When Breath Becomes Air: a selection of quotes

Title: When Breath Becomes Air

Author: Paul Kalanithi

Publisher: Random House New York

Pages: 228

My rating: ⭐⭐⭐⭐⭐

Who will like it? This is a deeply moving book, and although the language is plain, some paragraphs for me took some re-reading and time to sink in. I would recommend it to anyone interested in the broad meanings of human existence.

When I read this book the first time, I was taken aback at what medicine even is and what doctors do. Medicine deals with death and dying, but the concept of death was so cleanly cut out from my mind, like a silhouette of empty space on a blank wall. All I knew was from literature. I’ve marvelled at the beauty of “When I Have Fears That I May Cease To Be” by Keats, and felt the power in “Holy Sonnet 6” by Donne, and shared the momentary grief with Ben Jonson while reading “On My First Son”, but who was I to say I knew what death was?

Death is a “permanent, irreversible cessation of all biological functions that sustain a living organism” according to Wikipedia. Reading When Breath Becomes Air by Paul Kalanithi transformed my understanding of what we strive for, what human experience is, and what death is — or rather, life in the face of death. When I was barely halfway through when I initially read it, I didn’t even hesitate to recommend it to my mom, telling her that this was the most meaningful and mind-opening book I’ve read recently. We shared the library book and both finished it, and she felt the joys and frustrations and tragedy I felt. Kalanithi somehow reconciles the deepest subjects of human existence in the mildest and most approachable manner. I admire him for choosing his career for the pure, intrinsic reason of pursuing an understanding of human existence and striving to make progress in helping people, after spending his life studying so much literature, neuroscience, history, and philosophy. I’m just going to jot down a selection of quotes from the second time around skimming it because there’s much wisdom, perspective, and strength in his words.

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. T.S. Eliot’s “The Waste Land” resonated profoundly, relating meaninglessness and isolation, and the desparate quest for human connection. (page 31)

Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feelings: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the mere tedium of academic exercise. Everything teethers between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito… Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor. (page 44)

Early on, when I made a long, quick cut through my donor’s diaphragm in order to ease finding the splenic artery, our proctor was both livid and horrified. Not because I had destroyed an important structure or misunderstood a key concept or ruined a future dissection but because I had seemed so cavalier about it. The look on his face, his inability ot vocalize his sadness, taught me more about medicine than any lecture I would ever attend. (page 50)

As I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. (page 70)

In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me ot their nature, like trying to learn astronomy by staring directly at the sun. I was not yet with patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it. Drowning even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinigng to the same raft, caught in the same tide. (page 82)

Our patients lives’ and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving. (page 115)

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