In May of 2013, the Stanford University neurosurgical resident Paul Kalanithi was diagnosed with Stage IV metastatic lung cancer. He was thirty-six years old. In his two remaining years—he died in March of 2015—he continued his medical training, became the father to a baby girl, and wrote beautifully about his experience facing mortality as a doctor and a patient. In this excerpt from his posthumously published memoir, “When Breath Becomes Air,” which is out on January 12th, from Random House, Kalanithi writes about his last day practicing medicine.
Dr. Paul Kalanithi was preparing to wrap up his medical residency in neurosurgery when, in 2013, a CT scan revealed tumors throughout his body. He had stage 4 lung cancer. In his last two years of life, he continued caring for patients. He and his wife became parents. And Kalanithi, a gifted writer, wrote a book, When Breath Becomes Air, a reflection on being a doctor with a terminal illness.
He died March 9, 2015. He was 37 years old.
His widow, Dr. Lucy Kalanithi, is on a book tour for When Breath Becomes Air, which has resonated with a wide audience.
“It’s really kind of a bittersweet process, as you can imagine, quite bitter and quite sweet,” she tells NPR’s David Greene. “Paul died nearly 11 months ago, but being able to talk about how I feel and remember Paul is actually very healing for me. So it’s actually kind of wonderful at the same time.”
In her interview on Morning Edition, she reads excerpts from When Breath Becomes Air and talks about her late husband’s life.
On the cancer spreading to his brain and having a neurological impact
Would you trade your ability to speak for another five months of life, or what type of neurologic devastation would make it more reasonable to stop living than to be alive? And these are not theoretical questions in the neurosurgical context. …
Yeah, that was very hard. This whole second half of the book is Paul thinking about how to grapple, in a very real way, with his own mortality. And then when he was diagnosed with a form of metastatic brain cancer called leptomeningeal disease — it’s essentially like tumors are coating your brain and your spinal cord, and it also holds the prospect of seizures or trouble speaking, trouble thinking. So, it was so intense to get this diagnosis on top of everything else that meant that his ability to participate in all of the things that were bringing him meaning — particularly writing this book and being together with our daughter and our family — was really devastating.
On their daughter, Elizabeth Acadia Kalanithi
He was just thrilled to be a dad, and just the fact of having this infant just breathed this unbelievable life into our house. He was the one who initially had the strong instinct to have a child despite his illness. … I said to Paul, “Don’t you think that saying goodbye to a child would make your death more painful?” And he said, “Wouldn’t it be great if it did?” And what he meant by that was the joy and meaning of having a new family member is so great that wouldn’t it be great if that made it even more painful?
On whether Paul’s illness and death gave him the opportunity to help others through similar journeys
Yeah, it’s sort of bringing tears to my eyes … because he makes this joke in the book where he says something like, “Wouldn’t a terminal illness be the perfect gift to this young man who hoped to grasp mortality in a kind of intellectual sense?” Those questions became not at all theoretical. Paul really had to draw on all these things that he had been developing his whole life — he really returned to literature to cope, he fell back on his training as a physician. … What a funny confluence of factors that would prepare a young person to face this in a particular way despite looking at the fiery light of illness in real time.
He died in March 2015 and 10 months later his book was published in the US, where it went straight to No 1 in the New York Times bestseller list. It is now out in the UK. Lucy Kalanithi, a doctor and academic, is his widow. LOK
When Breath Becomes Air by Paul Kalanithi review – how to live, by a doctor who died aged 37
This fast-selling memoir by an idealist neurosurgeon facing an early death from cancer gains power and poignancy from its detailed descriptions and reflections on mortality
Has the book’s success surprised you?
It’s exceeded our wildest expectations. A month or so before it was published it was getting some critical acclaim but the big question was whether people would actually want to read a book about dying written by a man who had recently died. We weren’t sure. But it turns out they do. I think it is because the book is about living as well as dying. And although it is about what happened to Paul it is also about a universal experience – and it is so beautifully expressed. That’s what people are responding to and holding on to.
How does it feel for you to see him so celebrated after – and because of – his death?
