When Breath Becomes Air

Lucy, whose “capacity to love was barely finite,” meets Paul during their first year at the Yale School of Medicine (51). They marry afterwards and move to California, where Lucy begins her residency at UCSF. Her character emerges around the time of Paul’s diagnosis, and, upon first introduction, she is in the middle of a huge argument with him because of his failure to be upfront with her about his failure to tell her about his doctor visits, and his suspicions of having a serious illness.

Her perseverance, however, is clear from the moment of Paul’s diagnosis. She demands they see a couples’ therapist and acts as a one-woman support system until Paul’s parents eventually arrive in town. One night, as they lie in bed, Lucy helps walk Paul through an important conversation about having a child, and they decide to move forward with an assisted reproduction.

Lucy continues a full work schedule through the majority of her pregnancy. When Paul is committed to the hospital late into her term, she even begins to sleep overnight in his old office. She gives birth to their daughter, Cady, with Paul lying in a cot next to her. Lucy writes the Epilogue of the book, detailing Paul’s last days.

Emma is an oncologist, and Paul describes her as “one of the best” (124). She attends to Paul throughout his illness and is able to help him cope physically and mentally with cancer. She denies Paul information about his Kaplan-Meier curve (survival rates) in order to refocus his energy toward building a new life.

During their meetings together, Paul is humanized. Emma’s character is so important in the book because she plays dual roles in relation to Paul: both colleague and doctor. He feels an early kinship with her because of her bedside manner, but this doesn’t distract him from seeking her advice and guidance.

Emma’s suggestions often come in the form of open-ended ideas, for example, when she says, “if you ever want me to just be the doctor, I’m happy to do that, too” (182). Paul returns to this later on, after a week of her being on vacation. He realizes he misses her being in charge. Emma essentially helps Paul lift a burden from himself, so that his final days are fulfilling.

Jeff is Paul’s fellow resident. They grow close during their time at the hospital together as they find themselves “clinging to the same raft, caught in the same tide” (82). Jeff commits suicide as he is finishing his surgical fellowship. The news hits Paul hard. In a way, Jeff’s death gives Paul a brief glimpse of another version of his own reality. He imagines what he could have said to Jeff, what knowledge he might have shared, had he walked out of the hospital with Jeff that day.

V runs the neuroscience lab at which Paul works during his Stanford residency. He is someone Paul looks up to, not only because of his immense talent and capability, but because he prioritizes the study of medicine over celebrity. He eventually confides in Paul that he’s been diagnosed with cancer. V returns to the lab and continues practicing, but Paul notices that he has a changed perspective since his treatment. V acts as not only a mentor but as a double for Paul, someone who Paul strives to be. The conversations they have about cancer foreshadow Paul’s own experience as a doctor-patient.

Cady is the child of Paul and Lucy, born in the terminal stages of Paul’s cancer. Her life overlaps with his by just eight months. She becomes a central source of light and meaning in the book. Paul’s final words of the book are written to her, as he expresses that she “filled a dying man’s days with a sated joy” (199).

Paul’s father, unnamed in the book, is an important touchstone for Paul. Paul remembers “the absence of a father growing up” whose “unyielding dedication to his patients” made him both a specter in Paul’s early life but source of inspiration for Paul’s later years, as Paul grows into a neurosurgeon (20). A. Paul Kalanithi appears in the book frequently after Paul is diagnosed, offering undivided support.