Reflections on When Breath Becomes Air

I just finished reading When Breath Becomes Air by Paul Kalanithi, and it left me with so many deep questions about life, identity, and what truly makes life meaningful. I wanted to share a few of my thoughts here.

What physical limitations could you lose and still think life is worth living?

Kalanithi grapples with this question not only as a patient but also as a neurosurgeon, having had these difficult conversations with his own patients. It’s something I’ve thought about, too—especially in relation to running, which is such a core part of my identity. I run every day, and it’s hard to imagine a life without it. If I could no longer run, would I still consider myself a runner, or would I become someone who “used to run”? Would I still find the same joy in movement if it had to take another form?

I think about athletes who have redefined themselves after injury and wonder—how much of my identity is tied to what I do versus who I am? At my core, I can still be disciplined, determined, kind, and dependable, even without running. I don’t need to run to be a good friend, sister, or daughter. But I have to admit—I’m a much nicer person when I’m feeling good and getting my miles in, haha.

Are you chasing an identity that you no longer want to have?

Kalanithi went back and forth deciding if he wanted to pursue science, literature, or medicine. Unsure what he wanted to focus his time on.

 This question made me reflect on why I run. Is it a habit? Passion? A way to structure my life? Yesterday, I felt amazing after my run, but was it because of the run itself? Or was it the social interaction? The caffeine? The break from schoolwork? Running has brought me so much joy—it’s led me to places I wouldn’t have otherwise explored, introduced me to incredible people, and given me that undeniable post-run high. But it also makes me wonder: if I woke up one day and no longer felt that pull to run, would I allow myself to let go of it? Or would I cling to it just because it has always been a part of me?

How do you know what you truly want to do?

Kalanithi’s journey from literature to medicine, and ultimately to writing again, resonated with me. Life hasn’t been a straight path for me either. I’ve followed certain career trajectories, only to pivot when I realized they weren’t right. To me, figuring out what I don’t want has been just as important as discovering what I do want. It’s a process of elimination rather than a clear, linear journey.

How would your answers change if you had 1 year vs. 10 vs. 70 years to live?

This was one of the most profound questions the book made me think about.

• If I had only one year left, I wouldn’t waste time trying to build something new. I’d focus on deepening the relationships I already have and soaking up every moment.

• If I had ten years, that would be the hardest. It’s long enough to want to build a future, but not long enough to see it through. A lot of my current goals—finding the right career, meeting someone, possibly starting a family—are rooted in the idea of building something for the long haul. Would I change those priorities if I knew time was limited?

• If I had seventy years, well, that’s the kind of timeframe that lets you take risks, dream big, and not feel pressured to have all the answers now.

How do you determine if a life is worth living?

For me, it comes down to joy and purpose. If I can still find moments of happiness and feel like I’m contributing in some way—whether that’s through relationships, work, or just experiencing the world—then life is still worth living.

Would you want to live on a ventilator?

This is such a personal and difficult question. If there was a plan for me to recover and get off the ventilator, I’d want to fight for that. But if it was permanent, I don’t think I’d feel fulfilled. I had a patient with ALS who used a ventilator at night and a speaking valve during the day. His world was limited to a bed, and it made me think—could I be happy in that situation? I don’t know. I’d want to still see, interact, and engage with the world in a meaningful way.

If you had a last day at work, would you want it to feel normal or be recognized?

I’d want it to feel normal. No fanfare, no big speeches—just another day, one last time. I don’t love being the center of attention, and I’d rather leave quietly, carrying the memories with me.

How does what’s important to you change if you’re sick and only have a few years to live?

I think I’d be less anxious about the future. Right now, so much of my mental energy goes toward planning for what’s next, trying to set up a good foundation for the future. If time was limited, I’d probably let go of a lot of that and focus more on being present—on actually living rather than just preparing to live. And maybe that’s something worth thinking about, even without a diagnosis hanging over me.

Final Thoughts

When Breath Becomes Air is one of those books that lingers with you long after you turn the last page. It’s not just about death—it’s about life, about meaning, about identity. It made me think about what I value, what I want my life to look like, and how I define myself.

The last paragraph that Paul writes is his letter to his daughter, where he says:

“When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied.”

I loved this, and it resonated with me deeply. It was a reminder that even the small moments of care matter. As a nurse, it’s easy to feel like I’m not making a significant impact, especially in a world that glorifies big achievements. But something as simple as covering a patient with a warm blanket or bringing them their meal tray can bring temporary comfort—and that should be enough.

Walter White’s quote in Breaking Bad, when he finally admits: “I did it for me. I liked it. I was good at it. And I was really… I was alive.” So often, we justify our actions by saying we’re doing them for others, but in reality, we’re all chasing our own selfish successes. Paul’s letter to his daughter felt like the opposite of that. It was about finding meaning, not in personal ambition, but in the impact we have on others, no matter how small.