71 pages • 2 hours read
Paul KalanithiA 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.
The Prologue opens with Paul sitting in a hospital room with his wife, Lucy. When she asks him whether or not there’s a possibility that his ailment is not cancer, he tells her no.
Six months before this moment, Paul was thirty-six and on his way to the top of his field in neurosurgery. With fifteen months left in his residency, one of his professors told him he’d be the first candidate for a teaching position at Stanford when one opened up. In the midst of these successes, he began experiencing mild back pains and severe weight loss. A visit to the doctor results in a normal set of x-rays. A dose of ibuprofen dulls the pain, but the symptoms return as pain in the chest a few weeks later. One day, while lying in the park, Lucy sees him searching his symptoms on his phone and wonders why he isn’t confiding in her. Paul changes the subject and puts away his phone.
This, however, does not quell Lucy’s anxiety. She cancels the plans she and Paul have to visit friends in New York, describing the weight of the isolation she feels as a cause of him not openly communicating his symptoms with her.
When Paul arrives at his friend’s place in New York, he’s unable to make it through a day without suffering extreme exhaustion. After deciding to leave early, he discloses to the host, Mike, that he has cancer, the first time he’s uttered the word out loud to anyone.
Mike subsequently drives him to the airport, and upon stepping off the plane, he receives a call from his doctor telling him that the x-rays of his lungs returned and look “fuzzy.” He and Lucy go to the hospital and he checks into a room in which he’s often attended to the sick.
A younger version of Paul’s self knew he’d never be a doctor like his father, whose career pulled him away from his children throughout their childhoods. Paul’s father moves them the family from a suburb north of Manhattan to Kingman, Arizona, to start a practice that he hopes will become regionally recognized.
During this time, Paul forms a close relationship with nature, dodging black widows and rattlesnakes. Kingman–the least educated district in America according to the census–is foreign territory for Paul’s mother. She’d been trained in India as a psychologist before marrying Paul’s father, a Christian. This cultural difference, as well as the remote location of the new family’s home, creates tension between Paul’s parents.
His mother lavishes Paul and his brother with literature, and Paul soon forms a love affair with books that only feeds his attention to schoolwork, and he’s accepted at Stanford University.
The summer before his move to school is a transformational one. His girlfriend Abigail lends him a book that, despite not being high culture, gives him something crucial to think about. Its assertion that the mind is an operation of the brain starts him thinking about human existence, and that humans are biological organisms that also have free will. He opens his Stanford course catalog, adding a number of biology and neuroscience courses to his literature courses.
After almost completing his English literature and human biology degrees, Paul feels driven by a need to understand “what makes human life meaningful” (30). Throughout college, he had experienced both the need to study and the need to experience what he studied, so when the summer of his sophomore year rolls around, he decides between an internship at a research center and a gig as a prep chef at summer camp.
He chooses the summer camp, enjoying the colors, sounds, and sights of the Eldorado National Forest. He loves being outside at sunrise, experiencing his “speck like existence against the immensity of the mountain, the earth, the universe” while feeling his “presence among the grandeur” (34).
Back at school, his life is enriched by this mingling of study and experience, the pursuit of a “deeper understanding of a life of the mind” (35). During his senior year, one of his classes visits a home for people who have survived severe brain injuries. Distraught by the lack of visitors to the home, and by the guide, who explains that it is difficult to care for these children, Paul turns to his mentor. Only after this experience does he realize that a healthy brain provides our ability to make life meaningful.
Paul is accepted into the master’s program for English Literature at Stanford and dives into his studies, completing his thesis on Walt Whitman. He feels close to Whitman’s work, focusing on Whitman’s idea of “the Physiological-Spiritual Man” (40).
However, Whitman’s failings to materialize this concept, combined with Paul’s own inkling that literature has an adversity to science, leaves him again to wonder about where and how his interests intersect.
The beginning of When Breath Becomes Air thrusts the reader into the central conflict of the book, where the peak of Paul’s career meets the earliest stages of his cancer. In the Prologue, we are also introduced to another central narrative element of the book: Paul and Lucy’s marriage.
Kalanithi then introduces himself by focusing on several interests from his childhood, including literature, a passion for learning, and an interest in exploring the world around him (at this point, mainly the landscapes of Arizona). It is clear that the combination of his mother’s urgings and the solitude of their lives in Arizona produces a ripe environment in which Paul excels in school and forms a high capacity to focus.
The book Paul receives from his girlfriend, Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S., by Jeremy Leven, marks the beginning of what will be a long relationship with literature, one in which specific books and moments mark crucial changes in Paul’s perspective. He reads T.S. Eliot’s The Wasteland as a college student, and the concepts Paul gains by reading Satan is heightened by the understanding of metaphorical language garnered from The Wasteland.
When Paul experiences Eldorado National Forest, he has already formed a crucial skill set for considering the big, existential questions we face as human beings: what role do we play as individuals in our universe, and what gives life meaning?
An important scene occurs when Paul’s visits the home for children with head injuries. He sees a young woman wailing in front of a television, watching a soap opera with the sound off. She seems to represent the study of meaning (watching television) intersecting with the experience of meaning (her apparent sorrow). This image is one that reverberates throughout the book, as Paul weaves between studying life and living it.
This tension is only deepened when Paul completes his master’s thesis, realizing that literature, alone, has somehow thrown up a buffer between himself and the world around him.