When Breath Becomes Air: 27 lines that shook my world.

Written by Cole Schafer

June 17, 2020

When the plane shakes, the shit that’s truly important to us comes stampeding towards the front of our skulls like bulls we didn’t know existed.

Turbulence is a lovely gift in this way.

You’re blazing through the sky at nearly 600 miles per hour and suddenly the cabin shakes and then shakes some more, and in the blink of an eye, you become fully aware of the shit that matters to you most.

Generally, for me, it’s not my subscriber count over at Sticky Notes nor whether I hit my income goal for the quarter here at Honey Copy.

No, for me, it’s the faces that mean the world to me. It’s the ghosts of words I haven’t yet had the chance to put to paper. It’s the drinking of a cup of coffee whilst curled up with a good book. It’s grilling out with my brothers and friends, half-drunk at 2 a.m. on a Saturday. It’s laughing till my face stings. It’s laughing some more.

This to me is the beauty in turbulence.

Not the fear of dying that it evokes. But, instead, the way in which it reminds us to live.

Sometimes, this beauty comes in the form of rough skies. Other times, it’s a close call at a busy intersection barely dodging a jackass hurling through a red light.

And then, of course, turbulence can come in the form of a book, too.

When breath becomes air.

Earlier this year, a friend of mine sent me a copy of When Breath Becomes Air. I’m embarrassed to admit I put it off, opting for more ambitious books that could rocket my career forward like The Fish That Ate The Whale, Call Me Ted and Junior.

While all of these books are tremendous in their own right, they can’t teach the reader how to live.

Perhaps that’s the very thing I was looking for, almost subconsciously, when I finally picked up this tiny ivory gem.

When Breath Becomes Air was written by a neurosurgeon (and an astounding writer) named Paul Kalanithi.

At the age of 35, after having reached the pinnacle of his medical career, he was diagnosed with stage-4 lung cancer.

The book embodies Paul’s search for meaning and purpose as he pulls a Joan Didion and uses the craft of writing as a way to discover.

He’s essentially answering the question…

What makes a life worth living?

Here are a few lines from his masterpiece that I can’t stop thinking about…

27 When Breath Becomes Air quotes worth knowing.

On wisdom in the presence…
We are never so wise as when we live in this moment.
On dissecting cadavers…
Even working on the dead, with their faces covered, their names a mystery, you find that their humanity pops up at you –– in opening my cadaver’s stomach, I found two undigested pills, meaning that he had died in pain, perhaps alone and fumbling with the cap of a pill bottle.
On failing…
In an act of desperation, he cut open the patient’s chest and tried to pump his heart manually, tried to literally squeeze the life back into him. The patient died, and Nuland was found by his supervisor, covered in blood and failure.
On birthing…
He sliced that open as well, and a small face appeared, then disappeared amid the blood. In plunged the doctor’s hands, pulling out one, then two purple babies, barely moving, eyes fused shut, like tiny birds fallen too soon from a nest.
On finding your calling…
Putting lifestyle first is how you find a job –– not a calling.
On mastery…
The chairman, passing through the ward: “Always eat with your left hand. you’ve got to learn to be ambidextrous.”
On drinking and dying and not accepting…
An alcoholic, his blood no longer able to clot, who bled to death into his joints and under his skin. Every day, the bruises would spread. Before he became delirious, he looked up at me and said, “It’s not fair –– I’ve been diluting my drinks with water.”
On becoming jaded…
But in residency, something else was gradually unfolding. In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun.
On enduring pain without complaint…
Patients when hearing the news, most remain mute. (One of the early meanings of patient, after all, is “one who endures hardship without complaint.”)
On fighting despite the odds…
The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win for your patients.
On caring through suffering…
… patients don’t typically ask how their doctors are doing.
On being a statistic…
It occurred to me that my relationship with statistics changed as soon as I became one.
On dying while in love…
“What are you most afraid or sad about?” she asked me one evening while we were lying in bed. “Leaving you,” I told her.
On writing…
I needed words to go forward.
On weathering the storm…
I can’t go on. I will go on.
On living while dying…
… knowing that even if I’m dying, until I actually die, I’m still living.
On living with cancer…
As desperately as I now wanted to feel triumphant, instead I felt the claws of the crab holding me back. The curse of cancer created a strange and strained existence, challenging me to be neither blind to, nor bound by, death’s approach. Even when the cancer was in retreat, it cast long shadows.
On dying with a newborn daughter…
When you come to one of the many moments in life where you must give an account for 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.
On losing your mate…
At home in bed a few week before he died, I asked him, “Can you breathe okay with my head on your chest like this?” His answer was “It’s the only way I know how to breath.”
On healing without surgery…
When there’s no place for the scalpel, words are the surgeon’s only tool.
On being hungry in bizarre moments…
Here you are, violating society’s most fundamental taboos (cadaver dissection), and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito.
On planning without knowing…
I sat, staring at a photo of Lucy and me from medical school, dancing and laughing; it was so sad, those two, planning a life together, unaware, never suspecting their own fragility.
On changing perspectives…
Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.
On being young…
We often sneaked out at night to, for example, sing ‘American Pie’ beneath the window of the captain of the cheerleading team. (Her father was a local minister and so, we reasoned, less likely to shoot). After I was caught returning at dawn from one such late-night escapade, my worried mother thoroughly interrogated me regarding every drug teenagers take, never suspecting that the most intoxicating thing I’d experienced, by far, was the volume of romantic poetry she’d handed me the previous week.
On losing looks…
Any part of me that identified with being handsome was slowly being erased—though, in fairness, I was happy to be uglier and alive.
On being absent…
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.
On choosing mercy over justice…
The main message of Jesus, I believed, is that mercy trumps justice every time.

Paul died on March 9, 2015. He left behind a pair of brothers, a loving life partner, a newborn daughter and a book that has since taught millions of people how to live.

Thank you, Paul.

By Cole Schafer (but mostly Paul Kalanithi).