“‘When I talk to you about feeling isolated, you don’t seem to think it’s a problem. I need to do something different.’”

This comes from Lucy, after she realizes Paul is actually worried about having cancer. By isolating himself, Paul has inadvertently isolated Lucy. Because there is such gravity to the secrets being kept, the beginning of Paul’s illness is wrought with marital tension.

“I knew a lot about back pain—its anatomy, its physiology, the different words patients used to describe different kinds of pain—but I didn’t know what it felt like.”

Kalanithi makes the distinction between knowledge and experience quite early on in the book. This is a thread that will continue throughout, even precluding his cancer. In this scene, he is simply the object of another person’s perception; he is breaking a rule. On top of it, he’s still trying to decide whether or not he is terminally ill or is experiencing the daily pains that most humans suffer.

“From my desert plateau, I could see our house, just beyond the city limits, at the base of the Cerbat Mountains, amid red-rock desert speckled with mesquite, tumbleweeds, and paddle-shaped cacti.”

Paul explores Arizona after moving there at the age of ten. Kalanithi creates image-rich, rhythmic prose in order to draw attention to the importance of this childhood setting. The small house is dwarfed by the landscape, something Paul will experience again when he works at summer camp. His observations for and love of the world relay a curiosity that becomes central to his character.