Top highlights from When Breath Becomes Air
You cant ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.
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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.
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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.
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Will having a newborn distract from the time we have together?" she asked. "Don't you think saying goodbye to your child will make your death more painful?""Wouldn't it be great if it did?" I said. Lucy and I both felt that life wasn't about avoiding suffering.
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I cant go on. Ill go on.
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Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.
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I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didnt know when. After the diagnosis, I knew that someday I would die, but I didnt know when. But now I knew it acutely. The problem wasnt really a scientific one. The fact of death is unsettling. Yet there is no other way to live.
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even if Im dying, until I actually die, I am still living.
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The main message of Jesus, I believed, is that mercy trumps justice every time.
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Dont think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect lifeand not merely life but anothers identity; it is perhaps not too much to say anothers soulwas obvious in its sacredness. Before operating on a patients brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up anothers cross, one must sometimes get crushed by the weight.
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Life wasnt about avoiding suffering.
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The physicians duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.
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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.
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Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death -- it's something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility. Our patients' lives and identities may be in our hands, yet death always wins. 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.
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If the unexamined life was not worth living, was the unlived life worth examining?
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Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to diebut Id known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, Id spend time with family. Tell me one year, Id write a book. Give me ten years, Id get back to treating diseases. The truth that you live one day at a time didnt help: What was I supposed to do with that day?
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Literature not only illuminated anothers experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.
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Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.
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I will share your joy and sorrow / Till weve seen this journey through.
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I dont believe in the wisdom of children, nor in the wisdom of the old. 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 the moment.
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Yet the paradox is that scientific methodology is the product of human hands and thus cannot reach some permanent truth. We build scientific theories to organize and manipulate the world, to reduce phenomena into manageable units. Science is based on reproducibility and manufactured objectivity. As strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable. Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.
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All the idylls of youth: beauty manifest in lakes, mountains, people; richness in experience, conversation, friendships. Nights during a full moon, the light flooded the wilderness, so it was possible to hike without a headlamp. We would hit the trail at two A.M., summiting the nearest peak, Mount Tallac, just before sunrise, the clear, starry night reflected in the flat, still lakes spread below us. Snuggled together in sleeping bags at the peak, nearly ten thousand feet up, we weathered frigid blasts of wind with coffee someone had been thoughtful enough to bring. And then we would sit and watch as the first hint of sunlight, a light tinge of day blue, would leak out of the eastern horizon, slowly erasing the stars. The day sky would spread wide and high, until the first ray of the sun made an appearance. The morning commuters began to animate the distant South Lake Tahoe roads. But craning your head back, you could see the days blue darken halfway across the sky, and to the west, the night remained yet unconqueredpitch-black, stars in full glimmer, the full moon still pinned in the sky. To the east, the full light of day beamed toward you; to the west, night reigned with no hint of surrender. No philosopher can explain the sublime better than this, standing between day and night. It was as if this were the moment God said, Let there be light! You could not help but feel your specklike existence against the immensity of the mountain, the earth, the universe, and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur.
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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, that I would continue to feel such love and gratitude alongside the terrible sorrow, the grief so heavy that at times I shiver and moan under the weight of it.
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Those burdens are what make medicine holy and wholly impossible: in taking up anothers cross, one must sometimes get crushed by the weight.
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Bereavement is not the truncation of married love, C. S. Lewis wrote, but one of its regular phaseslike the honeymoon.
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The word hope first appeared in English about a thousand years ago, denoting some combination of confidence and desire. But what I desiredlifewas not what I was confident aboutdeath. When I talked about hope, then, did I really mean Leave some room for unfounded desire? No. Medical statistics not only describe numbers such as mean survival, they measure our confidence in our numbers, with tools like confidence levels, confidence intervals, and confidence bounds. So did I mean Leave some room for a statistically improbable but still plausible outcomea survival just above the measured 95 percent confidence interval? Is that what hope was? Could we divide the curve into existential sections, from defeated to pessimistic to realistic to hopeful to delusional? Werent the numbers just the numbers? Had we all just given in to the hope that every patient was above average? It occurred to me that my relationship with statistics changed as soon as I became one.
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We shall rise insensibly, and reach the tops of the everlasting hills, where the winds are cool and the sight is glorious.
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When there is no place for the scalpel, words are the surgeons only tool.
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Any major illness transforms a patientsreally, an entire familyslife.
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Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.
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I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I'm dying, until I actually die, I am still living.
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Relying on his own strength and the support of his family and community, Paul faced each stage of his illness with gracenot with bravado or a misguided faith that he would overcome or beat cancer but with an authenticity that allowed him to grieve the loss of the future he had planned and forge a new one. He cried on the day he was diagnosed. He cried while looking at a drawing we kept on the bathroom mirror that said, I want to spend all the rest of my days here with you. He cried on his last day in the operating room. He let himself be open and vulnerable, let himself be comforted. Even while terminally ill, Paul was fully alive; despite physical collapse, he remained vigorous, open, full of hope not for an unlikely cure but for days that were full of purpose and meaning.
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While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability - or your mother's - to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand's function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?
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Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation.
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Words have a longevity I do not.
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Putting lifestyle first is how you find a job --- not a calling.
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Before operating on a patients brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end.
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If you believe that science provides not basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, there for, life itself doesn't have any. In other words, existential claims have no weight; all knowledge is scientific knowledge. Yet the paradox is that scientific methodology is the product of human hands and thus cannot reach some permanent truth. We build scientific theories to organize and manipulate the world, to reduce phenomena into manageable units. Science is based on reproducibility and manufactured objectivity. As strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature or human life, which is unique and subjective and unpredictable. Science may provide the most useful may to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.
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(B)rains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.
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Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.
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In the end, it cannot be doubted that each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth. 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. And Truth comes somewhere above all of them, where,
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Severe illness wasnt life-altering, it was life-shattering. It felt less like an epiphanya piercing burst of light, illuminating What Really Mattersand more like someone had just firebombed the path forward.
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Moral duty has weight, things that have weight have gravity.
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Suffering can make us callous to the obvious suffering of another.
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In taking up anothers cross, one must sometimes get crushed by the weight.
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So what tense am I living in now?
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What kind of life exists without language?
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Doctors, it turns out, need hope, too.
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We are never so wise as when we live in this moment.
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What happened to Paul was tragic, but he was not a tragedy.
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If the weight of mortality does not grow lighter, does it at least get more familiar?
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Maybe, in the absence of any certainty, we should just assume that were going to live a long time. Maybe thats the only way forward.
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Death, so familiar to me in my work, was now paying a personal visit.
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At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living.
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You could not help but feel your specklike existence among the immensity of the mountain, the earth, the universe, and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur.
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