Paul Kalanithi, MD, the Stanford Medicine neurosurgeon who wrote When Breath Becomes Air, has been gone for five years now.
His memoir, a seminal autobiographical book about living while dying, was translated into 39 languages and spent 68 weeks on the New York Times bestseller list. Sometimes, even on the same page, it both rips you apart and makes you laugh.
It was shepherded to publication by his wife, Lucy Kalanithi, MD, after he died. A Q&A with Kalanithi — a clinical assistant professor of primary care and population health at Stanford Medicine — appears in the latest issue of Stanford Medicine magazine
We photographed Lucy Kalanithi and the couple’s daughter, Cady, reclining against his tombstone. Paul Kalanithi’s resting place, at the edge of a field at a memorial park in the Santa Cruz mountains, has a majestic view of the Pacific Ocean.
It’s where Kalanithi and Cady, now 5, like to picnic; and as Lucy Kalanithi wrote in the epilogue to the book, it is where the little girl rubs the grass “as if it were Paul’s hair.” The beautiful, tranquil setting befits the spirit of a man who wrote about dying with grace, elegance and composure.
The Q&A was based on a public conversation I had with Kalanithi last fall at San Mateo Library. We spoke to a full house about her husband’s death, his diagnosis, his final hours of life and what it means to move on after the death of a loved one. When I asked how many audience members had read Paul Kalanithi’s book, nearly every hand in the room went up.
I had heard that Britain’s Prince Harry said of his mother’s death, “Grief is a wound that festers.” So, I began our conversation by asking Lucy Kalanithi if she found that to be true.
She stopped with sort of a “hmmm,” look on her face and called his comment “sweet.” Then she added, “I don’t think of it as a metaphor like that because, as a doctor, I’m like, ‘Well if the wound festers, it’s really unattended, right?'”
With that, the audience broke out in laughter.
Kalanithi, at 40, is hardly what one would think of as a widow. Young and exuberant, you couldn’t imagine this woman had buried her husband at 36. So, I was curious: Does she relate to the word “widow”? It seemed so stodgy and out of sync to me — I wondered if she embraced it.
“I actually like the word widow,” she told me. “All of that, the starkness … the isolation or shockingness of the word widow. It felt apt. It felt accurately descriptive. … I found I really, really owned it.”
In the intensity of the pain and fear that accompanied learning her husband’s prognosis, the couple decided to have a child. How, I asked her, did they choose to start a family, knowing the father would be gone and she’d be parenting solo? And especially, how did she do it, while forging through a tunnel of grief?
“It was pretty crazy to do that,” Kalanithi admitted. “He was more sure than I was that he wanted to try to have a child.”
Then, she said something striking about one conversation they’d had about it:
I said, “I think it’s going to make it really hard. You’re really sick. I worry that having to face dying and having a new baby, who you may have to say goodbye to, is going to make it really hard. What do you think about that?” He said, “Wouldn’t it be great if it did make it really hard?” It was such a lovely statement of what our lives are about.
At the end of the book — and in a related Stanford Medicine magazine article — there’s a passage so achingly painful it brings tears to your eyes. What is the gift, Paul Kalanithi asks, that an infant gives to a dying man, and how should his daughter consider her young life when she thinks of him years from now?
Do not, I pray, discount that you filled the dying man’s days with 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.
With the passage of time, Lucy and Cady Kalanithi have moved into a new house, and she has fallen in love again. She continues to breathe life into her husband’s memory when she speaks at public events – which, until COVID-19, were plentiful. She said she likes reading his words aloud at events — it makes her continue to feel connected to him.
“I love Paul forever,” she told me. “He’s my family forever.”
In the epilogue, Lucy Kalanithi wrote about how her husband faced death and how he did so forthrightly:
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 was yes. I was his wife and a witness.
A witness is said to have knowledge of an event from personal observation or experience.
Yes. She was his witness.
Image by Timothy Archibald