The long hours of his residency–oftentimes 100 hours a week–take a toll on Paul and his fellow residents. He’s at the stage now where he is deciding the fate of his patients, and whether he will continue trying to save someone or let an injury take its course for the sake of the patient. Though these decisions place a huge responsibility on him, they start becoming daily occurrences. Paul wonders if “being so close to the fiery light of such moments only blinded me to their nature” (81).

For example, he and a fellow resident, Jeff, make an easy way of communicating how severe a patient’s head injury is, using state population. Paul is in the middle of opening an ice cream sandwich when he gets a page regarding a 22-year-old motorcycle accident victim, who the doctors have to let die, due to the gravity of the injuries. The family is brought in to view the body, at which point Paul remembers his dessert. He sneaks back in to retrieve it, puts it in the freezer, and thinks “pretty tasty” (84).

When he learns of the death of a friend who was in a car accident, Kalanithi finds that he cannot imagine her death without imagining the specific, gory procedures that likely would have been taken to try and save her life.