When Breath Becomes Air

by

Paul Kalanithi

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Paul Kalanithi Character Analysis

The subject and author of the memoir. When Breath Becomes Air is first and foremost an account of Paul’s life as well as his exploration of what makes a virtuous and meaningful life in the face of death. Paul grows up the son of a doctor in Kingman, Arizona, before studying English and Biology at Stanford, then attending the Yale School of Medicine. After graduating from Medical School, he and his wife Lucy return to Stanford so that Paul can complete his residency. During his time as a practicing surgeon, he discovers how to guide patients with compassion and care through life-changing illnesses and injuries and learns how to have judgment in both treating patients and in speaking with them. At the tail end of his training, Paul is diagnosed with terminal lung cancer and must confront his own mortality. With the support of his mother, father, Lucy, and his oncologist, Emma, he identifies his own values and works to make his remaining time meaningful. Ultimately, he discovers his priorities in his desire to write a book, and in his desire to become a father. He spends much of the last months of his life taking care of an infant daughter, Cady, and in writing When Breath Becomes Air. With this book, Paul is able to explore meaning in others’ lives and his own, and he leaves behind a legacy that will guide many readers through their own struggles.

Paul Kalanithi Quotes in When Breath Becomes Air

The When Breath Becomes Air quotes below are all either spoken by Paul Kalanithi or refer to Paul Kalanithi. For each quote, you can also see the other characters and themes related to it (each theme is indicated by its own dot and icon, like this one:
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). Note: all page numbers and citation info for the quotes below refer to the Vintage edition of When Breath Becomes Air published in 2017.
Prologue Quotes

At age thirty-six, I had reached the mountaintop; I could see the Promised Land, from Gilead to Jericho to the Mediterranean Sea. I could see a nice catamaran on that sea that Lucy, our hypothetical children, and I would take out on weekends.

Related Characters: Paul Kalanithi (speaker), Lucy Kalanithi
Page Number: 7
Explanation and Analysis:

And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.

Related Characters: Paul Kalanithi (speaker)
Related Symbols: Breath
Page Number: 16
Explanation and Analysis:
Part 1 Quotes

I knew medicine only by its absence—specifically, the absence of a father growing up, one who went to work before dawn and returned in the dark to a plate of reheated dinner.

Related Characters: Paul Kalanithi (speaker), Lucy Kalanithi, Paul’s Father
Page Number: 20
Explanation and Analysis:

My mother, afraid the impoverished school system would hobble her children, acquired, from somewhere, a “college prep reading list.” […] She made me read 1984 when I was ten years old; I was scandalized by the sex, but it also instilled in me a deep love of, and care for, language.

Related Characters: Paul Kalanithi (speaker), Paul’s Mother
Page Number: 26
Explanation and Analysis:

Though we had free will, we were also biological organisms—the brain was an organ, subject to all the laws of physics, too! Literature provided a rich account of human meaning; the brain, then, was the machinery that somehow enabled it.

Related Characters: Paul Kalanithi (speaker)
Page Number: 30
Explanation and Analysis:

It was as if this were the moment God said, “Let there be light!" You could not help but feel your specklike existence against the immensity of the mountain, the earth, the universe, and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur.

Related Characters: Paul Kalanithi (speaker)
Page Number: 30
Explanation and Analysis:

Only later would I realize that our trip had added a new dimension to my understanding of the fact that brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.

Related Characters: Paul Kalanithi (speaker)
Page Number: 38
Explanation and Analysis:

Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy.

Related Characters: Paul Kalanithi (speaker)
Page Number: 43
Explanation and Analysis:

How could I ever learn to make, and live with, such judgment calls? I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn't enough; moral clarity was needed as well.

Related Characters: Paul Kalanithi (speaker), Melissa
Page Number: 66
Explanation and Analysis:

When there’s no place for the scalpel, words are the surgeon’s only tool.

Related Characters: Paul Kalanithi (speaker), Jeff
Related Symbols: Scalpel
Page Number: 87
Explanation and Analysis:

Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don't think I ever spent a minute of any day wondering why I did this work, or whether it was worth it.

