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When Breath Becomes Air: A conversation with Lucy Kalanithi

A few months before he died, I interviewed Paul Kalanithi, MD, for a 1:2:1 podcast about a gorgeous article he wrote for Stanford Medicine entitled "Before I Go." I knew his days were short, yet when he came into the studio I was taken aback by his frailty. I think I was hit broadside because seeing him reminded me so much of my brother, Bill, in his last days alive. On the one hand each was still fighting cancer and yet there before you was a map illustrating how a disease overwhelms a body.

Paul spent his last months writing a book called When Breath Becomes Air. It’s a searing memoir that at times strikes you so hard, you cry. Already, it's being heralded as a great book that is "indelible."

One passage still stabs at my heart. It’s the rawest part of the article he wrote for Stanford Medicine, and it’s included in the book. It’s written as a note to his daughter, Cady, conceived after he was diagnosed and born while sand was slipping through his fingers:

When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with 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. In this time, right now, that is an enormous thing.

Now that his book has been published, it's his widow, Lucy, a physician at Stanford, who has become his voice. As we sat down for this 1:2:1 interview I told her I had felt so unsure about the direction of my questions the day I spoke to her husband. How do you sit across from someone living and talk about their dying? The same anxiety was there before I spoke with Lucy. Were there areas of grief still bandaged over that I shouldn't try to uncover?

In the end, the conversation with Lucy feels like a bookend. What began with Paul, a discussion about the time that remained for him, is cemented now with her words after he’s gone. (As we began, I told her that months before when Paul and I had talked he had sat in the same chair she was in. It comforted her knowing that.)

Although it has just been released, When Breath Becomes Air has already taken on a life of its own. The beauty of his words and his bravery facing death has ignited a rhapsody of critical acclaim. I know years from now, even decades, people will find solace within the pages of Paul's journey. His beautiful prose will linger and illustrate, and as Atul Gwande, MD, wrote on the back cover, this "memoir is proof that the dying are the ones who have the most to teach us about life."

So what is it that we can learn from Paul Kalanithi's premature death?  For me, I think of Thornton Wilder's poignant words from Our Town as a reminder of life's fragility: "Do any human beings ever realize life while they live it, every, every minute?"

For Lucy? In the epilogue she writes a beautiful passage about what she saw in the gloaming of her husband's life:

Paul's decision to look death in the eye was a testament to not just who he was in the final hours of his life but who he had always been. For much of his life, Paul wondered about death - and whether he could face it with integrity. In the end, the answer is yes.

I was his wife and a witness.

Previously: Paul Kalanithi’s book will probably make you cryStanford neurosurgeon Paul Kalanithi, who touched countless lives with his writing, dies at 37For this doctor couple, the Super Bowl was about way more than footballStanford neurosurgeon/cancer patient Paul Kalanithi: “I can’t go on. I will go on.” and "Stop skipping dessert:" A Stanford neurosurgeon and cancer patient discusses facing terminal illness
Image by Mark Hanlon

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