When Breath Becomes Air

After completing his two years of extensive study at medical school, Paul enters the second half of the program, spent in the hospital and the clinic. He meets the resident, Melissa, on his first day, and learns that he’ll be working in the labor and delivery ward. Melissa immediately begins briefing him on a patient, a 23-year-old about to give birth to a baby that is eight weeks premature. The patient is soon in critical condition, and the attending arrives to perform surgery. As soon as he leaves, Melissa gives Paul the opportunity to close some stitches. His work is sloppy and needs to be corrected by Melissa. Paul reflects, “Not only would my mind have to be trained, my eyes would, too” (61). He visits the twins in the incubator and heads home when the sun is up.

The next day, Paul is assigned to a different mother. He enters the room to begin the delivery and realizes that applying his textbook knowledge to his practice would be more difficult than he’d imagined. So much can go wrong. The attending helps Paul guide the baby out of the mother’s womb, and it’s a successful birth. He takes pleasure in informing the mother’s family in the waiting room.

Returning to the ward, Paul runs into Melissa. She informs him of the death of the twins. They each lived less than twenty-four hours. He experiences the images of life and death side-by-side. He can hear the mother crying in her room. He asks Melissa if the C-section was the right decision. She tells him that the only way to make decisions quickly is to make a “judgment call” (66).

Paul soon moves on to surgical oncology, rotating with another med student, Mari. She comes to him crying one day in the hall. She’d been in a procedure to determine whether or not the patient would go into surgery. They were checking to see if the cancer had spread too far. The cameras showed that the surgery would be called off. When she and Paul meet in the hall, she confides that she was so tired, and the surgery would have been so intense and grueling, that she’d secretly hoped for metastases.

In his final year of school, Paul watches as his classmates choose less-demanding concentrations. Many having become disheartened and exhausted from four years of nonstop work.

After seeing a pediatric neurosurgeon provide advice to a set of parents on not only the medical but the emotional, psychological aspects of dealing with illness, Paul chooses neurosurgery as his specialty. He sees the field as one that requires competency across a broad spectrum of knowledge and “presents the most challenging and direct confrontation with meaning, identity, and death” (72).

Paul and Lucy, who’ve been dating since their first year of medical school, marry and move to California for their residencies. Paul is at Stanford and Lucy is at UCSF. The first year of Paul’s residency is loaded with advice from his seniors: learn to be ambidextrous, be the absolute best in the hospital, time doesn’t stop during a surgery. This portion of his residency requires him to deal with an enormous amount of paperwork. These tasks, which initially force him to stay overnight at the hospital, eventually become completed within just hours. He learns that the paperwork is crucial, documenting the lives of his patients and telling their stories.

Paul experiences a spectrum of patients during his internship. His first patient to die is an eighty-two-year-old woman, Mrs. Harvey. His initial and minor procedure for her bowel obstruction seemed a success. Soon enough, she’d spiraled into a multi-day battle that Paul had to confront between rounds with other patients. There are days during which death is a consistent force around him, and there are those days during which the weight of death presses down on him, with Paul “trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down” (78).