[VIDEO PLAYBACK] [MUSIC PLAYING] -Five years down the line, I
don't help what I'll be doing. I may be dead. I may not be. [MUSIC PLAYING] If you asked me when I was 17
what I'd be doing with my life, I would have said I'd
definitely be a writer. But found medicine was, in
fact, the perfect place. I first began noticing symptoms
in my sixth year of residency. Obviously, Luci and I
were both very suspicious that I had some form of cancer. But actually having
the confirmation was still devastating. Since Cady's birth,
my time with her has had a very peculiar
and free nature. In all probability, I won't
live long enough for her to remember me. And so the time
just is what it is. It's a careful balance. If you don't think
about the bad case, that ending is going to be very
rough on you and your family. But if you don't think
about the good case, you're going to
miss an opportunity to really make the most
out of your life and time. [MUSIC PLAYING] [END VIDEO PLAYBACK] SPEAKER: Paul's critically
acclaimed memoir, "When Breath Becomes Air," is
a profound, searingly honest, and ultimately life-affirming
meditation on the challenge of facing death and the
relationship between doctor and patient. It's been a New York
Times bestseller. It's been published into
more than 40 languages. That's what I hear. What have people
been telling you? I hear that they've been
writing letters to you. What are the things
you're hearing? How is it changing people? LUCY KALANITHI: It's been, like,
the best and worst experience of our lives, obviously. And I just wanted to say
thanks for inviting me. I'm really excited to be here. I've never been
to Google before. Paul's best friend in
the world, Robin Moroney, is a writer who works
for Google, actually. And we have other
friends who work here. So it's really
exciting to join you. And I'm grateful
for the invitation. Sort of one of the
weirdest personal things about the book coming
out is I remember being so excited to see the
review in the New York Times-- like first of all, just to get
a review in the New York Times and then have it
be a good review. You're like, thank god. The reviewer, Janet
Maslin, wrote, "This is an indelible book." And it was, like, this
sort of weird moment for me of like Paul died. And then he's indelible
in a certain way. And so it's just this
bizarre combination of connecting with people
over him, like you say, and then missing him
at the same time. So yeah. People tweet me, and
they write to me. And the thing that I think
is the most gratifying to hear is when somebody
says, this helped me through a time of suffering,
to relate with Paul's words or what you said, this
deepened a relationship of mine in some way, or this made
me less afraid to die, which is quite a
profound thing to say. And I think that would have
meant a lot to Paul as well. So that's been really exciting. And then people write to
me about grief or about caregiving. A woman recently
wrote to me and said, caregiving is a beatitude. Grief is a beatitude. Like they're sort of these deep,
painful, and moving experiences that we all share. We can't avoid them. So I think just the
feeling of connecting with people over suffering. It's not something
any of us wants, but it's an immutable
part of our lives. And what we do with it? And it's been helpful for me
to feel less isolated, and also gratified in a certain
way because of what it would have meant to Paul and
what it means to Paul's legacy. It's the worst. But even being here
today with you, right? It's like I get to look in
your eyes and talk about Paul. And it helps me personally, too. SPEAKER: Yeah. In fact, before we started,
I was just telling Lucy that for all of us people
who might be strangers to her but who read the book,
you know, in some way, she feels like
part of the family because you've very courageously
shared some of the experiences and incidents in this book. They really move you and touch
you at a very, very deep level. So in terms of this format
of question and answers, our interview, what
we thought would work best is we will
try and let Paul speak through most of this interview. So we'll try and channel that. I've selected some quotes. And maybe if you could
help me read those quotes. And I will follow
up with a question. LUCY KALANITHI: Sure. Do you want me to read this one? SPEAKER: Yes. LUCY KALANITHI: I will
say one other thing about what people talk to
me or write to me about. So Paul started out the book
by talking about a rocky patch in our marriage, actually. So now I know a lot of
other people's marriages. The big secret of
being a grownup is people die and
marriage is hard. So anyway, that's
kind of-- he didn't spare anybody in the book,
including himself or me or whatever. But that's part of it, right? It's like intimate
and authentic. So this part here? SPEAKER: Yes, please. LUCY KALANITHI:
So this part is-- I'll just give a quick context. It's from the epilogue
to the book, which I wrote after Paul died, that
tells how Paul died and then reflects on him and what's
been happening since he died. And it mentions this best
friend of Paul's, which is Robin Moroney,
who's the Google dude. "Paul found poetry more
comforting than scripture in his ability to
forge from his life a cogent, powerful tale
of living with death. When Paul emailed his best
friend in May 2013 to inform him that he had terminal
cancer, he wrote, 'The good news is I've already
outlived two Brontes, Keats, and Stephen Crane.' The bad news
is I haven't written anything." SPEAKER: You know,
the reason I thought we'll start with this
is in reading this book, it's clear that Paul had the
unusual and remarkable knack of making sense out of the
somewhat messy intersection of what some would call
philosophy, science, religion, spirituality, and scripture. Can you talk to us a little bit
