Becomes Air by Paul Kalanithi - Book Summary

When Breath Becomes Air is a memoir written by Dr. Paul Kalanithi, a neurosurgeon who was diagnosed with cancer. This was one of the books that had a profound impact on how I viewed death, especially as someone in the medical field. His memoir teaches us about the relationship between chance, life and death.

Take-Home Message

In this book, Paul explains his life-changing experience of being a doctor, treating patients to being treated as a patient. He explains in his story what it means to live and die.

My Highlights

• 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? Though we had free will, we were also biological organisms—the brain was an organ, subject to all the laws of physics, too! Literature provided a rich account of human meaning; the brain, then, was the machinery that somehow enabled it.
• What makes human life meaningful? I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.
• Meaning, while a slippery concept, seemed inextricable from human relationships and moral values.
• 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.
• But I couldn’t quite let go of the question: Where did biology, morality, literature, and philosophy intersect?
• It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action.
• Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.
• But now the lurking possibility that we would have to employ these skills someday animated everything.
• In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.
• 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. Seeing the body as matter and mechanism is the flip side to easing the most profound human suffering. By the same token, the most profound human suffering becomes a mere pedagogical tool.
• Few books I had read so directly and wholly addressed that fundamental fact of existence: all organisms, whether goldfish or grandchild, die.
• What had not changed, though, was the heroic spirit of responsibility amid blood and failure. This struck me as the true image of a doctor.
• 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.
• 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, and every conversation with a patient undergoing brain surgery cannot help but confront this fact.
• 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?
• From that point on, I resolved to treat all my paperwork as patients, and not vice versa.
• I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking.
• I wondered if, in my brief time as a physician, I had made more moral slides than strides.
• I 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.
• Amid the tragedies and failures, I feared I was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient.
• 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.
• When there’s no place for the scalpel, words are the surgeon’s only tool.
• I had met her in a space where she was a person, instead of a problem to be solved.
• After surgery, we talked again, this time discussing chemo, radiation, and prognosis. By this point, I had learned a couple of basic rules.
• First, detailed statistics are for research halls, not hospital rooms.
• Second, it is important to be accurate, but you must always leave some room for hope.
• “Well, I guess I learned one thing: if I’m ever feeling down about my work, I can always talk to a neurosurgeon to cheer myself up.”
• 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.
• Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.
• 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.
• How little do doctors understand the hells through which we put patients.
• The pain of failure had led me to understand that technical excellence was a moral requirement.
• After someone suffers a head trauma or a stroke, the destruction of these areas often restrains the surgeon’s impulse to save a life: What kind of life exists without language?
• Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms.
• But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life.
• Our patients’ lives and identities may be in our hands, yet death always wins.
• Severe illness wasn’t life-altering, it was life-shattering.
• 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.
• how I approached neurosurgery: have a plan A, B, and C at all times.
• The fact of death is unsettling. Yet there is no other way to live.
• The angst of facing mortality has no remedy in probability.
• Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving.
• After so many years of living with death, I’d come to understand that the easiest death wasn’t necessarily the best.
• 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.
• 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.
• 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.
• Doctors, it turns out, need hope, too.
• Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after wind, indeed.
• Paul confronted death—examined it, wrestled with it, accepted it—as a physician and a patient.
• one trick to managing a terminal illness is to be deeply in love—to be vulnerable, kind, generous, grateful.
• What happened to Paul was tragic, but he was not a tragedy.
• You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

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