71 pages • 2 hours read
Paul KalanithiWhen Breath Becomes Air
Nonfiction | Autobiography / Memoir | Adult | Published in 2016A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more. For select classroom titles, we also provide Teaching Guides with discussion and quiz questions to prompt student engagement.
Part 2, Sections 7-9Chapter Summaries & Analyses
Part 2
Part 2, Section 7 Summary
Seven months after returning to surgery, Paul has his last CT scan of the residency and the last one he’ll receive before becoming a father. He doesn’t have time to review the scan before heading back to his work obligations. While reviewing them on his own, later, he recognizes a new tumor has developed.
He returns home to tell Lucy. Together, they map out what appointments they’ll need to make for Paul. He’s not sure he’ll be able to return to neurosurgery after the next round of treatments, but he’s got to go to work tomorrow, as he’s already prepared for the day’s proceedings.
The next morning is business as usual. He spends extra time with Mr. R, a patient who developed Gerstmann’s syndrome after having his brain tumor removed. Despite his cognitive impairments (inability to write or do arithmetic, among other things), Mr. R will likely make a full recovery.
He scrubs for what might be the last time of his career and enters the OR to work on what might be the last patient of his career. In the middle of the procedure his back begins to ache. The attending makes an error, accidentally cutting into the dura, which adds an hour to the surgery time. By this time, Paul is becoming exhausted, but he seamlessly finishes the procedure after the attendee scrubs out.
Paul gathers the belongings that have accumulated over his seven years at the hospital, leaving behind his books for others. He goes home, takes off his scrubs, and pulls the batteries out of his pager. He calls his friend Victoria to tell her he won’t be in on Monday, or perhaps ever again.
Part 2, Section 8 Summary
On Monday, Paul has his appointment with Emma. He hopes for her guidance more than anything. She urges him to see the tumor growth as just a “bump in the road” and tells him to continue doing things that matter to him (180). Paul considers how his world is more of a Greek tragedy than a Shakespeare play: that he cannot control his fate, but that Emma’s guidance is like the wisdom of an oracle.
Paul calls Emma a few days later, to go over the medical plans for the upcoming weeks. At the end of the call, she tells him that he is welcome to just be the patient and not the professional. He hadn’t considered this before.
The day after his first round of treatment, he already feels weariness setting in. His bagel with cream cheese tastes like salt, and fatigue is rooted in his bones. In the midst of the cycles, Paul finds out that he’s qualified for graduation. It is scheduled just two weeks before Lucy’s due date.
When the morning of the ceremony arrives, Paul is uncontrollably vomiting bile. He and Lucy rush to the hospital so as to avoid dehydration. He is hooked up to an IV and admitted to a room. Paul notices that the pill, Tarceva, has been taken off his list of medications. The medical resident, Brad, informs him that evening that Paul’s liver enzymes are too high to continue Tarceva. Paul invokes Emma’s opinion to try and sway Brad, but he won’t budge. He suspects it is causing some of Paul’s side effects. The ensuing argument ends in Brad’s defeat. He shuffles off to contact Emma, who apologizes for the confusion the next morning. She tells Paul she’ll be headed out of town for the week.
Over the course of the day, Paul’s body begins failing him. His diarrhea worsens, his kidneys begin to fail, and he cannot speak or swallow. He’s transferred to the ICU.
Lucy secretly moves into Paul’s old call room, so that she can check in on him as frequently as she needs to. As he moves in and out of consciousness, Paul notices each group of specialists at the hospital unable to coordinate with one another. He overhears their discussions with Lucy and his father, and understands that at this point, they will continue to rehydrate him until the effects of the chemo wear off.
When Emma returns a week later, Paul tells her he’d like to completely hand her the reigns and be the patient. With a clear sense of Emma’s being in charge, he can finally relax. Lucy is having her first contractions, so Paul’s mother drives him to his follow-up appointment with Emma. The disease looks stable, and the tumor might even be shrinking. He won’t be able to undergo chemo until he has regained his strength, and it will be a long road to recovery. Paul asks her what the next step will be. He’s worried that the first two plans have failed and that he might not be able to undergo any more treatment.
In the middle of his worrying, she tells him, “You have a good five years left” (193). Rather than sensing confidence, he senses she is pleading with him, that they will have to face this together.
Paul learns that Lucy is in labor on his way home from the appointment. He heads straight to the hospital and takes a cot in the delivery room as she gives birth. Their daughter arrives at 2:11 AM on July 4th and is named Elizabeth Acadia. He holds her in his arms, and where there was once an “empty wasteland” he sees “a blank page on which I would go on” (196).
Part 2, Section 9 Summary
Cady is a healthy baby, bringing a sense of newness to the household. Paul feels that every day he regains his strength, but that every day also brings him closer to his death. He wants to fill his time with activities he loves, but his exhaustion limits him. The future used to be important to him, when he was studying medicine, but now time feels arbitrary. He notes: “Languor settles in. There’s a feeling of openness” (197).Paul no longer knows which tense to use when speaking about his career as a neurosurgeon: present, past, or pluperfect.
He hopes he will live long enough that his daughter has a memory of him. He wonders whether he should write her letters, but he has no idea who she will be when she is old enough to read them.
There is only one thing he can say to his baby. He wants her to know that she has filled his last days with a “joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied” (199).
Part 2, Sections 7-9 Analysis
After Paul learns that his cancer has advanced, he proceeds to work his last day in the OR, before beginning treatment. The prose Kalanithi uses to paint his motions of scrubbing, operating, and visiting patients is sparse, the events of the day only interrupted by brief mentions of the aches and pains in Paul’s back. The hollowness of tone carries the weight of Paul’s realization that he likely will never return to OR again.
These pages also document the conversations during which he finally prioritizes his “perspective” as a patient, as much as he prioritizes his perspective as a doctor (190). The two have been at odds with one another since his diagnosis, and as his health fails him, his constant involvement in his treatment only exhausts him. So, allowing himself to be taken care of does not mean that he is giving up, only that he is experiencing his life in a new way, one in which he can “finally relax” (191).
There are many beginnings and endings contained within these chapters, many of them final. The arrival of Cady, however, is not something that can be contained, narratively, like the completion of a degree or the last day of Paul’s job. The possibility she represents transcends all of Paul’s suffering and triumph, because she brings happiness that is unquantifiable. She is a “blank page” (196). This harkens back to Paul’s unwillingness to reconcile the impossible ideas of science and certain human experiences. She brings Paul the “core passions” whose existence is explained by “scientific knowledge” (170). She is, in other words, something impossible, a transcending bridge between two realms of human experience between which there would otherwise “always be a gap” (170).