about Paul's beliefs, faith, and what kind of
perspective helped him make sense of
everything put together? LUCY KALANITHI: Yeah, sure. And by the way, going
back to that quote, "The good news is I've
already outlived two Brontes. The bad news is I haven't
written anything." It actually gets at
this really deep thing-- partly that Paul was funny. It's like a funny way, in
a way, to tell your best friend you have cancer. But it's also getting at
his deep ambition in general and the fact of what writing
meant to him because he's writing this as a neurosurgeon. But the big loss in
his mind immediately is his medical career
plus his love for writing. So Paul, as a child, as
he said in that video, had always thought
he'd be a writer. Was a real lover of literature
and thought he would-- he majored in English
and then went on to study history and philosophy
of science and medicine. And then surprised himself
by becoming a doctor. His dad was a doctor
who worked really hard. And initially Paul said, I
don't want to work in that way and thought he would
enter the humanities. And then ultimately
had this realization that meant a lot
to him, which was many of the critical,
life-changing moments we all face happen in a
medical context. And that's good news and
bad news-- everything from having a baby to having
a serious illness or trauma. He's sort of seeking what are
the underpinnings of meaning in our lives, from all
these various ways? And I'll just give an example. When Paul was becoming
more and more ill and having unexplained
symptoms when he was 36, he started losing weight. He started having terrible back
pain, and then night sweats and chest pain and
a cough, and had been working with his
doctor to figure out why. And then he got a chest x-ray. It had nodules on it. And maybe it was
tuberculosis and most likely it was metastatic cancer. And both of us knew that. And we were on our way
to Stanford Hospital because he was admitted to the
hospital for expedited work up of what's causing these
symptoms and the x-ray problem. And he packed three
books, actually, to take with him
to the hospital. And I was packing all the junk
like fuzzy socks and a health insurance card and whatever. And he's got this stack of books
that he's carrying with them. And the books were "Mere
Christianity" by CS Lewis, and a novel by
Solzhenitsyn, "Cancer Ward," and "Being in
Time" by Heidegger, which I don't know how you
concentrate on that book when you're feeling well, let
alone when you're feeling sick. But it was this stack of
literature and religion and philosophy. And they were sort of
like a little amulet. Like, I'm not taking
a medical text. I'm taking literature and books. So I think if you think
about literature or science or philosophy, they're all sort
of aiming at this question of, who are we as humans? What are we doing here? What do our lives mean? And I think he sort of
understood that all of those are paths to answering these
bigger questions that are not just technical, but sort of rich
and in many ways unanswerable. So I guess maybe that's
what I would say about that. And also, I think Paul
had been interested in this question
of human suffering and wrapping his head around
mortality and suffering. So I think when he himself
became ill, being a physician and being a reader, he had
a language to talk about it, right? I mean, reading
deepens our empathy. That's part of why we
read is to experience lives that are not our own. So he was able to
sort of fall back on those tools when
he became sick. And I think he says this
lovely thing in his writing where he says, I
didn't ask, why me? The answer to the question would
have been, well, why not me? And I think he sort
of had that approach to thinking about suffering. And it helped him
when he became ill. And some of that came
from practicing medicine and some came from literature. SPEAKER: In fact,
in the book there's this passage where he
describes first seeing the CT scans [INAUDIBLE]. And actually, my next
question is around that. Lucy, if I could ask
you to read that for us. LUCY KALANITHI: Sure. So this is from the
prologue to the book. "Lying next to Lucy
in the hospital bed, both of us crying, the CT
scan images still glowing on the computer
screen, that identity as a physician, my identity,
no longer mattered. With the cancer having invaded
multiple organ systems, the diagnosis was clear. The room was quiet. Lucy told me she loved me. 'I
don't want to die,' I said. I told her to remarry,
that I couldn't bear the thought of her being alone. I told her we should refinance
the mortgage immediately." SPEAKER: So he gets
this devastating news and begins talking to you
about securing your future, refinancing the mortgage. What was it about Paul that
kept him so action-oriented, so ambitious, as you said? And this is a recurring
theme of striving that comes across so
many times in the book. I wonder if you could
elaborate on that. LUCY KALANITHI: Sure. Yeah. And it's kind of interesting. So literally, one of
the first things he said was, I want you to remarry. And often you think
about with cancer, or even what kept him
so action-oriented, the obvious action when you
have a diagnosis like this is like, we'll beat it. We'll fight it. We'll find the best doctor. We'll beat this. And in a way, that sentence
of "I want you to remarry" is an immediate recognition of
I likely will not survive this. And both of us knew that. And so part of Paul's striving
during that time was he faced what was actually
happening to his body. He understood the fact that
his identity and his career trajectory, like 20 years as a
neurosurgeon or neuroscientist, or 30 years, maybe write a book. All of that just shattered. And so in this moment
