Paul Kalanithi

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.

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

The root of disaster means a star coming apart, and no image expresses better the look in a patient's eyes when hearing a neurosurgeon's diagnosis.

I have sat with countless patients and families to discuss grim prognoses: It's one of the most important jobs physicians have. It's easier when the patient is 94, in the last stages of dementia, and has a severe brain bleed. For young people like me - I am 36 - given a diagnosis of cancer, there aren't many words.

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.

When there's no place for the scalpel, words are the surgeon's only tool.

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.

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.

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.

The tricky part of illness is that, as you go through it, your values are constantly changing... You may decide you want to spend your time working as a neurosurgeon, but two months later, 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.

I knew medicine only by its absence - specifically, the absence of a father growing up: one who went to work before dawn and returned in the dark to a plate of reheated dinner.

I had spent so much time studying literature at Stanford and the history of medicine at Cambridge in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me.