Related Characters: Paul Kalanithi (speaker), Jeff
Page Number: 97-98
Explanation and Analysis:

If boredom is, as Heidegger argued, the awareness of time passing, then surgery felt like the opposite: the intense focus made the arms of the clock seem arbitrarily placed.

Related Characters: Paul Kalanithi (speaker)
Page Number: 104
Explanation and Analysis:

Good intentions were not enough, not when so much depended on my skills, when the difference between tragedy and triumph was defined by one or two millimeters.

Related Characters: Paul Kalanithi (speaker), Matthew
Related Symbols: Scalpel
Page Number: 105
Explanation and Analysis:

The secret is to know that the deck is stacked […] and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

Related Characters: Paul Kalanithi (speaker), Jeff
Page Number: 115
Explanation and Analysis:
Part 2 Quotes

My life had been building potential, potential that would now go unrealized.

Related Characters: Paul Kalanithi (speaker), V, Jeevan
Page Number: 120
Explanation and Analysis:

The angst of facing mortality has no remedy in probability.

Related Characters: Paul Kalanithi (speaker), Emma Hayward
Page Number: 135
Explanation and Analysis:

“Will having a newborn distract from the time we have together?” she asked. “Don’t you think saying goodbye to your child will make your death more painful?”

Wouldn’t it be great if it did?” I said. Lucy and I both felt that life wasn’t about avoiding suffering.

Related Characters: Paul Kalanithi (speaker), Lucy Kalanithi (speaker), Cady Kalanithi
Page Number: 143
Explanation and Analysis:

I got out of bed and took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.”

Related Characters: Paul Kalanithi (speaker)
Page Number: 149
Explanation and Analysis:

Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.

Related Characters: Paul Kalanithi (speaker)
Page Number: 162
Explanation and Analysis:

The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.

Related Characters: Paul Kalanithi (speaker), Emma Hayward
Page Number: 166
Explanation and Analysis:

Scientific knowledge [is] inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable.

Related Characters: Paul Kalanithi (speaker), Paul’s Father
Page Number: 170
Explanation and Analysis:

Feeling her weight in one arm, and gripping Lucy’s hand with the other, the possibilities of life emanated before us […] Looking out over the expanse ahead I saw not an empty wasteland but something simpler: a blank page on which I would go on.

Related Characters: Paul Kalanithi (speaker), Lucy Kalanithi, Cady Kalanithi
Page Number: 195-196
Explanation and Analysis:

Words have a longevity I do not.

Related Characters: Paul Kalanithi (speaker)
Page Number: 199
Explanation and Analysis:
Epilogue Quotes

This book carries the urgency of racing against time, of having important things to say. Paul confronted death—examined it, wrestled with it, accepted it—as a physician and a patient. He wanted to help people understand death and face their mortality.

Related Characters: Lucy Kalanithi (speaker), Paul Kalanithi
Page Number: 215
Explanation and Analysis:

Caring for our daughter, nurturing relationships with family, publishing this book, pursuing meaningful work, visiting Paul’s grave, grieving and honoring him, persisting…my love goes on—lives on—in a way I’d never expected.

Related Characters: Lucy Kalanithi (speaker), Paul Kalanithi, Cady Kalanithi
Page Number: 224
Explanation and Analysis:
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When Breath Becomes Air PDF

