Moving, inspiring, thought provoking

4.5/5 (re-rated higher from first read)

I am just utterly obsessed with the ideas explored in this book. I love how Kalanithi intertwines memoir with philosophy, literature, and medicine. This book has been incredibly influential in my own path to medicine and helped me realize the importance of humanities in medicine. And the afterword from his wife is utterly devastating.

* Literature provided a rich account of human meaning; the brain was the machinery that somehow enabled it. 
* I was drive less by achievement than by trying to understand: 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. Meaning, while a slippery concept, seemed inextricable from human relationships and moral values.
* My monastic, scholarly study of human meaning would conflict with my urge to forge and strengthen the human relationships that formed that meaning. If the unexamined life was not worth living, was the unlived life worth examining?... I could either study meaning or I could experience it.
* 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… You could not help but feel your specklike existence against the immensity of the mountain… and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur.
* I don’t 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 this moment. (from Mo’s short story)
* Brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.
* I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion.
* It was the relational aspect of humans (human relationality) that undergirded meaning. Yet this process existed in brains and bodies, subject to their own physiologic imperatives, prone to breaking and failing.
* It was not a simple evil, however. All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escort them into the world, and then back out. Seeing the body as matter and mechanism is the flip side to easing the most profound human suffering. By the same token, the most profound human suffering becomes a mere pedagogical tool.
* As medical students, we were confronted by death, suffering, and the work entailed in patient care, while being simultaneously shielded from the real brunt of responsibility, though we could spot its specter. 
* Putting lifestyle first is how you find a job–not a calling.
* 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?
* At moments, the weight of it all became palpable. It was in the air, the stress and misery. Normally, you breathed it in, without noticing it. But some days, like a humid muggy day, it had a suffocating weight of its own. Some days, this is how it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down.
* When there’s no place for the scalpel, words are the surgeon’s only tool.
* …informed consent–the ritual by which a patient signs a piece of paper, authorizing surgery–became not a juridical exercise in naming all the risks as quickly as possible, like the voiceover in an ad for a new pharmaceutical, but an opportunity to forge a covenant with a suffering compatriot: Here we are together, and here are the ways through–I promise to guide you, as best I can, to the other side.
* These burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.
* You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.
* Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.
* My relationship with statistics changed as soon as I became one…Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.
* If the weight of mortality does not grow lighter, does it at least get more familiar?
* 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.
* “I can’t go on. I’ll go on.” (Samuel Beckett)
* …seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.
* People often ask if it is a calling, and my answer is always yes. You can’t see it as a job, because if it’s a job, it’s one of the worst jobs there is.
* Even when the cancer was in retreat, it cast long shadows.
* The problem eventually became evident: to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning–to consider a world that is self-evidently not the world we live in…if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life doesn’t have any. In other words, existential claims have no weight; all knowledge is scientific knowledge. 
* There we were, doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now, was no more, and no less, than two people huddled together, as one faces the abyss. Doctors, it turns out, need hope, too.
* The future, instead of the latter toward the goals of life, flattens out into a perpetual present.
* There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.
* “Always the seer is a sayer. Somehow his dream is told; somehow he publishes it with solemn job” (Emerson). Writing this book was a chance for this courageous seer to be a sayer, to teach us to face death with integrity. (Lucy)
* I asked him, “Can you breathe okay with my head on your chest like this?” His answer was “It’s the only way I know how to breathe.” (Lucy)
* I was his wife and a witness. (Lucy)