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Behind 'When Breath Becomes Air': Exclusive Interview with Lucy Kalanithi
The widow of author Paul Kalanithi talks love, loss and literature
Book of the Month, Lucy Kalanithi
Judge Kim Hubbard told us that her February Book of the Month selection is her favorite pick to date. Written by Paul Kalanithi after he was diagnosed with Stage IV lung cancer, the Stanford neurosurgeon, who also has a Masters in English Literature, examines some of life's most important questions: What do we do with the time we have left and how do we live meaningfully? Some of his answers included spending time with his wife Lucy, and having a daughter named Cady. Lucy wrote the Epilogue to Paul's memoir after he passed away in March 2015, and has recently been busy sharing Paul's words with the world. We spoke with her in a 30 minute interview.
Check out the full audio interview here or read the full transcript below:
I read this book it was beautiful and hard to keep a dry eye - what has the whole process been like for you? Finishing the book, dealing with his death at the same time as raising your daughter. Can you update us on your life and how you've been dealing with all of this?
Yeah I sort of don't even know where to start. It's obviously totally surreal, especially now that the book has come out, it's like this mixing of private, personal, with public. As an example, I haven't been to Paul's grave in a week or two because I've been so busy with the book promotion, it's sort of like the good news and the bad news, you know. But it's been really wonderful and kind of a consolation for me - it was so important for me to complete it and carry it forward because Paul had worked so hard on it and I felt like he really had important things to say in drawing in his experiences, not only as a terminally ill person, but also drawing on his background in medicine and then literature and philosophy. I am so proud of him, that it was really wonderful to do this for him - finish it. Make sure it happened, that what he was trying to do happened. Then also feel connected to him still through that process.
You talked about this a little in the book but what was your reaction when Paul first decided he wanted to document this experience? Obviously he was passionate about writing - but it's such a personal experience for you and your family. Were you hesitant at all in the beginning?
About him writing a memoir?
I would say not hesitant, although like a little bit surprised and interested in how he was making those choices. The first thing he wrote was a personal essay, almost like a journal entry, that ended up being that piece, 'How Long Have I Got Left?' in the New York Times. He got this really immediate gratifying response to that where he suddenly was connected to other patients, or doctors, or others who responded to the themes in that piece. It was interesting because he said you know, this is such a personal story, he was almost surprised it resonated with other people and then it sort of became obvious, in the singular experience, people can see themselves and connect to each other through stories. The fact that he had always wanted to be a writer and then had this initial positive experience writing something public that led him to do that.
He was quite a private person, or he could be a private person, so it was actually interesting to see him want to be public with such a personal experience facing illness. He did start writing and then he did a couple of public interviews, like including an interview on stage at Stanford speaking with a Palliative care physician about his experience. It sort of became obvious why he would want to share that and stay connected through this purpose. I almost was surprised by how deeply authentic and detailed he was in describing his personal experience. Because he really didn't spare himself or anybody else anything. When he was writing the book, he writes about his own failures, and he just writes really starkly in some ways. But I actually think part of the reason people seem to be responding to the book is how authentic it is. So it kind of surprised me a little bit, but then now in retrospect it really makes sense to me. I wrote this piece recently in the New York Times called 'My Marriage Didn't End When I Became a Widow' and I don't think I ever would have done that had it not been for Paul's paving the way and then realizing how consoling it is to connect with people.
I also thought about our own experiences reading, Paul read so much poetry and literature about facing mortality. It was so helpful to him. He left this book behind, so to speak, a friend of his had given him this book 'Lament For a Son.' It's by this guy Nick Wolterstorff who was a Professor at Yale who lost his son in a mountain climbing accident when his son was 25. Nick Wolterstorff wrote this tiny little volume called 'Lament For a Son,' it's super mournful and just really stark and personal and Paul read it and loved it and before he died he said "can you give this to my parents when I die?" It was very helpful for his parents. It includes all these beautiful ideas - like the idea of owning your grief, not trying to suppress your grief, or he says this beautiful thing, where he says, "every lament is a love song." It talks about how grief is the flip side of love, the deeper your grief, the deeper your love. That's another example of this really singular experience that Dr. Wolterstorff writes about but then you realize how consoling and fortifying it is in your own life. I think Paul aims to do that same thing. He was writing for himself but he was definitely writing for readers and taking them into this personal experience that in a way then illustrates the universal and makes people feel connected, the more personal it actually is.
That brings me to what you were speaking about - the role of literature and how that consoled him and helped him - Sam Beckett's "I can't go on. I'll go on." Do you have any pieces of literature that you turn to now? I read an interview with Paul saying he was so fascinated by you when you guys first meet because you had a bookshelf full of books but that you didn't like to read.
I was sort of laughing. He sort of outed me for something which was like, half of those books were books I acquired and wanted to read and half those books are books I love. He thought it was hilarious. He was like, "What did you think of this book?" and I was like "I haven't read it yet." And he was like "What! Why is it on your bookshelf?" I actually think you're allowed to do that too.
