The Book in Three Sentences

The memoir of Paul Kalanithi, a neurosurgeon at Stanford University, who is diagnosed with terminal lung cancer in his mid-thirties. Kalanithi uses the pages in this book to not only tell his story, but also share his ideas on how to approach death with grace and what it means to be fully alive.

When Breath Becomes Air summary

This is my book summary of When Breath Becomes Air by Paul Kalanithi. My notes are informal and often contain quotes from the book as well as my own thoughts. This summary includes key lessons and important passages from the book.

  • On the suffering that often accompanies death: “With what strife and pains we come into the world we know not, but ’tis commonly no easy matter to get out of it.” -Sir Thomas Browne, Religio Medici
  • I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context.
  • 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?
  • Learning to judge whose lives could be saved, whose couldn’t be, and whose shouldn’t be requires an unattainable prognostic ability. I made mistakes. Rushing a patient to the OR to save only enough brain that his heart beats but he can never speak, he eats through a tube, and he is condemned to an existence he would never want… I came to see this as a more egregious failure than the patient dying.
  • 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.
  • One of the earliest meanings of the word “patient” is “one who endures hardship without complaint.”
  • When you take up another’s cross, you must be willing to sometimes get crushed by its weight.
  • “Boredom is the awareness of time passing.” -Heidegger
  • The pain of failure had led me to understand that in neurosurgery 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.
  • Death comes for all of us. It is our fate as living, breathing, metabolizing organisms.
  • Dealing with the fact of death is unsettling. Yet there is no other way to live.
  • Can we become comfortable with the most uncomfortable thing in the world—death? If the weight of mortality does not grow lighter, does it at least grow more familiar?
  • As a doctor, I was an object, a cause. As a patient, I was merely something to which things happened.
  • Life isn’t about avoiding suffering. The defining characteristic of an organism is striving.
  • “Even if I’m dying, until I actually die, I’m still living.”
  • The tricky thing about terminal illness (and life, probably) is your values are constantly changing. You try to figure out what matters to you and then you keep figuring it out.
  • How do you decide what to do with your life when you’re not sure how much life you have left? Maybe in the absence of certainty we should just assume we’re going to live a long time. Maybe that’s the only way forward.
  • 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.
  • No system of thought can contain the fullness of human experience.
  • 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.
  • “I sent you to reap what you have not worked for; others have done the work, and you are sharing the fruits of their labor.” -The Bible
  • Graham Greene once said that life was lived in the first twenty years and the rest was just reflection.
  • Most ambitions are either achieved or abandoned; either way, they belong to the past.
  • What happened to Paul was tragic, but he was not a tragedy.

Reading Suggestions

This is a list of authors, books, and concepts mentioned in When Breath Becomes Air, which might be useful for future reading.

  • How We Die by Nuland

When Breath Becomes Air by Paul Kalanithi

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