Although Paul Kalanithi dreamed of becoming a writer, he first planned to spend 20 years as a neurosurgeon-scientist. Tragically, however, in 2013—during his last year of residency at Stanford—the nonsmoking 36-year-old was diagnosed with stage IV lung cancer.
Soon after, he wrote a powerful New York Times op-ed piece, “How Long Have I Got Left?,” describing his diagnosis and struggle to make the best use of his remaining time. “Tell me three months,” he wrote, “I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases.”
In the months before his death in March 2015, Paul managed to do all three. He received treatment, continued to perform surgery as long as feasible, spent precious moments with his wife and family, became a father for the first time, and wrote a thought-provoking memoir about his life, illness and mortality, When Breath Becomes Air.
“He was working really hard,” recalls his widow, Lucy Kalanithi, a Stanford internist who met Paul while the two were in medical school at Yale. “He was suffering physically and of course emotionally. But he was very, very tough and thoughtful, and somehow coped and kept going.”
She describes her husband as “unbelievably smart, and, to top it off, the funniest person I’ve ever met, while at the same time, soft-spoken and subtle.” The couple often sat or lay side by side during his illness and Lucy’s maternity leave, with Lucy sometimes reading Paul’s words as he wrote. His manuscript afforded the couple a natural opportunity to communicate about what was happening and how Paul was feeling.
“It was exhausting, but we were having a really good time,” Lucy says. “It was very purposeful; we loved each other and we loved Cady [their daughter]. We knew that Paul’s time was limited and we were in pain . . . but it was kind of an amazing time. It’s a weird word to use, but also very fun.”
Lucy notes that her husband was “uniquely positioned” to write this book, and that she, as a physician, was also uniquely positioned to help take care of him, along with their families and friends.
“And it still took everything I had,” she says.
In the book’s foreword, Stanford physician and author Abraham Verghese aptly describes Paul’s writing as “stunning” and “unforgettable,” noting: “See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.”
Paul thought deeply before he wrote, and then his words flowed; his wife recalls that he wrote his op-ed piece during an airplane flight. “He wrote very quickly,” Lucy explains, “and didn’t spend a lot of time going back over it, partly because he didn’t have a lot of time and he knew it. Literally, he was racing to finish.”
The beauty of his prose is hardly a coincidence, because Paul earned graduate degrees in English, history and philosophy before turning to medicine. Early in the book he declares, “I knew with certainty that I would never be a doctor.” Pages later, he eloquently traces his unforeseen career trajectory, explaining, “I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context.”
Paul didn’t expect to face his own intersection so soon. Summing up his transformation from physician to patient, he writes: “Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle. I’d always imagined the doctor’s work as something like connecting two pieces of railroad track, allowing a smooth journey for the patient. I hadn’t expected the prospect of facing my own mortality to be so disorienting, so dislocating.”
The book was nearly complete when Paul died. “One of the last things he said to me was ‘Please get this finished,’ ” Lucy remembers. She explains that all the words in the book are his: His editor occasionally supplemented his manuscript with passages written elsewhere in essays, his book proposal and lengthy emails to friends.
Lucy also penned a powerful epilogue describing Paul’s last days in a sad but elegant coda to the book. “I’m not at all a writer like Paul was,” she admits. “But writing that epilogue—I just loved it. It was the most meaningful thing I’ve ever written.”
As she works part time at Stanford (planning to return full time in March), Lucy finds the grief process to be “unexpected and unpredictable.” She rejoices in every milestone of their daughter Cady’s life. “Paul would have loved that her first word was ‘dog,’ ” she says. “There are all these little things that are just so bittersweet because he’s not here.”
When Breath Becomes Air closes with Paul’s heartbreakingly beautiful words to Cady, who brought him so much happiness during his dying days. “I’m so happy that he wrote it for her,” Lucy says. “That passage is my prized possession. I haven’t memorized it. I didn’t even try. I’ve just read it so many times.”
In the midst of her grief, Lucy remains excited about the book’s publication. “I’m keeping a promise that I made to Paul, which feels really important and makes me feel purposeful.”
“I’m very happy about sharing him with the world,” she adds. “This book will be on people’s bookshelves. I can’t believe it. Paul really wanted to be a writer. We worked so hard to make it happen.”
Nonetheless, she can’t help but lament: “I’d give anything for you to be talking to Paul rather than me.”
Editor's note: This article has been updated to correct the date of Paul Kalanithi's death.