Paul Kalanithi Character Timeline in When Breath Becomes Air

The timeline below shows where the character Paul Kalanithi appears in When Breath Becomes Air. The colored dots and icons indicate which themes are associated with that appearance.
Prologue
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The memoir opens on Paul flipping through his CT scan images, seeing that his lungs are matted with numerous tumors.... (full context)
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Paul describes the circumstances that led to this moment: he had been losing weight and experiencing... (full context)
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The X-rays had not indicated any issues, and Paul had chalked it up to hard work and an aging body. Paul explains that this... (full context)
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A few weeks later, Paul’s weight drops again and he has severe chest pain. He decides to get another X-ray,... (full context)
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Lucy decides not to join Paul on a vacation they had planned to take to New York City to see some... (full context)
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Paul offers to skip the trip and see a couple’s therapist, but Lucy is adamant about... (full context)
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Paul’s back stiffens in pain during the flight to New York. He hopes his symptoms will... (full context)
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Lucy picks Paul up from the airport. He tells her that he has cancer. She affirms that she... (full context)
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Paul is admitted to the hospital. As he sits in a room in which he has... (full context)
Part 1: In Perfect Health I Begin
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Paul jumps back in his narration to his teen years. He is sitting on a desert... (full context)
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Paul recounts how he was familiar with medicine only because his father—a cardiologist—was so often absent... (full context)
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In his childhood, Paul enjoys the freedom of the desert and grows familiar with the pantheon of wild animals... (full context)
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Paul gives a little more background on his family: his mother and father had eloped and... (full context)
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Paul’s mother’s greatest fear is the lack of good education in Kingman, which had been identified... (full context)
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Paul elaborates on the books that sparked his passion for literature: Brave New World gives him... (full context)
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Paul’s mother also drives Paul and his brothers, Suman and Jeevan, to Las Vegas to be... (full context)
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As Paul finishes high school, Paul’s girlfriend Abigail (who attends a local college) suggests he should read... (full context)
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Paul pursues degrees in both English literature and human biology at Stanford, his studies driven by... (full context)
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Heading into Paul’s sophomore summer, he is torn between getting an academic internship at a primate research center... (full context)
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Paul chooses the camp. He describes the beauty he finds in the lakes and the mountains,... (full context)
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Back at Stanford, Paul continues to study philosophy, literature, and neuroscience. He also works in an fMRI lab and... (full context)
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Senior year of college, Paul visits a home for people who had suffered severe brain injuries for a neuroscience class.... (full context)
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When the class returns to campus, Paul vents to his professor about the parents of the children in the home. The professor... (full context)
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As graduation looms, Paul wants to continue his studies, so he applies for a master’s in English literature at... (full context)
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Paul studies Walt Whitman for his thesis, a poet who also wanted to find a way... (full context)
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Paul begins to prepare his medical school application, loading up on chemistry and physics in his... (full context)
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Paul describes the first time he dissects a dead body, and how strangely normal it feels.... (full context)
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Paul explains how cadavers end up on the table. They donate themselves to schools, unlike in... (full context)
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Though a cadaver’s humanness is undeniable, Paul confesses that it is easy to forget that they are human when reduced to piles... (full context)
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Medical students, Paul writes, experience death and suffering but are also shielded from the brunt of responsibility. But... (full context)
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Paul and Lucy attend Yale when Shep Nuland still lectures there. Nuland’s work How We Die... (full context)
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Another story of Nuland’s proves particularly important for Paul: when Nuland was a young medical student, he was alone in the OR with a... (full context)
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After two years of studying, Paul begins the next phase of medical school. The final two years, he explains, are spent... (full context)
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His first night in the hospital, Paul meets the resident he’d be working with, Melissa. Melissa tells him to keep an eye... (full context)
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Paul figures out that something has gone wrong, and the twins’ only shot at survival is... (full context)
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Melissa sews up the woman’s wounds, and asks Paul if he’d like to place the last two stitches. Paul’s hands shake as he does... (full context)
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Paul explains that the twins are considered to be on the edge of viability and that... (full context)
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The next night, Paul returns to work and helps with a more routine pregnancy. Melissa pushes Paul to the... (full context)
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Paul informs the baby’s family of the good news. Afterwards, he asks Melissa about the twins... (full context)