and henceforth, striving was reshaping a new identity,
which initially was going back to work as a neurosurgeon. And then, frankly, "When
Breath Becomes Air" became the reshaping
of his identity and the ultimate purpose of
his life and was sustaining. Even as his body was collapsing
and he became more isolated and was at home and
frail, the writing was sort of a way to continue
to stay connected to others and to feel like he had a
future, even if he wouldn't be alive. It was this really interesting. And having a child actually
meant some of the same things. And one of Paul's
friends said recently, I think that Paul
felt this struggle to find meaning in our lives
is there meaning in our lives. And so the fact of striving was
extremely meaningful to him. And I'm supposed to
teach our daughter about that, which is something
we all teach our kids, right? It's like it's important
to strive, to do your best, and to be a good person. You can't do it all the
time, but it's important. SPEAKER: What really touched me
in reading that was on the one hand here, he is very
pragmatic, recognizing the vulnerability of himself. And at the same time,
he's not giving up either. I mean, there is this
huge sense of just going on despite all the hard-- LUCY KALANITHI: Right. Until you die, you're alive. SPEAKER: Yeah. And he wrote years
ago-- and maybe we could just pick
up that thread. LUCY KALANITHI: Should
I read this part? SPEAKER: Yes, please. LUCY KALANITHI: "Years
ago, it occurred to me that Darwin and Nietzsche
agreed on one thing. The defining characteristic
of the organism is striving." And then this next
part skips around. And this is about
coping through reading. "I began reading literature
again-- Solzhenitsin's "Cancer Ward," BS Johnson's
"The Unfortunates," Tolstoy's "Ivan Ilyich,"
Nagel's "Mind and Cosmos," Wolf, Kafka, Montaigne, Frost,
Gravel, memoirs of cancer patients, anything by
anyone who had ever written about mortality. I remember the moment when my
overwhelming unease yielded, when that seemingly impassable
sea of uncertainty parted. I woke up in pain,
facing another day. No project beyond
breakfast seems tenable. I can't go on, I thought. And immediately, its
antiphone responded, completing Samuel
Beckett's seven words, words I had learned long
ago as an undergraduate. I'll go on. I got out of bed and
took a step forward, repeating the phrase
over and over. I can't go on. I will go on." SPEAKER: So this is the exact
opposite of just giving up is being very realistic and
yet very, very powerful. And you know, striving
and progress, I think, has been a constant theme
in reading the book. And there's a video
that I watched where he says that
just as the clock logs on hours, as the clock of
our lives logs on more hours, there should be a
measurable increase in some sort of progress. Can you maybe talk
about that idea and how that drove
how he did things? LUCY KALANITHI: Yeah. I guess maybe I'll reflect
on what Paul was writing about and talking about. He said this interesting
thing in an interview. Because he wrote some
of that that I just read ended up in a New York
Times little essay that he wrote that was super
serendipitous that it even ended up in the New York Times. And then that led to
his securing a book deal and writing this book. SPEAKER: And there was a
story about how it actually got into the-- LUCY KALANITHI: Oh yeah. Do you want me to just
tell that really quick? And then I'll go back
to the time thing. So Paul was on an airplane
after having returned to work as a neurosurgery
resident for about a year while he was healthy
enough to do that. And he wrote an essay
that ultimately ended up being entitled, "How
Long Have I Got Left?" And it was about how even
when you know you're dying, the uncertainty about how
much time you have left or how it will happen itself
is its own type of pain. Uncertainty is just hard to
tolerate in general, I think. And everybody can
relate to that. So he wrote an essay about that. And he sent it to two people,
a family member and then Robin Moroney, the Google
guy, who's a writer. And Robin wrote back and
said, you buried your lede. You're funnier
than this essay is. And you're kind of making
three different points. And I don't know. And the family member
wrote back and said, I forwarded this directly to
the oped desk at the New York Times. I hope that's OK. And it's crazy because then
it was published, which Paul was exceedingly excited about. He started getting emails
from patients and doctors and felt really good about that. And got a literary agent in
the process, who has since told me one path to being
able to write a book is to get a shorter
essay published somewhere and demonstrate
a response to it. And that's FYI, if anybody
here is trying to write a book. And so Robin Moroney
can eat his words. What was I going
to say about that? That's the story. I can't remember the link
back to the time thing. But I'll just say
briefly about time. Paul said time used to have this
linear progression feel to it. And now, while dying, time
feels more like a space. And that's really interesting. And I think I've talked
to a number of people about the experiences
of aging and dying. And I've had older
or elderly people relate to that sense
of the change of time-- less linear, more like a space. And goals change
over time, right? So we all think, and I think,
about my life projected literally over decades. And there's a lot of sort
of future-oriented thinking. And then that changes as you get
closer to the end of your life. And in a way, it's
not better or worse. It's just a shift. I was just listening to
this podcast with Paul as I was driving over. Because if I'm going to talk
about Paul, sometimes I'm like, I want to hear his voice. Or if I just miss him, I
want to hear his voice. And he was talking about how
