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Littler Books cover of When Breath Becomes Air Summary

When Breath Becomes Air Book Summary, Notes, and Quotes

Paul Kalanithi

3.7 minutes to read
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One Sentence Summary

A deeply moving memoir that explores life, death, and the human experience in the face of mortality.

Bullet Point Summary, Notes, and Quotes

  1. Paul Kalanithi is a neurosurgical resident doing his training at Stanford in his last year. He has earned respect, won awards, and has job offers from major universities. He is looking forward to finishing residency, having kids, and spending time with his wife Lucy.
  2. Paul starts experiencing back pain and gets scans done. The CT scans show Paul's lungs are filled with advanced, stage IV cancer.
  3. Prior to the diagnosis, Paul and Lucy started to have relationship issues, Lucy feels Paul is not confiding in her and that Paul is not spending enough time with her. Lucy decides to move out for a week.
  4. After Paul confirms the cancer diagnosis and shares it with Lucy, she vows to never leave him.
  5. Paul is admitted to the Stanford hospital and feels his hopeful future evaporate.
  6. Paul's father is Christian and his mother is Hindu. Paul's grandparents didn't approve of his parents' marriage so his parents eloped from India to the United States.
  7. Paul grew up in Kingman, Arizona. His father is a doctor, but Paul didn't envision himself as a doctor.
  8. His desire to become a writer was influenced by his mother's love for literature.
  9. Before university, Paul reads Jeremy Leven's Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S. The book's idea that the mind is a product of the brain's activity activated his interest in neuroscience.
  10. Paul pursues degrees in English literature and human biology at Stanford. He was driven by the question of what makes life meaningful, and believes both fields offer diverse perspectives on human experience.
  11. Paul applies for a master's in English literature, focusing on Walt Whitman for his thesis. Eventually he realizes he doesn't fit into the English department due to his interest in science.
  12. Paul applies to medical school and is accepted to Yale School of Medicine, where he meets Lucy.
  13. Paul encounters and learns about death from dissecting cadavers and Shep Nuland's book How We Die.
  14. Paul does two years of theoretical study, followed by practical experience in hospitals and clinics.
  15. Post medical school, Paul chooses to return to Standord for residency to specialize in neurosurgery due to his interest in the brain's role in identity.
  16. Paul has an intense schedule at residency with abundant paperwork and being on emergency call, but he realizes the importance of them as lives depend on them.
  17. Paul has concerns about desensitization to death, but a friend's death prompts Paul to emphasize more emotional care for patients.
  18. Mid-residency, Paul studies neuroscience in addition to neurosurgery. V, head of the neuroscience lab, becomes Paul's mentor. V becomes diagnosed with pancreatic cancer but recovers and returns to work.
  19. Paul describes the sixth year as a time-intensive black hole due to copious hours spent in the operating room. The intense focus and precision needed in brain surgery to avoid catastrophic mistakes makes him lose sense of time.
  20. Nearing the end of residency, Paul is reminded of the weight of doctors' responsibility.
  21. Jeff is a doctor friend of Paul's. One of Jeff's patient dies, leading to Jeff's suicide. Paul wishes he could have shared the lesson that death is inevitable but striving for the patients is still worthwhile.
    1. “Even if you are perfect, the world isn't. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
  22. At Paul's cancer diagnosis, tumors have invaded multiple organs and he believes death is approaching.
  23. Paul's oncologist Emma lays out treatment but won't give statistics to avoid pessimism.
  24. Paul had grown weak and required his family's help to perform basic functions.
  25. Positive news emerges when tests show that Paul's cancer, due to a tumor mutation, can be treated with Tarceva, a medication less intense than typical chemotherapy.
  26. Paul and Lucy discuss having a child they'd planned on before the diagnosis. Lucy feels it's Paul's choice since he won't see the child grow up. Paul feels it's Lucy's choice since she may raise the child alone. Eventually, they agree to have a child.
    1. “‘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.”
  27. Paul regains strength with treatment and physical therapy. New scans show Paul's lungs nearly tumor-free and his cancer is now stable.
  28. Paul returns to the operating table, refusing to give up his career prematurely. He tailors therapy to build surgeon-specific strength.
  29. Seven months post-return to surgery, Paul's last CT scan before fatherhood and graduation reveals a new lung tumor.
  30. Paul works his final day and cries in the car after he finishes his last surgery.
  31. Paul starts chemotherapy every three weeks, facing weariness and complications.
  32. Paul misses his graduation as he begins vomiting and spends a week at the hospital.
  33. Two days post-hospital release, his daughter Cady was born on July fourth.
  34. Cady brings Paul immense joy, having created something lasting beyond Paul's lifetime.
  35. Paul concludes the book with a message to Cady, expressing that she has given him the greatest joy of his life.
    1. “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man's days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”
  36. Lucy talks more about Paul's death in the epilogue.
  37. Paul's third treatment option fails around Christmas and the cancer spreads to the brain.
  38. Due to the severity of his condition, Emma finally gives an estimate of his remaining time.
  39. Paul focuses on writing the memoir in his last days.
  40. Paul's breathing becomes increasingly challenging and leads to hospitalization.
  41. Paul, concerned about being permanently on a ventilator, opts for "comfort care".
  42. He communicates readiness to die, says goodbye to family, and removes the breathing mask. Paul slips into unconsciousness and takes his last breath.
  43. Lucy notes the memoir is, in a sense, unfinished despite Paul's tireless efforts.
  44. Paul's goal was to help people understand death and confront mortality.
  45. Lucy expresses gratitude for being part of Paul's meaningful life journey and witnessing his dignified approach to death.

When Breath Becomes Air: Resources