When Breath Becomes Air

by Paul Kalanithi

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Part 1, Section 1 Summary

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As part 1 (titled “In Perfect Health I Begin”) opens, Paul remembers his path to being a doctor. Initially, he has no interest in going into the medical profession, even though he comes from a family of doctors. He is more interested, as a child, in becoming a writer—a dream which has never left him.

Paul recalls his father as a fine cardiologist beloved by his patients; as a parent, though, Paul felt his father to be distant and only sporadically available to his children. Their relationship was characterized by “short, concentrated (but sincere) bursts of high intensity.”

When Paul is ten, his family moves from Bronxville, New York, to Kingman, Arizona. Young Paul is fascinated by the desert terrain and wild animals that are a part of daily life in Kingman. He is told various so-called “country facts” about the landscape by the locals, though these “country facts” are largely exaggerations concerning the supposed lethality of the wildlife, designed to make fools of newcomers and tourists. Once he finally feels at home in Kingman, Paul himself starts sharing “country facts” with outsiders.

Paul wonders how his father convinced his mother, who has a severe phobia of snakes, to move to Kingman. The two eloped from India to New York City, much to the displeasure of his father’s Christian family and his mother’s Hindu relations (Paul mentions that his maternal grandmother refuses to call him by his Western first name, preferring to use his Indian middle name, Sudhir). Regardless, Paul’s mother comes to occupy herself with other matters once the family settles into their new home.

Paul’s mother quickly learns that the Kingman school system is ranked among the worst in the country. Terrified her children will not receive an adequate education, she combs through college reading lists and assigns books to her children. Paul enjoys the many works of literature he encounters through this exercise, particularly George Orwell’s 1984, which his mother has him read when he is ten. “I was scandalized by the sex,” Paul notes, “but it also instilled in me a deep love of, and care for, language.”

Paul’s mother also gets herself involved with the school board, demanding that AP classes be added to the curriculum, and drives all of her children to Las Vegas to take standardized tests such as the PSAT, SAT, and ACT. Her efforts bring about positive changes in the school system, allowing students to feel that their futures can lie beyond the narrow confines of the town.

Paul is accepted into Stanford, but the academic year begins a month later than most other colleges. While his friends are attending classes at their universities of choice, Paul spends time alone in the desert or with his girlfriend at the time, Abigail, who works at the only coffee shop in Kingman. One day, Abigail recommends that Paul read something other than his preferred “high-culture crap” and lends him a book entitled Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S. Paul is not impressed with the book, but it sparks an interest in neuroscience. He dual-majors in English and biology, hoping a synthesis of the two subjects will reveal to him what makes life meaningful—particularly as one of Paul’s concerns is that he is not living his life to the fullest.

After school starts, Paul fears he is becoming too inwardly focused through his extensive study. This problem comes to the forefront during Paul’s sophomore summer, when he considers two jobs: interning for a prestigious primate research center or working as a prep chef at Sierra Camp. When he...

(This entire section contains 1158 words.)

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picks the latter, Paul baffles his biology adviser (“When you grow up, are you going to be a scientist or a . . .chef?”) but feels that this is the best option for forging new relationships. His reading has convinced him that relationships and love are what give life meaning, and as he puts it,

I could either study meaning or I could experience it.

Paul does not regret his choice: he makes new friends and gains an appreciation for living in the moment during his time in the wilderness.

For the next two years, Paul continues his studies, pursuing literature, philosophy, and neuroscience. He also deepens his friendships with “various escapades” and pranks. However, one of his most formative experiences occurs during a field trip to a home for individuals with brain injuries. The sight of a woman screaming and crying in front of a television chills him. Paul is surprised to learn that most of the patients’ relatives visit them less regularly over time and sometimes eventually cut off contact. Paul’s interaction with one of the patients, who smiles at him when he touches her hand, convinces him there must be some awareness somewhere within these people. He realizes how delicate the brain, and therefore someone’s sense of identity, can be.

As graduation approaches, Paul joins the English literature master’s program at Stanford. He wants to synthesize the power of language and communication with what he learns in his neuroscience classes, saying,

I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion.

Paul is excited to study with philosopher Richard Rorty and undertakes a thesis on Walt Whitman’s concept of the “Physiological-Spiritual Man.” Pursuing this thesis (which he titles “Whitman and the Medicalization of Personality”) convinces Paul that he does not want to focus on literary studies as a future career: he finds it “overly political and averse to science.”

With one career option discarded, Paul briefly considers moving to New York City with friends who plan to work in the arts. While walking home from a football game one day, though, he decides to study medicine, realizing that medicine will allow him to better understand Whitman’s “Physiological-Spiritual Man.” Even though time for literature and friends will have to be sacrificed for the grueling work required, Paul feels it is a worthy trade-off. During the year of study he must complete before he can apply to medical school, Paul is unwilling to take even a part-time job, since that would give him less time to prepare. A friend lets him sleep in an abandoned dorm building she manages, and when the building is occupied, Paul lives in a tent by Lake Tahoe.

While waiting for his medical school applications to go through, a process which takes about eighteen months, Paul has a “free year.” He takes the advice of professors who suggest he pursue a degree in the history and philosophy of science and medicine before leaving academia entirely. Paul enrolls in the HPS program at Cambridge, but the discussion of (rather than living of) life-and-death questions leaves Paul dissatisfied. Craving “direct action” after years of reading books, Paul returns to the United States to attend medical school at Yale.


Prologue Summary


Part 1, Section 2 Summary