he was at his 15 year Stanford reunion. He graduated from
Stanford in '99 and just had the reunion
the year before he died. And somebody said,
oh, it's going to be fun to be at the 30th
and see how everybody's doing. And Paul was like, it'd probably
be kind of rude to say, well, I probably won't
see you at the 30th. And he was asked, isn't that
strange and painful to think, you're not going to be
at the 30th reunion? And he said, well,
at certain times, I just sort of conceive of
it as like a fact of life. It's not any more painful
than if someone said, well, I'll see you at
the 150th reunion. And any of us here would be
like, well, no you won't. It's not distressing
in the same way, right? It's more like if
you've conceptualized that it's unfair
that you wouldn't be at the 30th or the 150th. And I think that that tendency
about thinking about time is just really the
difference between how are you conceiving
of your future and what actions
are you taking now that lead to a future,
versus are focused more on the present. And one little
side bit about that is there's all this research
about mindfulness meditation or mindfulness. And I don't know if Google gives
you guys courses on mindfulness and stuff. It's helped me cope
a lot, actually. And one of the things
is sort of this frame of acceptance or non-judgment. And some of it is about
being in the moment, focusing on the present moment. And there's all this research
about how that's good for you. And I think when
you're terminally ill or when you know your
loved one will die, you are focused
more on the moment. And even for us
having a child, we decided to have a child
after Paul got sick. And then she died when
he was eight months old. And I think even when
you have a young infant, oftentimes you're
wishing away time. Like, I wish she would
sleep through the night. I wish this period
of infancy were over. I Can't wait till
she's 5 or 10 or 20. And I think, given that Paul's
life expectancy was so short, the experience of having
an infant and those moments were actually really wonderful. So now I think a lot more about
the future and the present or the ways of
conceiving about time. It sort of takes some of the
pressure off in a good way, or reframes what you think
life or illness means. SPEAKER: I was also asking
you, when you sign books, you write "Shantih
shantih shantih." Can you share with us
what inspires that? LUCY KALANITHI: Yeah. So after Paul died and
I told Random House I'll do a book tour. I'll do whatever
you tell me to do. And I didn't know if
I would like doing it. I was like, I'm going
to promote the book and keep this promise to Paul. And I did end up liking
doing it for him. And then they told me I
was going to sign books. And I was like, I'm
going to sign the books? And then they said,
think of an inscription. Apparently Oprah
writes, "Blessings. Oprah." And one of Paul's
friends was like, well, you should just
write, "Blessings. Oprah." I'm going to have to
think of my own thing. And so then I sort
of had this brainwave and decided to write, "Shantih
shantih shantih," which is the last line of the
poem "The Wasteland," which I literally bought the
cliff notes for after Paul died because I wanted to
sort of dig into that poem. It's pretty obscure
in some places. It's about life and death. And it's kind of funny at times. But the last line is
"Shantih shantih shantih." TS Eliot writes it
with no punctuation, just sort of leaves
it as a send off. It just sort of hangs
there at the end. And "shantih" is a Sanskrit word
that essentially means peace. Like at the end of yoga classes,
people say "om shanthi." And it's that word. And TS Eliot transliterates it
and spells it S-H-A-N-T-I-H, which is sort of
a weird spelling. Oftentimes it's
transliterated T-H-I or T-I. And he himself
sort of translated it to mean the
peace that passeth all understanding, which
is actually a Bible verse. It's sort of like this
interfaith version when Eliot translates it. And I sort of think of it as
like a blessing and a sendoff, and then a literary
reference in honor of Paul, and almost like a
little description because Paul inspired me sort of
with his calm or with his peace despite great suffering. And you know, he
wasn't a perfect dude. He was also a normal person,
and funny, and complicated. But he was brave. And so it's like a
secret message to him, and then kind of a
blessing to the person that I'm signing the book for. So it's the end of that
poem "The Wasteland." SPEAKER: Thank you. Thanks for sharing. There was part, going
through illness, where Paul describes how it's
a process and not a one time event, unlike death. And there was a lot of decisions
that came along the way. Having a child was one of them. But before we get to
that, there was this part about him being able to continue
his practice as a doctor or not. And I was wondering
whether you could share how you guys thought
about that as this was going on. And there's a couple of
lines that I have selected from that part of the-- thanks. LUCY KALANITHI: This one? SPEAKER: Yes. LUCY KALANITHI: Yeah. "Graduation from residency
required two things." And this is after he gets
sick and he goes back to work. "Meeting a set of national
and local requirements, which I've already done, and the
blessing of the faculty." And then briefly
in between here, he talks about how he runs
into a fellow resident or young faculty who says they
may not actually graduate you. And he says, " 'What? I don't mean to sound cocky,
but I'm a good surgeon. Just as good as--' 'I know. I think they probably just
want to see you performing the full load of a chief. It's because they
like you, seriously.' I realized it was true. For the past few months,
I'd been acting merely as a surgical technician. I had been using
