When Breath Becomes Air Quotes

“If the unexamined life was not worth living, was the unlived life worth examining?”

“In anatomy lab, we objectified the dead, literally reducing them to organs, tissues, nerves, muscles. On that first day, you simply could not deny the humanity of the corpse . . . Anatomy lab, in the end, becomes less a violation of the sacred and more something that interferes with happy hour, and that realization discomfits. In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.”

“Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death?”

“As a resident, my highest ideal was not saving lives—everyone dies eventually—but guiding a patient or family to an understanding of death or illness.”

“Well, I guess I learned one thing: if I’m ever feeling down about my work, I can always talk to a neurosurgeon to cheer myself up.”

“I recall the sun filtering through the magnolia tree outside my office and lighting this scene: Paul seated before me, his beautiful hands exceedingly still, his prophet’s beard full, those dark eyes taking the measure of me . . . I remember thinking ‘You must remember this,’ because what was falling on my retina was precious. And because, in the context of Paul’s diagnosis, I became aware of not just his mortality but my own.”

“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.”

“I expected to feel only empty and heartbroken after Paul died. It never occurred to me that you could love someone the same way after he was gone.”

“There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.”

“But how do you know when the tracing looks bad enough? Which is worse, being born too early or waiting too long to deliver? ‘Judgment call.’ What a call to make. In my life, had I ever made a decision harder than choosing between a French dip and a Reuben? How could I ever learn to make, and live with, such judgment calls?”

“I had a nagging sense that there was still far too much unresolved for me, that I wasn’t done studying.”

“Even if I’m dying, until I actually die, I am still living.”

“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.”

“The days are long, but the years are short.”

“In this room, I had sat with patients and explained terminal diagnoses and complex operations; in this room, I had congratulated patients on being cured of a disease and seen their happiness at being returned to their lives; in this room, I had pronounced patients dead . . .”

“Any part of me that identified with being handsome was slowly being erased—though, in fairness, I was happy to be uglier and alive.”

“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.”

“It’s very easy to be number one: find the guy who is number one, and score one point higher than he does.”

“Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it.”

“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.”

“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.”

“Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.”

“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.”

“One night on the sofa in my apartment, while studying the reams of wavy lines that make up EKGs, she puzzled over, then correctly identified, a fatal arrhythmia. All at once, it dawned on her and she began to cry: wherever this “practice EKG” had come from, the patient had not survived. The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating to asystole, and they could bring you to tears.”

“The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.”

“My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I’ve spent almost a third of my life preparing for it. I had mapped out this whole forty-year career for myself—the first twenty as a surgeon-scientist, the last twenty as a writer. But now that I am likely well into my last twenty years, I don’t know which career I should be pursuing. If I had some sense of how much time I have left, it’d be easier. If I had two years, I’d write. If I had ten, I’d get back to surgery and science. If only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?”

“Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line. But now I don’t know what I’ll be doing five years down the line. I may be dead. I may not be. I may be healthy. I may be writing. I don’t know. And so it’s not all that useful to spend time thinking about the future—that is, beyond lunch.”