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Paul asks Melissa if doing an emergency C-section was the right thing to do. She responds... (full context)
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Paul’s ob-gyn rotation ends, and he is next placed in surgical oncology. A fellow med student... (full context)
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...first Mari is relieved, but when she leaves the OR she confesses her guilt to Paul. (full context)
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Paul jumps to his fourth and final year of medical school. He watches as his classmates... (full context)
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Paul chooses neurosurgery as his specialty. This decision is cemented for him when he listens in... (full context)
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Paul is also drawn to neurosurgery because of the brain’s relationship to patients’ sense of self,... (full context)
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Paul and Lucy marry just after they finish medical school, and then head to California to... (full context)
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Paul’s paperwork, however, reveals fragments of patient’s narratives, such as the story of an eight-year old... (full context)
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Paul describes the first patient he loses—an eighty-two-year-old woman named Mrs. Harvey who is admitted for... (full context)
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Paul resolves to treat his paperwork as patients, and not the other way around. Paul describes... (full context)
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In his second year of residency, Paul is the first to arrive in an emergency. The schedule takes its toll on him:... (full context)
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Paul admits that he also made mistakes. He comes to believe that saving only enough of... (full context)
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Paul worries that being so close to death only blinds him and dulls him to it.... (full context)
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Paul describes another instance in which he rushes to the trauma bay with an ice cream... (full context)
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Paul hears that his friend, Laurie, has died in a fatal car crash. These words conjure... (full context)
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Paul remarks that if he had been more religious in his youth, he might have become... (full context)
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Paul draws a connection to his father, who brought comfort and levity to his own patients.... (full context)
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Paul describes the guidance he provides to a thirty-five-year-old woman who is rushed to the hospital... (full context)
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Paul speaks about how brain diseases are often strange and somewhat incomprehensible to people. Often news... (full context)
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Paul moves to the topic of brain cancer, describing its two varieties: primary cancers, which are... (full context)
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Paul informs Mrs. Lee of her prognosis and of the surgery and treatments that she will... (full context)
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Paul says that there is also a price to empathy and bearing responsibility for patients. In... (full context)
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Even with the job’s hardships, Paul never questions the value of his work. Before operating on a patient’s brain, Paul knows... (full context)
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In the middle of residency, doctors train in additional fields. Paul chooses “the most rigorous and prestigious path”—that of a neurosurgeon-neuroscientist. He begins to work in... (full context)
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...electrical engineering and neurobiology and a fellow second-generation Indian affectionately called “V.” With V’s permission, Paul sets out to develop technology that could write signals into the brain (not just read... (full context)
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Paul meets with V weekly and comes to respect him deeply for his avoidance of the... (full context)
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...radiation treatments. They are successful, and V returns to work a year later, just as Paul returns to his clinical duties at the hospital. On his first day back, V confesses... (full context)
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Paul is now in his sixth year in neurosurgical residency, which he describes as a black... (full context)
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The intense focus required in surgery, Paul says, makes the clock feel arbitrary—two hours can feel like a minute. He feels that... (full context)
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Now a chief resident, Paul acknowledges that responsibility rests primarily on his shoulders. Technical excellence, he says, is a moral... (full context)
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Paul provides other examples in which his precision is crucial. One day, he is performing surgery... (full context)
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Paul tells the reader that certain parts of the brain are considered off-limits to surgery because... (full context)
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Paul describes a patient, Mr. Michaels, who experiences this kind of damage to his language centers.... (full context)
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...many precautions, and the patients are often awake and talking during the surgeries. Another of Paul’s patients insists on having surgery to remove his tumor even though the board of doctors... (full context)
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Paul draws near the end of his residency, and he fields job interest from all over... (full context)
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Paul receives a phone call from his friend and co-resident, Victoria. She tells him that Jeff... (full context)
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Paul wishes that he could have spoken with Jeff and offered some comfort with what he... (full context)
Part 2: Cease Not till Death
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Paul’s narration jumps forward to the day he is diagnosed with cancer, where the prologue left... (full context)
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Paul’s friend Victoria stops by his room, and the two discuss the scans and his treatments.... (full context)
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Paul’s brother Jeevan arrives and tries to comfort Paul by telling him that he has already... (full context)