cancer as an excuse not to take full
responsibility for my patients. On the other hand, it was
a good excuse, dammit. But now I started coming
in earlier, staying later, fully caring for the patients
again, adding another four hours to a 12-hour day." It's pretty rigorous, right? You're like, Stanford,
cut him a break. But then this is the important
thing about being a doctor. It's not just a technical job. It's connecting
with those patients and taking full responsibility
for every aspect of their well-being. SPEAKER: Despite what you
were going through yourself. LUCY KALANITHI: Yeah. I mean, it's one of the
tensions about being a doctor. It's like the best and worst
part because it's stress on you too, emotionally and physically. Yeah, that's what
he's talking about. SPEAKER: Did you think
that was helpful for him in a certain way, even though
it was taxing on him physically, as he mentions in the book? LUCY KALANITHI: Yes, for sure. He kind of surprised me
by going back to work. It didn't surprise me because
I knew his personality. But I think a lot of people,
if you were given months to a few years to live, and
maybe the outside possibility of a decade, many people
would quit their jobs. I certainly would not fault
somebody for doing that. I might do that. But he really wanted
to go back to work, and initially didn't
think he could, and did. It was very important
to his identity. It was what he'd
been training for. It was a very
considered decision to leave the humanities
and enter medicine and then neurosurgery. And so initially, or always,
he got this really deep meaning from taking care of patients. Later, writing the manuscript
for "When Breath Becomes Air," was another way to
feel like an expert or to feel like he was
helping people or even healing people in a
completely different way. So that ended up
being the case later. I did a book reading
recently and one of the questions
from the audience was Paul, when he went
back to work as a surgeon, was having really
excruciating back pain and he felt dizzy in the
operating room at one point. And there were all
these safeguards to keep his patients safe. That was obviously
the first priority was that he could sufficiently
act as a doctor, even though he himself was ill. But somebody said, do you
think he put more wear and tear on his body? Do you think he died sooner
because he went back to work and was not sleeping as
much, working so hard? And I was like,
well, I can't think of a mechanism by which
working as a neurosurgeon would make your chemo drug fail. So I don't really think so. And I was sort of like, whoa,
that's a ballsy question to ask me to my face. But at the same time, it was a
really good question, actually. And I was reflecting on it. And I was like, well, I wonder. And if I think Paul
could have even chosen, I think it gets to this
question of the quality of your life versus the
quantity of your life. And I think, especially
when you're ill, it's fair and brave
and good to also think about the quality of your life. And so I think about him
taking on that burden was actually him taking
on meaning and identity. And something that
he really wanted was to keep being a physician
despite his illness. And it ended up
working for a while. So I think it added deeply
to the quality of his life during that time that
he could still work. SPEAKER: I think you
also refer to the same-- in talking about life support
and being on a ventilator, the duration is not necessarily
synonymous with quality of how much time you have." LUCY KALANITHI: Yeah. Right. And there's that narrative
of the battle, right? Like beat it, fight it,
live every millisecond that you could. But there's a set of
tradeoffs, especially as treatments get harder to
stand or less likely to work. And so at the very
end of Paul's life, as you know-- and
I wrote about it in the epilogue to the book--
he became very ill very fast and came up against a
decision about whether to be put on a ventilator,
on a breathing machine, and chose not to be. He had knowledge as a
physician that it would likely extend maybe the duration of
his life by hours to days. But if he couldn't interact
or go home or write or hold our child, or ever come off
that breathing machine, which was the most likely,
then it wasn't for him. So he decided not to do it. And instead, our baby came
into the hospital room. And the gears totally
shifted completely to quality and not quantity. And I only remember
that day or those hours almost as a series of
images, like snapshots in my mind, because it
was so painful and so intense to know that that
was the last day of his life, and to be holding him in the
bed and knowing he's right here. And then he went to sleep. And then he died
a few hours later. And it's like, he's right here. And then he's like literally
about to disappear. It was so intense. And that decision making
was so hard and painful, and even confusing, to
weigh the tradeoffs. But I think that's one of our
great challenges in medicine is to be able to help people,
or within our families, be able to weigh the tradeoffs. Because it's not
as simple as always throw all technology
at the issue. It's like, what makes
sense to you as a person? And I think he made a
really brave choice. And I think it was the
right choice for him. But it's really
hard in the moment to know and to make
choices like that. SPEAKER: I think by
sharing it I mean, you guys have done
a great service to a lot of other people who
are in similar situations. And they feel that there is
a sense of empathy coming towards us because
there's other people who are going through the same. And in fact, Paul,
in the book, shared a really personal decision,
which you referred to, deciding to have a baby. And I was wondering if you
