Paul Kalanithi's When Breath Becomes Air—a memoir by a young, gifted neurosurgeon who chronicled his own journey through terminal illness—came out about a year ago. I remember devouring all 256 pages of it on an evening flight from Los Angeles to New York, between swigs of cheap airline whiskey and those sad little bags of salted peanuts.
Dude was 36, and just starting to get to the exciting part of his career when he learned that he had stage four metastatic lung cancer. When he found out he was going to die fairly soon, he decided to write about it. His account isn't depressing or philosophical, though. It's open and hopeful in some parts and fearful and frustrated in others. He was funny. He expected a lot from himself. He liked whiskey. Somehow, he was all of us.
Paul didn't get to finish, so his wife Lucy—also a doctor at Stanford—took the reins, wrote the epilogue and got the book published just months after he passed away. While his story was fueled by passion and courage, it left me thinking about loss, Lucy, and their baby daughter, Cady.
And how messed up it is that humans have a cookie-cutter manner of grieving. Step one: Be sad. Step Two: Move on. Relationships aren't that cut and dried, so how could losing your partner be?
When I interviewed Lucy, I had to curb an obnoxious feeling of familiarity. Traveling through Paul's book made me feel like I had been next to her, holding her damn hand through it all. In reality, I hadn't been holding onto shit except for my own misconceptions. Lucy's grief is not sad. It's fierce, layered, and it contains, ironically, more life than a lot of people's joy. I talked to her about how her day-to-day is different, two years after she started grieving.
How has going through what you did with Paul affected the way you care for your patients?
I think a lot about how to help people get medical care that matches their values. And obviously, Paul talked a lot about that in the book. The TEDMED talk [I did] is about that idea—what medical care can help you with your best life?
Paul said this interesting thing—because he was practicing as a neurosurgeon for ten months after he was sick and he said it made him focus much more not just on the rare risks of a possible neurosurgical procedure but what it was actually going to feel like. Not just the rare effects, but the most likely effects on you and your life. He took people, a lot more, through the experiential aspects of the procedure or illness that he wouldn't have thought to before. That was just because he was embroiled in an illness but also because an oncologist was doing the same thing [for him] by describing: "You're going to go on this chemo and here's what's most likely to feel like." He found that so helpful.
Do you believe there are any rules to grieving? Were there any that you followed in your process?
The only one that I abided by was to have no rules. I think it's really non-linear. I can just give you an example: We went to Paul's grave with a bunch of people on what would have been Paul's 39th birthday, just over a year after he died. [It was] around sunset and somebody brought sparklers. People brought beers and snacks and were just kind of congregating around a grave. It was really sad but also kind of like a cocktail party at the same time. It was everything mixed together—which is what I keep feeling like my life is like.
I had brought these little speakers so we were playing bossa nova, which Paul really liked, and suddenly I turned around and literally sitting on Paul's gravestone was this huge bottle of Johnnie Walker Blue, and I was thinking, like, That's awesome. It made me super happy. Some people may think that it's weird, but it felt really right because Paul's friends were there and there's whiskey sitting on top of a gravestone. No rules about it. Whatever feels right to celebrate the person or mourn the person, within reason.
By just reading his book—which is a tiny but powerful glimpse into his personality—it felt like that's exactly what he would've wanted.
Yeah absolutely. During Paul's memorial service his brother did this amazing thing. We had a very traditional service in Stanford Memorial Church, and we had hymns with an organ and it was a religious service and people were wearing black. And then Paul's younger brother did one of the final eulogies and this is so crazy...This was like, the most sacred moment of my life, because of exactly what you just said, that Paul would have wanted it.
Jeevan, in the middle of this really beautiful eulogy, pointed to one side of the church and said, "I want you all to do one final thing. I want this side of the church to say 'Death Be' and this side of the church to say 'Not Proud." It's from John Donne's poem. So the whole church was [chanting] "Death, be not proud" and I was like, _Whoaaaaa, this is really crazy. _And for the very last one he put on this gorilla mask from Paul's gorilla suit, because Paul used to keep a gorilla suit in the trunk of his car; he would say it's "for emergencies only."
That was so right, what Jeevan did at the end of the [service]. Now that I feel like I connect to other people's grief too, I think those are the moments that are really comforting for people. It's when they feel connected to the real person who died.
How are you keeping his spirit, his sense of humor, and all of that alive for Cady?
I don't know yet, I'm trying to figure it out. I want to make one of those Shutterfly picture books and I want it to have pictures of [Paul] and describe him in kind of age appropriate two- or three-year-old ways, maybe with things that he liked to do. Like, "he liked dogs; he liked to make jokes; he liked reading" and then link it to the things that she likes, just so that he is in her consciousness, like here's this person named "Paul." If I say, "What's your daddy's name?" she says "Paul" but those things kind of feel like a party trick.
It makes me really happy when she says them but I don't think it means anything to her. So I think I wanted to make her a book like that so when we're talking about Paul she has a place to slot that information into her mind. Maybe at certain points of her life, Paul will not be important to her and that might be the more painful thing for me. It's going to be up to her; I just feel a big responsibility to shape that.
There's a section in your Times op-e**d where you touch on the moment you removed your wedding ring. Did that change any part of your grieving process?** I think it's the other way around. Where I was in the grieving process was changing, so then it was okay to take the wedding ring off. Right now I'm wearing Paul's wedding ring on my right hand with my engagement ring on top of it. Those could be any rings—you would figure it'd be a family ring or something, and obviously if you look at my hands you see I'm not married, but probably at some point I'll take those off, too.
Is there a point when grief transforms into some other type of emotion for you? What comes after grief?
I don't know if there is a thing after it. I don't think it ends, but for me the feelings that come along with it come in waves, or the sting diminishes. It's not as fiery-painful as it was before, but I love Paul exactly the same. That hasn't changed at all.
He sort of used to kiss the air at me sometimes. Like if we were at a party and he was across the room and I looked at him, and he would just sort of raise his chin a little bit and sort of blow a kiss. And now I also kiss the air up, like if I come around the corner of the house and I see a picture of him I'll kiss the air, or if I see a thing that reminds me of him I'll kiss the air and I don't even notice when I'm doing it. It's an instinct. I'm totally open to the idea of falling in love again—I'm not on OKCupid; it's definitely not that day yet. But I think the idea of loving him forever no matter whatever else happens to me and Cady is true, and I think it's certainly true for people who have lost a parent. I feel like you do have that ongoing relationship with them.