Lucy Kalanithi on love, loss and lessons from When Breath Becomes Air

After Paul Kalanithi was diagnosed with stage IV lung cancer, he fathered a child, finished a neurosurgery residency and wrote the best-selling memoir "When Breath Becomes Air." He died last year at age 37, before it was published. His wife, Dr. Lucy Kalanithi, talks to Dr. Goldman about being the book's sherpa and the keeper of Paul's legacy.
After being diagnosed with terminal lung cancer at only 36, neurosurgeon Paul Kalanithi used his last remaining years to write about mortality as both doctor and patient. His widow, Dr. Lucy Kalanithi, talks about what drove him to write "When Breath Becomes Air." 0:47
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Paul Kalanithi's memoirWhen Breath Becomes Air was published in January of this year, and today, it still occupies a space on the New York Times bestseller list. 

It was a dream fulfilled for Kalanithi, a brilliant up-and-coming neurosurgeon at Stanford University School of Medicine, but one he didn't live to see to fruition.   

He died on March 9, 2015 at age 37 of metastatic lung cancer. 

The book is a bracing valedictory which largely focuses on his last year of life and the choices he makes to live out his final days without regret.

His wife, Dr. Lucy Kalanithi says working on the book gave Paul's life new meaning, even as he faced death. 

Dr. Lucy Kalanithi finished her husband's manuscript after he died and devoted the past year to promoting When Breath Becomes Air. ((courtesy of Lucy Kalanithi))

"That was at a time he knew his body was slowly failing and he was dying, and so to continue to feel purposeful and connected to the world was so profound and sustaining," she tells Dr. Brian Goldman, host of White Coat, Black Art. 

In fact, Kalanithi was always torn between a writing career and medicine. The book's title is inspired by one of his favourite Elizabethan poems. 

The poem from which the book When Breath Becomes Air derives its title.
 

In fact, Paul secured his book deal largely thanks to a widely-shared piece he wrote about his illness for the New York Times, called How long have I got left?

Lucy says her husband pressed his doctor to give him a specific timeline for his illness, but the oncologist's "outright refusal" to prognosticate helped him make crucial choices about the shape of his final days, a lesson he passes on to his readers. 

"She (the oncologist) brought him back to life. Every time she saw him she said, 'What is important to you at this stage? What can I help  you do in your life?'  She helped him understand he could return to being a neurosurgeon, despite having terminal cancer, and we initially thought that was impossible," says Lucy.

Dr, Paul Kalanithi returned to neurosurgery after he was diagnosed with stage IV lung cancer. He died in March 2015 before his memoir When Breath Becomes Air was published. (© Norbert von der Groeben)

The illness also prompted the couple to start a family.   

"What it did tell us was, we were having a baby and he would likely survive to meet her, but he likely would not survive to see her grow up. And that was all the information we needed....to cope somewhat." she says.

Their daughter Cady is now two-years-old. 

"The end of the book is definitely a love letter to (Cady). He's writing directly to her...I think it's a great responsibility of mine to help her figure out where she came from," Lucy says. 

In addition to raising Cady, for more than a year Lucy's role has been that of sherpa for her husband's book, as well as the keeper of his legacy. 

"I felt so compelled to carry out Paul's wish to get this in the world," she says. 

But far from being an exercise in grief, the work has been cathartic and revealing. 

"I think after somebody dies, a lot of the time we don't know how to respond. We don't know if we'll make someone more sad by asking about it," she says.

 I think a lot people feel lonely in grief because no one is saying their loved one's name." - Lucy Kalanithi, on how promoting her husband's book helped her deal with grief. 

"For for me it's the opposite. Paul died 19 months ago and now, I'm talking...about Paul  That's turned out to feel really good. And it teaches me something about grief." 

Lucy worked to finish the manuscript and has even found a way to sign the book in Paul's absence. 

Lucy Kalanithi finished her husband Paul's best-selling manuscript When Breath Becomes Air after he died. She toured to promote the book and also signed copies. (Lucy Kalnithi )

"I put a heart around Paul's name, then I write "shantih, shantih, shantih."  

That is the last line of the poem The Wasteland, a work that had special meaning for Paul. 

"(T.S) Elliot translated it as 'The peace that passeth all understanding,' which is a biblical phrase. It's sort of an inter-faith idea of peace or calm despite adversity, a literary reference, a blessing and send-off, and a nod to Paul's favourite poem,' Lucy explains. 

Lucy, Paul and baby Cady. (©Suszi Lurie McFadden)

She says the central message of the book is that the amount of time you are given is not as important as what you do with that time, but making those choices is difficult. 

"It's very painful and it involves raw honesty."

Say it out loud, try to get accurate information,  face it together and, make real choices about how you how you want to live." - Lucy Kalanithi, on facing end-of-life choices 

The year after Paul's death, which she wrote about when the book was published, has been filled with lessons.

"I didn't realize that I'd continue to love him exactly the same way, and continue to feel proud of him and connected to him. It's been 19 months since he died, and the sting is much, much less. And the love is exactly the same." 

(This week, we'd like to thank Stanford University School of Medicine for permission to use segments from "A strange relativity," produced by Mark Hanlon,  which appeared in the article Before I Go). 

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