could share with the audience a little bit about how
you guys thought about it. Because I think it's a
beautiful line that he writes. LUCY KALANITHI: Yeah. Can I just answer part
of the question first? So this was, obviously, one of
the other hardest decisions. We had always
thought that we would have a child toward the end
of Paul's residency training, which would have
been that same year. Or try to have a child. You can never predict. And we'd also been going
through this rough patch in our marriage that I
mentioned and he mentioned. And then he was
diagnosed with cancer. And everything sort
of came to a head. And then we started
talking about, how are we going
to cope with this? And would we ever consider
having a child still? Which was kind of a crazy
decision in some ways. And both of us knew
that he would likely die during the child's infancy
or young childhood, which is a big challenge for me, and
a big challenge for our family and for him and for
our daughter, who ended up being born in 2014. Each of us was worried
about the other one. I'll just read the part
about this conversation. "'What are you most afraid of
or sad about,' Lucy asked me one night as we were lying in bed. 'Leaving you,' I told her. I knew a child would bring
joy to the whole family, and I couldn't bear to picture
Lucy husbandless and childless after I died. But I was adamant that the
decision ultimately be hers. She would likely have to
raise the child on her own, after all, and care for both
of us as my illness progressed. 'Will having a newborn
distract from the time we have together?' she asked. 'Don't
you think saying goodbye to your child will
make your death more painful?' 'Wouldn't it be
great if it did?' I said." And I love it. I think, "Wouldn't it
be great if it did," I think, is recognizing that
the joy and suffering, both of those, would be greatly
deepened by the experience of having a child and then
needing to leave that child. But sort of accepting both of
those as a rich part of life is what he's getting at. So she just turned two. Her name's Cady. She's doing very well. We have this huge,
supportive family. And it's on me, I
think, to help her understand where she came from
and help shape the narrative of her life going forward. And she's really thriving. And I'm so happy
we had that child. And I remember at
the time, I was worried about inviting
additional uncertainty and pain. Nobody has a child because
it's going to be easy. You have it, hopefully, because
it's going to be meaningful and you feel ready to do that. And so I sort of had to
picture, how does that fit into our lives now? And I read a book at that time
called "Far From the Tree" by Andrew Solomon. I don't know if anybody
has read that book. It's amazing. It's long and dense. But Andrew Solomon,
the writer, is-- this is going off on a
tangent a little bit. Is that OK? SPEAKER: Yeah, of course. It's about parents and kids. LUCY KALANITHI: Yeah, yeah. It's about parents and kids. And Andrew Solomon
is gay and dyslexic. And his mother was extremely
supportive with his learning disability and less
accepting of his being gay. And he writes that it
led him to conceive of this idea of horizontal
and vertical identities and the way in which your
identity can be shaped by your family, or the way
in which you have identities that you need to seek
connection and support outside your family. And so he writes these
various chapters on autism, different types of
disability, children who are born out of rape,
children who are criminals. He interviews Dylan
Klebold's mom. And it's really intense. And it's all these versions
of strife within a family and challenges for
parents and children. And the parents,
almost to a person say, I would give anything to
spare my child suffering. But the degree of
resilience and meaning that this has brought me
and my ability to cope, and my child's ability
to thrive in our family, is very clear to me. And it talks about how the love
families have for each other and the sense of meaning that
people can get despite struggle is really deep. And so it sort of
helped me understand both the sort of profound
goodness of having a child, and also the degree to which
struggle that comes from that is OK. And it's part of life. And even when it's
extreme, families often are able to cope. So it sort of
bolstered my ability to think about doing that. And then I was really scared
of postpartum depression. My sister had really bad
postpartum depression twice. She's a blogger and has
shared that publicly. So we strategized a lot about
any way to help prevent that, because that would have been an
emotional separation from Paul, which would have-- SPEAKER: You had
a ticking clock. LUCY KALANITHI: Yeah. And it's like, if Paul
lives for eight months and I'm depressed
for three months, I thought that would be really
painful because depression is emotional isolation
from other people. And I think my ability
to take care of him and connect with him if
that was compromised. So anyway, it was spooky. It was spooky. But I'm really glad we did it. SPEAKER: Thanks. In fact, I'm going to jump
around a little bit myself as well, because you wrote a
brilliant Op-Ed in the New York Times entitled "My Marriage Did
Not End When I Became a Widow." And you also describe
that grieving did not signal-- it wasn't a static
phase beginning or ending. It's one phase of an ongoing. Could you maybe speak
to that a little bit? LUCY KALANITHI: Sure. And you're talking
about this last part? SPEAKER: Yes. LUCY KALANITHI: And just to
say grief was so hard for me. Obviously, I'm sure
anybody in this room can relate if you've lost
a loved one close to you. And I developed horrendous
tingling in my hands that for a while I had
catastrophic thoughts about and was convinced I had a
