Because Paul is a neurosurgeon, he spends much of his memoir writing about the brain: how it functions, how it fails, and the information it can store. However, Paul also understands that being a doctor does not solely boil down to the technical knowledge or skill that one has—a successful doctor must also have experience, which is much more challenging to acquire. Paul’s journey through residency leads him to discover that textbook knowledge is important, but the judgment that comes from facing problems on the ground is much more valuable.
When Paul is in high school, his mother places a high premium on her sons getting a traditional education. She would drive them more than a hundred miles to Las Vegas to take standardized tests to get into college, and she also demanded that their school add AP courses. Paul is eventually accepted to Stanford, fulfilling her expectation. But in Paul’s sophomore year of college, he chooses to spend his summer as a chef at a camp rather than being an intern at a primate research center, which aligns more with his mother’s vision for his life. Though Paul doubts his decision at first, he realizes how valuable his time exploring the lakes, mountains, and deserts near the camp is because it gives him first-hand experience of the natural world. Though this is unrelated to his future career, his comment that “every day felt full of life, and of the relationships that give life meaning” demonstrates how much he values real-world experiences in his quest for a meaningful existence.
As Paul goes through medical school and residency, he understands more and more the value of experience and developing his own judgment, rather than relying on the textbook knowledge he gained in medical school. During Paul’s first day at the ob-gyn, for example, the resident explains that it’s a judgment call on whether to deliver babies very early when they have abnormal heart rhythms or to wait longer in order to let them develop more. Paul understands that this kind of decision cannot be made through intelligence alone; one must also have experience, and with that experience, an ability to judge future situations. Similarly, when Paul is in residency, he describes how he aims to understand his own patients in order to make tricky judgment calls. He says that before he operates on anyone’s brain, he first tries to understand his patient’s mind: “his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end.” This aids him in making such judgment calls about a patient’s life and wellbeing. In this way, it is not just knowledge that helps him perform surgery—it is judgment that allows him to provide a future for patients that they would most want to have.
When Paul moves from the role of doctor to the role of patient, he also relies on his oncologist, Emma, for the same judgment and guidance he provides to his own patients. Emma uses her own experience and what she knows of Paul to determine the best treatment for him. Understanding that Paul’s career is important to him, she helps him choose drugs that won’t damage the nerves in his hands so that he can continue to perform surgery. Emma also refuses to tell him where he lies on statistical curves because she thinks that these dry facts will be damaging to Paul’s hope in his future. Thus, knowledge here is not only insufficient, it is also potentially harmful. Instead, Emma uses her judgment and relays guidance on how Paul can spend his remaining time meaningfully, helping him work towards recovery and get back to his job as a neurosurgeon.
Paul and his family clearly value knowledge and intelligence—concrete factual information and the ability to learn that information. But throughout his life, he also discovers the value of actual understanding. Both as a doctor and as a patient, Paul sees that the textbooks he reads in medical school have their limitations. He comes to realize that “no system of thought can contain the fullness of human experience.” Thus, Paul’s knowledge may help save lives, but Paul’s judgment ensures that those lives can remain meaningful.
Knowledge, Experience, and Judgment ThemeTracker
Knowledge, Experience, and Judgment Quotes in When Breath Becomes Air
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.
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.
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.
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.