71 pages • 2 hours read
Paul KalanithiWhen Breath Becomes Air
Nonfiction | Autobiography / Memoir | Adult | Published in 2016A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more. For select classroom titles, we also provide Teaching Guides with discussion and quiz questions to prompt student engagement.
Part 2, Sections 1-3Chapter Summaries & Analyses
Part 2
Part 2, Section 1 Summary
Chronologically, this section begins where the Prologue ends, with Paul and Lucy together in the hospital room, staring at the CT scan images. As they go through a flurry of logistical information–calls to family, Paul’s suggestion to Lucy to remarry–Paul realizes he has shifted from being a caretaker to being a patient, that he won’t be able to resume his residency, and that all he has been striving for will go unrealized.
Paul’s family gathers in his hospital room while Emma Hayward, his oncologist, stops by to introduce herself. He asks her to discuss the Kaplan-Meier survival curves, to which she responds, “absolutely not” (122). She says this information will come later, that for now she has just come to meet them. She even suggests that Paul may be able to go back to work. His family reaches out to the medical network to find the best oncologist in the country and discovers that all arrows point toward Emma.
In the two days leading up to their first full appointment, Paul rests. He considers an earlier version of himself, reflecting on how his future had seemed so different then. Paul has become so sick that getting up to use the restroom is no longer automatic; it has become a task. All around him, his loved ones help him adjust life as a patient. They buy him a comfortable mattress and bedrails. They also have his prescriptions delivered. His father declares that Paul will survive this illness.
Part 2, Section 2 Summary
A few days later, Lucy and Paul meet Emma at the clinic. There is a brief discussion of treatment options: traditional chemotherapy and new therapies that “target specific molecular defects in cancer itself” (128).
Emma tells Paul that he has a PI3K mutation, though they won’t know what it means until the results from the EGFR test come back. Emma has both a plan and a backup plan, putting Paul at ease. In case it is the mutation Emma expects, Paul can take a pill. If not, she’s arranged a chemo appointment for the following week. Because Paul is adamant about wanting to keep use of his hands for surgery, Emma suggests they just go with carboplatin for the chemotherapy.
She leaves the room after mentioning that there are some lung cancer research fundraisers interested in meeting him. Lucy knows Emma is a good doctor, but she worries that Emma likes Paul, which could hypothetically interfere with her treatment of him. Paul replies that this is the least of their problems. Paul checks his Kaplan-Meier curve online (Emma has still denied giving him this information) only to find that although an EGFR mutation seemed to add a year to a patient’s life, with the potential for long-term survival, there was an 80 percent chance of death within two years.
Paul and Lucy go to the sperm bank, because the cancer drugs will have an unknown effect on Paul’s sperm. Lucy begins to cry when the woman helping them asks what will happen to the sperm if one of them dies. At this moment, the word hope comes to Paul’s mind. He considers what the word means and how it can right statistics, that “The angst of facing mortality has no remedy in probability” (135).
Upon returning home from the sperm bank, Paul is told that he does have a treatable mutation. He will proceed with the pill, Tarceva, rather than with chemotherapy. In the following weeks, he regains some strength, although his skin becomes acne-ridden (though this actually symbolizes a positive reception to the drug) and is constantly bleeding from blood thinners.
At the first of their bi-weekly meetings, Emma helps Paul work through some important questions about his plan for the future, specifically about what he will do in terms of a job. Paul states that if he has less time, he wants to write. With more time, he’d like to pursue his surgical practice. Before cancer, he’d planned to give twenty years to each.
Paul and Lucy see a couple’s therapist at Lucy’s insistence. The therapist tells them that they may have no advice for them. Paul laughs after they leave, though Lucy wonders, if there is no room for improvement, is this as good as things get? Despite all of Paul’s training in science and medicine, nothing has trained him to make the life decisions he’s going to have to make.
Part 2, Section 3 Summary
Paul has been gaining his strength, as a large portion of his schedule is devoted to physical therapy. The two goals he has set for himself with his physical therapist are to ride his bike again and to go for a jog. After meeting his bike-riding goal and riding six miles, he wonders: is this a success or a defeat, in the face of the thirty miles he might usually ride? Paul and Lucy do not want the rest of their time together to be about avoiding suffering, and they decide to have a child; they will “carry on living instead of dying” (144). Because Paul’s medication affects his sperm, Lucy immediately undergoes assisted reproduction.
Six weeks after beginning treatment, Paul receives his first CT scan, in order to gauge how effective the Tarceva pills have been. Even a small growth would be considered a success, but the scan reveals significant reduction in the tumor. The cancer has stabilized.
Having some sense of normalcy returned to him, Paul attends a reunion of former Stanford neurosurgery graduates. Although he enjoys being around them and catching up, he feels he is witness to his phantom dreams playing out in the lives of his friends. This destabilizes his identity, opening up the question: “Who would I be, going forward, and for how long?” (147).
In hopes of gaining the language to further explore the ideas of death and illness, Paul begins to read again. He consumes everything, from Montaigne to Frost. It is literature that gives meaning and shape to his life, that catalyzes his return to the important questions, and that pushes his return to the OR.
Paul’s physical therapy becomes specialized for what will be hours of grueling labor when he returns to work. Emma still will not give him a survival timeline, but she offers that another patient of hers has been on Tarceva for seven years with no issues. Emma is sure that he will be capable of going back to work.
Part 2, Sections 1-3 Analysis
These chapters immediately follow the events of Prologue, and they outline the beginning of Paul’s recalibration to his future. As he wonders what he will do, a day at a time, statistics emerge as a theme of the book. The first time this appears is when he learns that Emma is one of the best professionals in her field. He “wondered at the string of events” that led him to this point (124), and begins studying his Kaplan-Meier curve to get a handle on the probability of his death. Paul mentions that “only 0.0012 percent of thirty-six-year-olds get lung cancer” (133). This is an early stage of information processing. Because Paul is so barraged by the news of his cancer, he has to try to give it shape, to make sense of it. This is all a precursor to the existential questioning that comes later. He concludes: “It occurred to me that my relationship with statistics changed as soon as I become one” (134).
Emma, Paul’s doctor, becomes a central character in these chapters. Although those in her field describe her as compassionate, most of her actions on these pages are weighed against what Paul would do if he were in her position. He likes that she has a “plan A, B, and C at all times” but grows frustrated that she won’t discuss survival rates with him (129). It is difficult to get a sense of her motives right away, because Paul is (as we learn later) not prepared to give up his role as a doctor.
While the stabilization of Paul’s cancer prompts him to go to his Stanford reunion, he is shaken that he’s surrounded by people pursuing a dream that may no longer be attainable to him. It is this tension that likely pushes him to throw himself into literature. Kalanithi has not described such an urgent consumption of books since his college days, and a sense of renewal and rebirth surfaces, although this time, he is “searching for a vocabulary with which to make sense of death” (148). This dependency on vocabulary complicates Paul’s earlier dichotomizing of literature and experience. How can one exist without the other? Kalanithi’s reflections here seem to suggest that this is the point at which he realized that they are, for him, two sides of the same coin.
