When Breath Becomes Air


Paul Kalanithi

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Themes and Colors
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Science and Literature Theme Icon
Knowledge, Experience, and Judgment Theme Icon
Human Mortality, Strength, and Support Theme Icon
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Throughout high school and college, Paul believes that literature and language are the best way to understand the life of the mind, but eventually he comes to realize that biology and neuroscience determine the rules of the brain and are therefore vital to comprehending human existence. At various stages of his life, Paul turns from literature to science and back to literature in order to fully grapple with death, as he realizes that the two complement each other and offer different perspectives on the subject. Within his own experience and writing, Paul demonstrates that both language and science are integral to understanding human life.

Throughout Paul’s youth and college experience, literature is the primary shaper of his worldview. He sees language as the crucial means of enabling human connection and understanding death. Paul’s mother aims to ensure that Paul is receiving a good education, and so she provides him with a college prep reading list. Brave New World becomes foundational for his moral philosophy and is the subject of his college admissions essay. He also notes that Hamlet helps him through adolescent crises. After setting aside literature during his years at medical school and in residency, Paul returns to reading when he is diagnosed with lung cancer. He reads many different works by authors who have written on mortality (Tolstoy, Nagel, Woolf, Kafka, to name a few), as well as memoirs of other cancer patients, in order to give himself a vocabulary for speaking about death and finding commonalities with his own experience. One work that emerges throughout the book is T.S. Eliot’s The Waste Land, which resonates with Paul in college for its discussions of “meaninglessness, isolation, and the desperate quest for human connection.” Paul quotes Eliot at other crucial moments in the memoir: when Paul discovers that his tumors are resisting his first treatment and have grown again; when his oncologist, Emma, releases him from the responsibility of being his own doctor; and finally, when he is told that he should be videotaped daily doing the same task to track any deficits in his speech, he opts to recite the poem from memory, demonstrating his personal use of literature to make sense of his own mortality.

Despite the centrality of literature to Paul’s life and thought, his interest in science helps him realize that literature is limited in its ability to account for human existence. As he grows older, science becomes another way in which Paul grapples with philosophy, morality, and quality of life. While Paul is still in high school, he reads a novel called Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S. Even though Paul says that it is a relatively simplistic novel, he is astounded by its assumption that consciousness isn’t mystical, but rather a result of mechanical brain operations. Therefore, Paul realizes that the brain is the foundation of human experience. In order to better understand this revelation about human existence, Paul pursues a career in medicine, which confirms for him that the mechanics of the brain are a defining aspect of the humanity he finds in literature. For example, as Paul learns about neurosurgery, he becomes able to map essential human functions onto the physical structures of the brain. During a particularly tricky surgery, an attending doctor tells Paul that if he cut two millimeters deeper into the brain, the patient would be completely paralyzed, with the exception of the ability to blink. This underscores that humanity is, in some ways, mechanical: what makes people human comes from the physical operations of the brain. Furthermore, while working with cadavers in medical school, Paul finds himself psychologically reducing human bodies to simple organic matter for study. Without cognition, Paul finds it difficult to recognize humanity in a cadaver, which shows him the paramount importance of the brain.

Yet the memoir argues that neither science nor literature alone can fully account for what makes people human. Paul comes to believe that combining the wisdom of science and literature makes life most meaningful by helping people understand themselves and the world around them. Paul relays that, during surgeries, the areas of the brain that control language are considered to be completely off-limits to operation, since the language centers in the brain are so central to human life and existence that doctors feel that the possibility of damaging them isn’t worth the risk. For Paul, this shows that literature—an art form wholly dependent on language—is central to humanity. Paul also recounts an experience in college in which he visits a home for people who had suffered severe brain injuries, usually in their youth. Seeing that these people have very little means of retaining human connection because they lack many language functions, Paul realizes that the brain gives rise to the ability to form relationships and make life meaningful. Another interesting intersection between language and science lies in Paul’s knowledge that statistics alone cannot help a patient understand their prognosis; the language that the doctor uses to describe their condition is equally important. Paul describes how, in a case like glioblastoma (an aggressive brain cancer), rather than saying “Median survival is eleven months,” or “You have a ninety-five percent chance of being dead in two years,” Paul explains, “Most patients live many months to a couple of years.” This verbal nuance is not only more accurate, Paul finds, but it is also more comforting and compassionate.

In addition to realizing that science and literature are both vital to human existence, Paul uses both subjects to make his own life meaningful. He tells his oncologist that he always planned to spend the first twenty years of his career as a surgeon, and the last twenty as a writer. Faced with limited time, Paul blends this love of science and literature in writing this account of his neuroscientific education and career. When Breath Becomes Air not only proves how vital literature and science are in general, but also how important they were to Paul himself in his final months of life.

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Science and Literature Quotes in When Breath Becomes Air

Below you will find the important quotes in When Breath Becomes Air related to the theme of Science and Literature.
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:

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:

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:
Part 2 Quotes

The angst of facing mortality has no remedy in probability.

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

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: