When Breath Becomes Air by Paul Kalanithi


What a wonderfully heavy and moving read. In it, neurosurgeon Paul Kalanithi confronts the question of what makes life meaningful in the face of death. He wrote the book after being diagnosed with Stage IV lung cancer at the peak of his career.

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Key Takeaways

Strive for the top

“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

Nothing you do will ever be perfect, but that doesn’t mean that you shouldn’t strive for perfection. For example, if you want to be a more positive person, you might say, “I’ll never complain again.”

Of course, there will be times when you complain again, and that’s okay. But in striving for this difficult, but rewarding ideal state, you will get much closer to becoming a person who doesn’t complain than if you had set the bar lower.

Life isn’t about avoiding suffering

“Will having a newborn distract from the time we have together?” she asked. “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.”

After being diagnosed with cancer, Paul and his wife discuss the idea of having a child. They both know that he’s going to die and that it will distract from their time together, but they understand that life isn’t about avoiding suffering. That additional suffering may also be accompanied with extreme joy. They had the child.

This too, shall pass

“I can’t go on. I’ll go on.”

At the depths of your pain and suffering, it might seem as though you cannot go on. It might feel like the end of you. But the moment you recognize you can’t go on also might be the moment you realize that you can go on. No matter how painful or difficult what you’re facing may be, you can go on.

Science and its shortcomings

“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.”

The scientific method is incredibly effective – hypothesize, experiment, measure, evaluate, repeat. Eventually, you get to results that matter and can be replicated. But what science fails to grasp are the foundational elements of what it means to be a human – love, hate, weakness, suffering, virtue. And because of that, science cannot solve everything, at least not if we value the human experience.

Realities of a terminal diagnosis

“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.”

The candor and clarity that Paul expresses about his dilemma is remarkable.

Every week is different

“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.”

Whereas death is a one-time event, living with a terminal illness is a process. It’s a process where you are seeking how to spend your limited time and where that process of seeks yields different answers. There is no answer. You just do your best every day.

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