When Breath Becomes Air

by

Paul Kalanithi

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Scalpel Symbol Analysis

Scalpel Symbol Icon

The scalpel—a small knife used in surgical operations—represents the double-edged sword of operations and medicine in general. In order for many of Paul’s patients to be treated or operated on, their bodies or their brains must first be cut open with a scalpel. Paul describes how cutting a body open, though necessary, is also a “trespass on the sacrosanct.” The use of a scalpel mirrors the cost/benefit question that all patients must face, particularly when undergoing brain surgery. For instance, is saving a life by cutting out a tumor worth the risk of accidentally also cutting the hypothalamus, which could then cause that patient to become a slave to his or her appetites? This is no mere hypothetical question. It is something that actually happens to one of Paul’s patients, and therefore the kind of practical question that surgeons must always ask themselves. During a surgery on a brain-stem malformation, an attending doctor tells Paul that if he were to cut two millimeters deeper, the patient would have locked-in syndrome and would be completely paralyzed, except for the ability to blink. Thus, the scalpel is not only a tool for excising diseases and defects, but also a representation of the risks of surgery and medicine.

Scalpel Quotes in When Breath Becomes Air

The When Breath Becomes Air quotes below all refer to the symbol of Scalpel. 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:
Time Theme Icon
). Note: all page numbers and citation info for the quotes below refer to the Vintage edition of When Breath Becomes Air published in 2017.
Part 1 Quotes

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:

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:
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Scalpel Symbol Timeline in When Breath Becomes Air

The timeline below shows where the symbol Scalpel appears in When Breath Becomes Air. The colored dots and icons indicate which themes are associated with that appearance.
Part 1: In Perfect Health I Begin
Science and Literature Theme Icon
Knowledge, Experience, and Judgment Theme Icon
Human Mortality, Strength, and Support Theme Icon
...the first time he dissects a dead body, and how strangely normal it feels. The scalpel unzips the body, an action that constitutes both a medical rite of passage and a... (full context)
Human Mortality, Strength, and Support Theme Icon
...an emergency C-section. The attending doctor cuts open the woman’s stomach and uterus with a scalpel, and pulls out the two babies. They are rushed to the intensive care unit. (full context)
Science and Literature Theme Icon
Knowledge, Experience, and Judgment Theme Icon
Human Mortality, Strength, and Support Theme Icon
...the death of their loved one. He realizes that “When there’s no place for the scalpel, words are the surgeon’s only tool.” (full context)