Paul Kalanithi

“People often ask if it was calling. My answer always is yes.”

“I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again. The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own experiences, I would have to translate them back into language. Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward.”

“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. Books became my closest confidants, finely ground lenses providing new views of the world.”

“Putting lifestyle first is how you find a job - not a calling.”

“A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form.”

“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.”

“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.”

“Everything teeters between pathos and bathos: here you are, violating society's most fundamental taboos and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito.”

“Before operating on a patient's 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 another's cross, one must sometimes get crushed by the weight.”

“Before operating on a patient's brain... 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.”

“While all doctors treat diseases, neurosurgeons' work is the crucible of identity. Every operation on the brain is, by necessity, a manipulation of the substance of our selves.”

“Often I return to the grave after leaving flowers – tulips, lilies, carnations – to find the heads eaten by deer. It’s just as good a use for the flowers as any, and one Paul would have liked. The earth is quickly turned over by worms, the processes of nature marching on, reminding me of what Paul saw and what I now carry deep in my bones, too: the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this. What happened to Paul was tragic, but he was not a tragedy.”

“People react differently to hearing 'Procedure X has a 70 percent chance of survival' and 'Procedure Y has a 30 percent chance of death.' Phrased that way, people flock to Procedure X, even though the numbers are the same.”

“What makes human life meaningful? I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.”

“Words have a longevity that I do not have.”

“A resident's surgical skill is judged by their technique and speed. You can't be sloppy, and you can't be slow.”

“What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find on her own... the angst of facing mortality has no remedy in probability.”

“Humans are organisms, subject to physical laws, including alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation.”

“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.”

“The diagnosis was immediate: Masses matting the lungs and deforming the spine. Cancer. In my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to see if surgery offered any hope. I'd scribble in the chart 'Widely metastatic disease - no role for surgery,' and move on. But this scan was different: It was my own.”