When Breath Becomes Air

The memoir opens on Paul flipping through his CT scan images, seeing that his lungs are matted with numerous tumors. He explains that he’s very familiar with these scans, as he himself is a neurosurgical resident in his last year of training at Stanford. His wife Lucy sits by his side, and asks if he thinks it could be something else. Paul tells her he knows that it is cancer.

Paul describes the circumstances that led to this moment: he had been losing weight and experiencing ferocious back pain. His primary care doctor had suggested that he take X-rays to try and determine the cause. Paul had worried that he might have cancer but reassured himself that cancer is improbable at thirty-six years old.

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 hard work had earned him the respect of his seniors and won him prestigious national awards, followed by job offers from major universities. He describes that he had “reached the mountaintop,” and looked forward to a more manageable life with Lucy and their future children.

A few weeks later, Paul’s weight drops again and he has severe chest pain. He decides to get another X-ray, this time of his chest. Lucy sees that Paul is researching the frequency of cancer in people his age, and she is upset that he isn’t confiding in her.

Lucy decides not to join Paul on a vacation they had planned to take to New York City to see some of his friends, saying that she had decided instead to move out for the week. She expresses concern that they want different things from their relationship. Paul is absent much of the time, and she worries that his schedule won’t change once he becomes an attending neurosurgeon.

Paul offers to skip the trip and see a couple’s therapist, but Lucy is adamant about needing time alone. Paul decides to go on the trip, figuring that if he has severe cancer, as he suspects, this may be the last time to see his friends. Lucy tells him she loves him as she drops him off at the airport.

Paul’s back stiffens in pain during the flight to New York. He hopes his symptoms will clear after a few days away from his hectic life, but he quickly realizes that this is not the case. He confesses to his friend Mike that he may have cancer. Paul’s doctor calls, telling him that the X-rays look blurry, and that she’s not quite sure what that means. Paul knows that it likely means he has cancer.

Lucy picks Paul up from the airport. He tells her that he has cancer. She affirms that she will never leave him, setting aside her previous concerns.

Paul is admitted to the hospital. As he sits in a room in which he has seen many of his own patients, he reflects on his time as a doctor—that in this room, he had congratulated patients on being cured of a disease, and had pronounced patients dead. In his mind, he sees the future toward which he had been striving for the majority of his life evaporate.