disabling nerve disorder and couldn't take care of Cady. It turned out that that was
a physical symptom of grief. And I was like,
wouldn't this be great if it were a physical
symptom of grief? But I have a disabling
nerve disorder the year that Paul died, which
turned out not to be true. It just lifted. But Paul writes about how
his own mom had seizures after her father died. I mean, it's immense. You know, it's like
the easiest times for me are often
situations like this, where I'm able to speak
and connect with people. And the hardest times are after
7:00 PM when Cady goes to bed and I'm home alone. It's been very hard. But I wrote this essay that
ended up in the New York Times by the grace of Random House,
because Random House has a whole machine once you
have a book with them. So the essay is called
"My Marriage Didn't End when I Became a Widow." And it's about the
idea of feeling like a relationship continues
or your love for somebody continues even after they die. And it's based
somewhat on a piece of writing by CS
Lewis in the book "A Grief Observed," where
he says, "Bereavement is not the truncation of married love. It's one of its regular
phases, like the honeymoon. What we want is to live our
marriage well and faithfully through that phase too." And it really made sense to me. It's like even promoting
the book for Paul, or making a memorial service,
or raising our daughter, Paul is still a thread
in our lives, obviously. And I still feel
obligated to Paul and just sort of serve
Paul's legacy too. So I wrote about that. And this is right
at the beginning of that piece, where
it's describing visiting Paul's grave. "When my husband died from
cancer last March at age 37, I was so grief-stricken
I could barely sleep. One afternoon, I
visited his grave in a field high
in the Santa Cruz mountains overlooking
the Pacific Ocean and lay on top of it. I slept more soundly
than I had in weeks. It wasn't the vista that
calmed my restless body. It was Paul, just
there under the earth. His body was so
easy to conjure-- limbs that had linked with
mine at night, soft hands that I had grasped during the
birth of our daughter, eyes that had remained piercing even
as cancer thinned his face. And yet he was
impossible to hold. I lay on the grass instead,
my cheek against the ground." SPEAKER: Thanks. So I actually, while
you were speaking, realized that we kind of
lost track of time as well. But we still have a few minutes. And I want to open
this conversation up to include the audience,
if you have any questions. LUCY KALANITHI: We have a
daughter who, her dad is Paul, but she doesn't have any
of her own memory of Paul. So how will I help
shape her knowledge of Paul, her memory of Paul? So in a way, the book
"When Breath Becomes Air" is a letter to her. People ask me whether Paul
wrote her letters or left a particular writing
specifically to her, and he didn't. He was conceiving of
the book the whole way through as a way to
communicate with her. And one of its greatest
stresses was not to be able to complete it or
not to be able to leave behind for her the manuscript to read. And the last paragraph of the
book is a love letter to her. And it's like my
prized possession. And I have it memorized, even
though I didn't even try. And that's a key message to her. And then I think there's
this whole network of people who knew Paul and
loved Paul, especially his brothers and
our sisters-in-law, and friends and
family and pictures. And so I think all
of that sort of exists to help her understand
who he was at whatever point it is meaningful to
her to discover that. I think in a way, the
most painful thing for me might be if she's
not interested in learning about Paul, which maybe would
be true at various times in her life and
different at other times. And so in a way, it's
sort of up to her. But I want to help
her understand where she came from too. She's not in any type of
pain from having lost Paul. But later, she'll be in
a different type of pain because she doesn't have memory. And her cousin, Eve, who is
Paul's brother's daughter, is the oldest cousin and
just started kindergarten. And she may remember Paul, or at
least have some images of Paul. And we have this great photo
of them drinking a mango lassi with two straws. And I wonder whether Cady
will see those pictures and feel envious if Eve even
has a small memory of Paul, or if Eve, her older
cousin, when she's buying alcohol
for underage Cady, will also be telling
her about Paul. So I think that
relationship with her family is going to be important too. I keep saying stuff
like the word "ballsy." That makes me be like, this
is going to go on YouTube. I'm a doctor. But I think it's OK. SPEAKER: Cool. Yes? LUCY KALANITHI:
It's pretty simple. I practice
mindfulness meditation for a short period
of time each day. And I used to be like, I'm
not good at mindfulness. I keep figuring out I'm not
thinking about my breath or whatever and having
to redirect my attention to the path of my breath. But I think there's
no such thing as being good at it or not. It's purely about noticing and
then redirecting your mind. And I started doing
it actually well before Paul became ill when I
had an episode of depression during my residency training
that was relatively mild. But it's actually quite
common during residency when physicians are
new at their jobs and under stress and
not sleeping very much. And so there's starting
to be more recognition and support for that. But I had a
therapist at the time who wrote down this thing on
her whiteboard in her office. She wrote, pain plus
non-acceptance of pain equals suffering. And at the time I was like,
well, I don't accept this. This must not be. And then later I
realized what she meant, which is the fact
of not accepting pain that you can't change does
