When Breath Becomes Air

When Breath Becomes Air

You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! then make time, while you be,
But steps to your eternity.

—Baron Brooke Fulke Greville, “Caelica 83”

At age 36, Paul Kalanithi was diagnosed with terminal cancer. As a young neurosurgeon at the cusp of a promising career, he was forced to face the question of what makes life truly meaningful. More than a decade prior, as a literature student in Stanford, he explored language as a means to connect the Physiological & the Spiritual. 

"There must be a way, I thought, that the language of life as experienced – – of passion, hunger, of love – – bore some relationship, however convoluted, to the language of neurons, digestive tracks, and heartbeats."

He wrote this book in his dying days, with a melancholic yet determined search to answer deeper questions for himself and to help people understand what really matters when facing the only certainty in life.  

“Severe illness wasn’t life altering, it was life shattering. It felt less like an epiphany, a piercing burst of light illuminating what really matters, and more like someone had just firebombed the path forward. Now I would have to work around it.”

Prior to his diagnosis, he was driven by a need to find his place in the world, and meaning that he felt would come with it. As he comes to the completion of his training, the health problems he initially brushed aside become more and more acute, and a diagnosis confirms his intuition that things were more serious than he thought. The sacrifices that he had made in pursuit of his sense of self started to unravel as his time horizons started to shrink. 

"I could see a nice catamaran on the sea that Lucy, our hypothetical children, and I would take out on the weekends. I could see myself finally becoming the husband I had promised to be." 

As he progressed through his treatment, he was struck by how misguided his priorities in life were. While the mission of wanting to transform neurosurgery through his research was noble to him, the cost to those he loved became evident.
He was forced to confront the reality of the present, as opposed to the hypothetical future by both his sickness and his primary doctor, Emma. She played a pivotal role in the remainder of his life, providing him a balance of both the medical options available and how they would relate to his deeper identity.  

"The physicians duty is not to starve off death or return patients to their old lives, but to take int out 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. Emma hadn't given my back my old identity. She'd protected my ability to forge a new one."


There is a brief moment where it seems like the cancer can be treated, and he gradually returns to performing surgeries. That sliver of hope was dashed when a large tumor was discovered in his lungs, and he had to give up his work for good.


"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."

As his strength faded, he missed his graduation and became bedridden. His wife gave birth to a girl, Elizabeth, who filled him with joy, even as he slipped away. The book ends abruptly with a moving epilogue written by his wife, on her own journey towards his finality. 

One lasting idea that is particularly applicable to an increasingly quantified world is that data and language are abstractions of truth, and what is lost is the precious meaning that they would have imbued us with if only we listened. The fullness of human experience will never be described, and there is tremendous beauty in surrendering to the mystery of it all. 

"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.

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.


Between these core passions and scientific theory, there will always be a gap. No system of thought can contain the fullness of human experience."

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When Breath Becomes Air - Paul Kalanithi