When Breath Becomes Air

Paul is able to implement this kind of care later on in his residency, once he becomes completely in charge of his patients’ well-being. He thinks of his father for inspiration, who had always had such a patient and appropriately humorous bedside manner.

Paul even considers the paperwork to be a unique opportunity to forge connections with patients. In the case of one patient, Mrs. Lee, who had an aggressive kind of brain cancer, Paul refuses to leave her in the dark. He wants her to know what he thinks her condition is, even before all the testing is complete. After he tells her, he describes “the vastness of the chasm between the life she’d had last week and the one she was about to enter” (93). He gives her his most honest assessment, finding that a gentle yet realistic disclosing of information helps arm the patient with the proper tools to face illness.

He finds himself crying in his car on the way home from work one evening as the weight of the day catches up with him.

The path of neurosurgery often requires its practitioners to excel in other areas as well, the most “rigorous and prestigious” being neurosurgeon-neuroscientist (99). Thus, Kalanithi begins working in a Stanford lab dedicated to basic motor neuroscience during his fourth year.

The head of the lab, called V, is someone for whom Paul has the utmost respect. V strives to “be authentic to the scientific story and to tell it uncompromisingly” and values this above being published in prestigious journals to reach stardom (100). V discloses to Paul one day that he has been diagnosed with pancreatic cancer. Paul witnesses his battling and recovery, noting how the illness has left V with slightly thinned and whitened hair. During one of their final chats in the lab, V expresses that it has taken quite some time for all of the pain of the recovery to amount to being “worth it” (101).

In his sixth year, Paul gets to work at six in the morning every day of the week. Time moves quickly for him, especially in the operating room. Even more crucial than being good at surgery is being quick at it, for both the patient’s sake and for the sake of each staff member who wants to go home at a reasonable hour from work.

Paul is a chief resident now, summarizing that neurosurgery is “a commitment to one’s own excellence and another’s identity” (108). There are some parts of the brain that are so delicate that as little as one millimeter of damage can completely alter the course of a patient’s life. The Wernicke’s area of the cortex is for understanding language, and the Broca’s area is for producing language. As a med student, Paul had seen the effects of these parts of the brain being altered; for example, there was an elderly man who would only speak in streams of numbers. Another patient was so violently vocal throughout the surgery that the doctors knew they were able successfully remove a tumor impacting the language parts of the brain by noting changes in the patient’s speech patterns. Paul thinks about what would be sacrificed with just one wrong move: “What kind of life exists without language?” (109).

Paul receives a plethora of news about prospective jobs for himself, positions that fit his skill set exactly. He feels that the elements of his career and his understanding of his career are finally starting to come together, until he receives a call from his co-resident, Victoria.

Victoria tells Kalanithi that their friend has committed suicide after one of his patients passed away. Paul imagines what he could have done to console his friend, if he’d been there. He thinks about how much time they’d dedicated to learning to face death. He says: “You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving” (115). It is at this point in the book that the hardships Paul has faced start to force him to think existentially about his career.