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That night, Paul briefly meets his oncologist, Emma Hayward, prior to a more official appointment the following week.... (full context)
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Emma continues stepping through what Paul’s treatment might look like and offers to discuss how Paul might be able to return... (full context)
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Emma leaves, and Paul, Lucy and his family begin to search their network of medical colleagues for the best... (full context)
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Paul had grown noticeably weaker over the previous week, and basic functions like going to the... (full context)
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Paul begins to do research on his cancer, but the sheer amount of information overwhelms him,... (full context)
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Paul’s family works to help Paul adjust to a new life, creating an account with a... (full context)
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Paul and Lucy return to the hospital for his first official appointment with Emma. Emma explains... (full context)
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...of the tests for a common mutation, EGFR, will come back the next day. If Paul has this mutation, he can take a pill called Tarceva instead of chemotherapy. If not,... (full context)
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Emma tells Paul that if he has to have chemotherapy, she will swap out one of the drugs... (full context)
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Paul explains one of the paradoxes of coming so close to death: before he was diagnosed,... (full context)
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Paul does a bit more research and discovers that having an EGFR mutation seems to add... (full context)
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The next day, Paul and Lucy visit the sperm bank to preserve options because the cancer drugs might affect... (full context)
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Paul contemplates the idea of hope in a statistical context. He questions whether hope is merely... (full context)
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Paul and Lucy return home from the sperm bank and learn that he does have the... (full context)
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At Paul and Emma’s first appointment after his treatment begins, the two discuss Paul’s future. Emma tells... (full context)
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Paul becomes slightly frustrated that Emma is not giving him more of a sense of how... (full context)
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Paul and Lucy also start seeing a couple’s therapist who specializes in cancer patients. The therapist... (full context)
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Paul realizes that he is starting to see death as both a doctor and a patient.... (full context)
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The bulk of Paul’s time is now spent in physical therapy. Paul’s body at this point is frail, but... (full context)
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The largest decision that looms over Paul is whether he and Lucy should have a child. Lucy feels that the choice should... (full context)
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Paul and Lucy agree to have a child. Because of the medications Paul is on, they... (full context)
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Six weeks after starting treatment, Paul has his first CT scan to measure any improvement against the cancer. The CT tech... (full context)
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Emma concludes that Paul is well enough to meet every six weeks. That weekend, Paul looks forward to reconnecting... (full context)
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Paul returns to reading literature. He reads works on mortality and memoirs of cancer patients in... (full context)
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Paul pushes himself to return to the OR, refusing to give up his life and his... (full context)
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Paul is both excited at the prospect of another ten years, but also nervous about returning... (full context)
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Paul and Victoria discuss how best to reintroduce Paul to the daily routine. He would only... (full context)
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Paul pores over his textbooks the night before, reviewing the steps of the operation. He arrives... (full context)
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Each successive day, Paul remembers more and more of his training. His strength improves, as does his fluidity and... (full context)
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At his next appointment with Emma, Paul confesses that he is disappointed that a surgeon-scientist position at Stanford had been filled when... (full context)
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Later that day, one of the professors at Stanford stops Paul in the hospital hallway. She tells him that some of the other professors are concerned... (full context)
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It strikes Paul that he has gone through the five stages of grief (Denial, Anger, Bargaining, Depression, and... (full context)
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Paul continues to work towards graduation, only a few months away. His body is wearing out,... (full context)
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Paul also worries that if he were to move to Wisconsin, he would be far from... (full context)
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A few weeks later, during Lent, Paul, Lucy, and his mother and father attend church together. Paul interprets the reading that day... (full context)
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Paul had come to hope for a scientific framework to explain life, but Paul reasons that... (full context)
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Paul had thus returned to what he believes are the central values of Christianity (sacrifice, redemption,... (full context)
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Paul’s musings ultimately come to these conclusions: no one person can say anything definitive about God,... (full context)
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Seven months after Paul returns to surgery, he takes another CT scan—his last before finishing residency and becoming a... (full context)
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Paul returns home to tell Lucy about the cancer growth. It is Thursday night, and he... (full context)
