When Breath Becomes Air, Paul Kalanithi’s posthumously-published memoir of his battle with terminal lung cancer, details Paul’s post-diagnosis grappling with how much time he has left. Paul has spent a third of his life working toward a career in neurosurgery, only to have the future for which he has worked so hard abruptly taken from him. In the face of this, Paul demonstrates that even though time is a fixed entity (one only has so much time left), a person’s perception of time can rapidly change in the face of death. Ultimately, he argues, time creates a paradox: the most meaningful moments occur when one takes advantage of the present, yet there is no other way to live than by having faith in the future.
When Paul is diagnosed, he is in despair over his lost future, but his brother Jeevan tries to comfort him by saying that he has already accomplished so much. This upsets Paul; he tells the reader that he has spent most of his life “building potential,” planning for a future that would no longer exist. However, Paul’s oncologist, Emma, argues that instead of preparing to die by receding from work and spending time with his family, he should aim to return to neurosurgery and be optimistic about the time that he has left. Emma insists that, although the future might not look like he initially imagined, he may still be able to accomplish some of his goals. Paul takes this advice. When his first treatment successfully prolongs his life, he comes to the understanding that, in the absence of certainty, people have to assume that they are going to live a long time.
Despite deciding to live essentially as he always had—with the assumption that he will have a future—Paul also realizes that often the most precious experiences in one’s lifetime occur when a person is living fully in the present. Prior to Paul’s diagnosis, he spends most of his time at the hospital (often working eighteen-hour days), but he never feels that this time was wasted. He describes how the clock seems particularly irrelevant when he is in surgery, because he is so focused on the vital and intricate task at hand. When Paul is diagnosed with cancer, he realizes that his future has flattened out into a “perpetual present,” because, as with his experience with time during surgery, every moment becomes crucial for him. Thus, Paul realizes that he must take his ambitions for the future and make them happen in the present.
For example, Paul had always hoped to return later in life to writing, and after his diagnosis, he begins to write When Breath Becomes Air. Writing not only allows Paul to accomplish a goal within his limited time, but it is also a project that ensures that his legacy will last into the future. Paul also immediately jumps into fatherhood after he is diagnosed with cancer. He and his wife Lucy want to take advantage of whatever time he has and give him the experience of being a father, which he had always wanted sometime in the future. Their daughter Cady not only provides him with a means of carrying on his own legacy after he is gone, but she also provides him an immense amount of joy in the present. In the days leading up to his death, Paul decides that he only wants to be kept alive with the help of machines if the prospect remains of spending meaningful time. In the absence of that hope, he is not willing to be kept alive by those machines if they inhibit his enjoyment of the time he has left, and so he cuts his future short in order to interact naturally with his family.
Paul’s perception of his future shifts rapidly and constantly as he grapples with his diagnosis. He maintains some optimism in the face of having little time left, and he also tries to achieve some of the goals that he had hoped to complete by the end of his life. The tragedy of the memoir lies in the fact that the book and his daughter outlive Paul significantly, but the fact that Paul becomes a writer and a father in the final months of his life suggests that in living for the present in the face of finite time, Paul is able to produce some of his most meaningful accomplishments and fully enjoy his remaining time on earth.
Time Quotes in When Breath Becomes Air
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.
My life had been building potential, potential that would now go unrealized.
“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.
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.
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.
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.