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 4-6Chapter Summaries & Analyses
Part 2
Part 2, Section 4 Summary
Part of Paul wishes Emma would have discouraged him from working again. Ever since he’d stopped working, the weight of the responsibility had been lifted from his shoulders. However, the “moral duty” he feels is too overwhelming, his passion too strong to deny, and on top of it all, Lucy is supportive of his decision (151).
During his first surgery, a temporal lobectomy, Paul begins to faint. He has the junior resident take over for the rest of the operation while he rests in the lounge and then goes home.
The preceding days go more smoothly, as Paul successfully completes surgeries, remembering his own way of doing things. Within a month, he’s nearly back at his previous capacities. His regained wellness prompts him to continue his job search. Another resident mentions that she is worried about Paul graduating. As much as Paul is liked, he needs to be able to keep up with the full spectrum of a surgeon’s duties, including administrative work. Thus, he returns to his fourteen-hour work day. Despite the painful and depleted state of his body, he completes procedures so quickly and smoothly that even the attending doctors are surprised.
Paul takes a moment to reflect on how far he has come. He feels he’s experienced the five stages of grief (denial, anger, bargaining, depression, acceptance) backward, beginning with the initial acceptance of his own death and ending with denying his body a chance to rest while he works around-the-clock. He thinks that this denial is “the only way forward” (162).
Part 2, Section 5 Summary
Paul must increase his doses of Tylenol and NSAIDS in order to keep up with the demands of his job. He gets a job interview offer in Wisconsin that would grant him millions of dollars to open a lab, be the head of his own clinical service, have job offers for Lucy, and give the couple a beautiful and scenic place to live. On top of it, they’d fly Paul to continue his appointments with Emma. He is in disbelief that he is living out a reality that was less than a year ago absolutely unattainable to him.
While driving him home from dinner, the chairman pulls his car over and shows Paul a lake that he can boat on, ice-skate on, and swim through to get to work. He realizes that the job is a fantasy, and that he does not want to strand Lucy in Wisconsin with a newborn and a sick husband.
He has spent his recovery time trying to regain his old self and his former trajectory. However, cancer has altered his ideal life, and he realizes that he has to decide how he wants to spend the rest of the time he has left. He again hears Emma asking him: “You have to figure out what’s most important to you” (165).
Paul asks himself what kind of person he wants to be. He understands that a surgeon’s job is to take a patient and care for him until the patient can walk again. It is a “temporary responsibility, a fleeting power” (166). Life after the hospital carries on without the guidance of the surgeon, and the challenges it presents are left to be faced by the patient and his or her family.
Emma, who supported each of his decisions along the way, has not pushed him into an identity; rather, she has created the circumstances where he must find his identity on his own.
Part 2, Section 6 Summary
During Lent, Paul and Lucy attend church with Paul’s parents, who have flown in from Arizona. After hearing a Bible passage read in which the disciples take Jesus’s metaphorical language as literal, Paul reflects on his own relationship to religion over the years.
Although raised in a Christian family, Paul was an atheist for years, believing that there could be no God because God’s existence could not be proven. During all his years as a scientific and existential thinker, however, he began seeing that if “if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning” (169).
Feelings like love and hatred cannot be measured in a laboratory; there will always be gray space between science and these human experiences.
The central values of Christianity are what draw Paul toward it, not necessarily whether or not God exists. He’s interested in the pursuit of goodness and knows that each of us cannot know everything. What he draws from the sermon is that it’s the collective human experience that drives us toward the “Truth.”
Part 2, Sections 4-6 Analysis
Paul begins rebuilding his former self in these sections. He works hard enough to search for jobs again, leading to his Wisconsin visit, during which his dream position is dangled in front of him. He has an epiphany here, reflecting, “the lab wasn’t the place I wanted to plunk the remainder of my chips” (165).
His rejection of his dream job is more than a recalibration of his life; it is a reimagining of what constitutes his ideal future. Kalanithi begins the scene by listing all the positive aspects of the job: “millions of dollars to start a neuroscience lab, head of my own clinical service, flexibility if I needed it for my health[…]” (163). It is then followed by a list of why those positive aspects no longer fit into his life: “Lucy would be isolated, stripped of her friends and family, alone, caring for a dying husband and a new child” (164). This juxtaposition of pros and cons serves to contextualize Paul’s life as a cancer patient. It is not simply that these things might be unattainable; he no longer wants the future he wanted before.
The subsequent church scene provides the narrative framework for Paul’s reflections on the relationship between science and meaning. The prose begins to adopt an autumnal quality, both a combination of the longevity of Paul’s illness and a foreshadowing of the events to come. For example, Kalanithi writes: “No system of thought can contain the fullness of human experience,” and “In the end, it cannot be doubted that each of us can see only a part of the picture” (170, 172). As Kalanithi continues to pull together the themes laid out early on in the book–death, medicine, and literature–the portrait of a fulfilled thinker emerges.