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Paul sets his worry aside for one more day—his last day as a neurosurgeon. He arrives... (full context)
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Paul prepares for his last surgery case, in which he will remove bony overgrowths from a... (full context)
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Paul gathers his things from the hospital but leaves his textbooks behind. He gets into his... (full context)
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Paul and Lucy go to Emma’s office on Monday. She says that they will look for... (full context)
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No targetable mutations are found, and so chemotherapy becomes Paul’s only option. Paul asks Emma about the different chemotherapy agents and their side effects, asking... (full context)
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Paul, Lucy, and Paul’s mother go to the infusion center together for Paul’s chemotherapy, to which... (full context)
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This cycle continues until the day of Paul’s graduation. As he is dressing, he is struck by a wave of nausea, and he... (full context)
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Paul and the resident, Brad, discuss his medical history and medications. That evening, the nurse reviews... (full context)
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Over the course of the day, Paul’s condition rapidly deteriorates. He becomes severely dehydrated and is transferred to the intensive care unit.... (full context)
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Emma returns and informs Paul that he’s been in the intensive care unit for over a week, but that he’s... (full context)
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Paul is discharged from the hospital, and two days later, Lucy has her first contractions. She... (full context)
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...home from the hospital, Lucy’s mom calls to say that Lucy has gone into labor. Paul and his mother turn back. Paul lies down on a cot in the delivery room... (full context)
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...days and weeks, Cady experiences a series of firsts: a first grasp, smile, and laugh. Paul, on the other hand, has less and less energy, and he feels the days are... (full context)
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Paul struggles with how to think about the future, because he had always been so future-oriented.... (full context)
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Paul’s final words in the memoir express hope that Cady will have some memory of him.... (full context)
Epilogue
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Lucy takes over the narration, opening with the circumstances of Paul’s death: surrounded by family, in a bed a short distance away from the labor and... (full context)
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Lucy jumps back in time to describe Paul’s deterioration. Around Cady’s first Christmas, when she is five months old, Paul’s third treatment option... (full context)
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By the spring, Paul needs supplemental oxygen to make his breathing comfortable. The cancer infiltrates Paul’s brain. The prospect... (full context)
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Lucy describes Paul’s final Saturday. The family sits in their living room, holding Cady on his lap, Paul’s... (full context)
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To prepare for his clinical trial, Lucy must videotape Paul doing the same task every day to track any decline in his speech. Paul opts... (full context)
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The next day, Paul has a severe 104-degree fever. Paul, Lucy, Paul’s father, and Paul’s brother Suman return from... (full context)
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That evening, Paul’s condition worsens abruptly, and he struggles to breathe. Lucy calls an ambulance, and Paul tells... (full context)
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That evening, Paul consults with physicians about the steps forward. The critical-care attending doctor tells Paul that BiPAP... (full context)
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Paul thinks about the alternative: choosing “comfort care,” even though death would be more certain and... (full context)
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Cady arrives and is nestled next to Paul. Paul’s medical team discusses his respiratory failure with Lucy outside. Paul’s condition is declining, and... (full context)
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Lucy returns to Paul’s bedside. He tells her “I’m ready,”—to take the mask off, to start morphine, and to... (full context)
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An hour later, Paul’s BiPAP machine and monitors are turned off, and morphine drips steadily through his IV. His... (full context)
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...a family friend arrives to take Cady home for the night. Lucy holds Cady against Paul, knowing that Cady doesn’t understand that this moment is a farewell. As the room darkens,... (full context)
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Lucy tells the reader that When Breath Becomes Air is in a sense, unfinished, because Paul was not able to complete the manuscript. But she also recounts how tirelessly Paul wrote... (full context)
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...confesses that many of their friends and family will have been unaware of her and Paul’s marital trouble before reading the book. She is glad he included it, however, because it... (full context)
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Lucy explains that Paul was committed to ensuring a meaningful future for her, and that she in turn worked... (full context)
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Lucy writes that Paul’s voice in When Breath Becomes Air seems somewhat solitary. She feels the book misses the... (full context)
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Lucy knows that Paul was and would have been proud of the book, which was a culmination of his... (full context)
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Paul is buried in a willow casket at the edge of a field in the Santa... (full context)
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Lucy visits Paul’s grave often, pouring wine out on the grass for Paul, and rubbing the grass as... (full context)
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Lucy knows that had Paul lived, he would have made great contributions to the fields of neurosurgery and neuroscience. Instead,... (full context)
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Two days after Paul’s death, Lucy writes a journal entry addressed to Cady. She writes that “When someone dies,... (full context)