Bittersweet is a vast understatement. But it is fantastic to watch him developing a legacy through the positive reaction. It is very meaningful to me. It’s just under a year since he died and it feels like no time at all: I still want to be thinking about Paul and talking about Paul, and having the opportunity to remember him in a communal way rather than in a lonely way is very helpful.
How would he have felt about the impact of the book?
I think he would have been totally thrilled. His eyes would have been sparkling. He would have been so excited to be part of the conversation around the book because he was so interested in death and mortality.
How did you feel about him writing about your marital problems in the book?
The bottom line is that I felt fine about it. I was surprised at first that he did it because Paul was a relatively private person and I thought of asking him to take it out but then I thought, no, it’s part of the story and it’s important to be authentic. People respond to authenticity and I felt like, OK, go ahead and share it. Now I feel glad it’s in there. It feels real.
There’s a heartbreaking irony in the way his cancer drew you back together and saved your marriage…
I agree. But I think now that it was good timing because our problems came to a head and got out on the table right before he was diagnosed. I often wonder what would have happened if we hadn’t confronted our troubles when we did. As it was, we regained hope in our relationship and started to draw back together literally a week before he found out he had cancer. I think this meant we were in a stronger position to deal with it.
How easy was it to decide to have a baby when you knew he might not live long enough to be a father?
Not at all easy. It was really very considered, as you can imagine. We certainly had our eyes wide open in that we knew it was likely that he wouldn’t live to see her grow up and I would go on to be a solo parent after he died. We first talked about it as soon as he was diagnosed but for a few weeks we were really unsure. We both had the instinct to do it but were both worried about the implications for the other one. I feared it might make his death so much more painful if he had to say goodbye to a child. But he said: “Well, wouldn’t it be great if it did?” His view was that life wasn’t about avoiding suffering, it’s about making meaning. It was obviously a big risk to have a child, to invite more uncertainty and possible pain in to our lives, but it was the best decision I ever made.
I knew that if Paul himself could have described the way he died then he would have done
Did you understand Paul’s decision to push himself back into work to finish his residency after his first bout of lung cancer?
I did understand – because of knowing him the way I did. Not everybody would go back to work in his situation, many people wouldn’t. Everyone has different priorities and Paul endured a certain amount of physical suffering in order to work as a neurosurgeon and to write the book. But he was a natural learner, very driven and a deeply curious, impassioned person. Going back to the operating theatre underscored how much his work was a part of who he was.
Paul’s faith in God has surprised some reviewers. It is rare in a scientist. Do you share it?
He was a top scientist but empirical research didn’t explain for him what it meant to be human. One time I asked him straight out, “Do you believe in God?” and he answered that he thought just as important a question was “Do you believe in love?”, to which his reply would be yes. I thought that was really striking. I would say the same thing.
Writing the epilogue for the book must have been hard for you. How did you approach it?
The hard part was that I have never thought of myself as a writer at all. I’m a doctor: I can write a medical chart and express information. But I’ve never felt compelled to write an essay or anything longer. So when Paul’s editor asked me if I would consider writing an epilogue I was shocked. But I recognised that the story was unfinished and I knew that if Paul himself could have described the way he died then he would have done. I wrote it two months after he died, which was a very raw time and it was actually really helpful and I was so glad to have that opportunity.
Paul’s last paragraph is a beautiful account of the joy your daughter Cady brought him in his final months. What will you tell her about him?
I’ll tell her lots of things but in a sense the book will tell her all she needs to know. Writing it was a way for him to communicate with her after his death. Through reading it and through things he left for her that I am keeping she will understand how much she was loved by him.
What does the future hold for you and Cady?
People keep asking me, “Hey, are you going to stay in your house?” Well, I’ve made a decision not to make any decisions for at least two years. Our house is where Paul and I lived, then where the three of us briefly lived and now it is where Cady and I live. For me it’s now about reforming the space so I can move forward as a doctor, a widow and a mom. I’ve kept a lot of Paul’s things, but a few months ago I painted all the walls white and remade the bookshelves so that he doesn’t have his own bookcase any more, so I am slowly changing things.
At the moment of diagnosis Paul said he hoped I would get remarried. He meant it really lovingly but it was so shocking to me at the time. Now I feel that even if I do ever get remarried I am positive I will love Paul for my entire life. He will stretch into my past and into my future.