lead to increased suffering. And I think for me, mindfulness
has been helpful for that. I have a lot of
friends or colleagues or patients who love
that app Headspace. I don't own stock
in them or anything. But there's an
app on your phone. And they help you track your
progress with meditation. And they have these
little, short meditations you can listen to. I know people have a lot
of success with that. Obviously, it's based
in Buddhist practice, which I don't really
know anything about. But I think it has a lot of
those sort of little snippets of it have really resonated
with me and helped me cope and, I think, made me
more resilient because I don't resist suffering that I
can't change in the same way. But it's an ongoing,
daily process. Oh. Do I plan to write more? Maybe. I don't know yet. I find writing to
be a real struggle. I thought I would be
more nervous to speak. But I actually am
doing OK speaking and feel good doing that. I'm giving a talk at
Ted Med in December, which is one of the first
talks that I have to deliver. And it's a different thing,
actually, to figure out, rather than just talking
about a personal experience with some sideswipes at
what the deeper thesis is, to think about how to present a
message and what kind of thing I want to actually
be contributing to a conversation about
particularly health care. So I think that's kind
of an exciting next step for me is to think about that. And one thing that I'm
really interested in is getting back to that
question of grappling with difficult
decisions in medicine. How do we communicate
with each other about what's actually
happening, and how to weigh the tradeoffs
when we really wish we could beat an illness
but we may not be able to. So maybe you are
right about that. I don't know. It's kind of an exciting
and strange time to have a role in medicine,
or even in the public sphere. That's way different from what
I ever thought I would have. And it's based on Paul's
leadership in that way to connect a personal experience
to a bigger picture question. So I don't know. But thank you. Yeah. Thank you. Yeah. I'd love to. So getting at that
question of medical culture and how we have those
conversations and balance quality and quantity of life. And I know Atul Gawande
was here to speak. And his book "Being
Mortal," and his work since, testifying in front of the
Senate and all these things, is all about, how do we
understand that people have other goals for their lives,
rather than just safety and quantity of life? And I think we have
all this technology. In medical culture
and in medical school, you're often taught,
we get to fix things. And we get to use all
these technological tools. And then the key is the
wisdom of how to do that. And I think we'll start
incorporating a more ancient narrative too,
with our modern tools. And then there are all
these other-- you're right. Doctors listen to doctors. So it's good to be
able to talk about that in medical schools and medical
conferences and settings. And there are tools for
doctors, too, like Vital Talk. Or Atul Gawande
has a lab in Boston that puts out
trainings for doctors. And then for patients
and families, there are really good tools too. I'm blanking on the
specific name of it. There's one called the
Conversation Project, I think it's called,
that's really good. And there are a number
of different books, like "The Conversation" by
another doctor in Boston. It's funny those both have the
word "conversation" in them. But I think that's
one of the keys. Angelo Volandes. That's who wrote
"The Conversation." SPEAKER: Thanks. LUCY KALANITHI: Oh. How do I reconcile my love for
Paul with having to move on? Yeah. I don't know the answer to that. I mean, I think part
of it is that I didn't know that I would have all these
positive feelings about Paul that would stretch forward,
like loving him or feeling proud of him. I think I thought I would just
feel devastated and lonely and deflated. And instead it's like,
I feel this other way. I still feel good about Paul. I think the idea of
moving on or moving past, I think that idea of living
with something makes sense to me too. I hope I remarry in the
future, like Paul said. But I think I'll love Paul
at the same time as well. And I actually
just met somebody. You guys probably
remember Brittany Maynard, who was a young woman
with a high grade brain tumor who lived in
California and then moved to Oregon to seek medical aid in
dying if that became necessary for her, if her suffering and
dying, if enough was enough. And she ended up
dying after ingesting a medical aid in
dying medication and becoming a big advocate
for Death With Dignity. And her husband, Dan Diaz, has
continued to speak and testify in front of state legislatures. And I met him the other day. Someone was like, you
should meet this guy and talk about grieving
publicly and being propelled by your love
for your late spouse. And I was like, that is sort of
a weird, singular experience. And so we hit it off,
talking about that and doing work on behalf
of somebody who's not here. And so I think you do just
continue to honor that person and then progress
forward in your life and understand the ways in
which they've influenced you. And she said, actually,
in this beautiful video about him remarrying. She said, there's
no part of me that doesn't want him to move
forward and be a father, and these things that they
couldn't have together. And I think it's like this
beautiful, generous thing that you would say when
you're losing somebody. Or Paul and Brittany lost me
and lost Dan and lost the future that they would
have had with us. And so yeah. It's like, I can't go on. I will go on. SPEAKER: Thank you
so much once again. And thank you all
for being here. LUCY KALANITHI:
Thanks for having me. [APPLAUSE]