Especially since he died - we had very different tastes in literature. I actually considered myself a reader just not compared to Paul, Paul was just like unbelievably connected to books and just had like - he never could throw away a book. His parents still have like 22 boxes of books at their house in Arizona because Paul never ever rid himself of a book, ever. I'm a reader, just not to that extreme degree. I kind of like recent, non-fiction, which is different from Paul liking English literature, as far back as it goes. Poetry has been really helpful for me since Paul died. There are all these beautiful poems. I really love, "Surprised by Joy," which is this [William] Wordsworth poem about the experience of grief, and then I love this other poem called, "Last Night the Rain Spoke To Me," I think it's a Mary Oliver poem. It's sort of about the idea of going forward and the last line is something like, "Oh the long and wondrous journeys still to be ours." And it makes me think of me and Cady. It's kind of like this turning forward and remaining in the moment.
There's another poem called, "Elegy to Philip Sidney," which is by Greville, who's a poet, whose poem Paul drew the epigraph in the title for his book from. This other poem, "Elegy to Philip Sidney," is like 600 years old and it's about Greville losing his best friend, Philip Sidney, and it's so, so, so heartbreaking. There are a couple of lines that really make me think of Paul. The last few lines say - talking about going to a grave - and it says something like "Salute the stones that keep the limbs that held so good a mind." It's just this heartbreaking thing that's kind of like a tribute, and a lament, and it makes me think of Paul. There's also another line in that poem that says "Death slew not him, but he made death his ladder to the skies." I can barely say it without crying. It's sort of like...I really like the idea of, there's the battle metaphor for cancer. Which often works, but not for terminal cancer.
There was a headline after Paul died, his death got covered in a few local news pieces. One of them said, "Stanford Neurosurgeon Succumbs to Cancer." I was like, I don't think Paul succumbed. He died, but I don't think he succumbed. That theme shows up in literature. So do a lot of others. Poetry has been very helpful. I've read, 'The Year of Magical Thinking,' before, and I keep thinking I should go back and read it. I read C.S. Lewis' terrible book on grief, I mean terrible because it's so heartbreaking. It's almost too painful to read, he's so pained that I almost couldn't do it. It just depends what strikes you. I have been reading a lot since Paul died.
That brings me to my next question which is from Kim Hubbard, who selected your book, she's the books editor at People Magazine. She said that she was floored by your writing and thought you were such a beautiful writer yourself. Do you have plans to write your own book?
No. I've learned, since, learning more about publishing and writing, that writers don't have to love writing. I think Paul actually loved writing, he enjoyed the actual process of writing. Even though it was hard work. For me writing feels a little more like pulling teeth. With that New York Times piece ultimately it feels like my heart is on that page. I feel so good about what's written there but the process - it takes me a very long time. I need a lot of help with it. It's easier for me to talk than to write. I think, I'm more of a talker than a writer, so I'll have to figure out what to do with that.
Fair enough. I wanted to ask about something you said in the Epilogue about thinking the only thing really missing from the book was Paul's sense of humor. I'm curious about that. Can you tell us more about it to get a better sense of who Paul was?
Yeah. It's funny because I did an interview with Katie Couric last week, her piece just came out on Yahoo News and it's like this 9-minute news piece. And at the beginning she let me talk about how Paul was really funny. I don't know if you can link to it - but it definitely gives people an example. I talk at the beginning - there's these pictures of him being sweet and goofy and then I talk about this little detail, which was, when we were in medical school he had been a sketch comedian in college and he was an extremely talented comedy writer. I say in this Katie Couric thing and they even show a photo where Paul had a fake mustache in his Yale Medical School ID for four years. He had thrown it on at the beginning of med school out of his pocket he put the mustache on right before they took the ID photo. I think for him it was almost like this anodyne...at the time he thought he would enter medical school and then become too serious. I think it was like almost a challenge to himself, to retain himself.
The book is really serious, and it's written by a dying person, and it draws on the deepness of Paul's intellectual self. But then he was super, super funny and even his friends who read the book will say like "Oh it's not funny enough." But it's like, that's not who Paul aspired to be as a writer in the world. He just was so cute and snuggly and funny. It's funny because, I read this interview a long time ago, there's this psychologist at Harvard called Dan Gilbert. He's talking about his best friend who died whose another psychologist named Dan Wegner and he says this thing: "Humor is the place where intelligence and joy meet." And it's like, it was this lovely thing to say about his friend, and I loved it because I think the same thing about Paul. He was super funny and it was that same kind of idea, he was observant, and joyful and it came out in this other way too.
I love that. Can you give us an update on your daughter? How is she doing?
She's 18 months. She's doing great. It's really funny because she just doesn't know what's happening. She loved Paul, and then Paul died, and she wasn't really aware, and now the book's coming out, and she doesn't know...When Paul was alive, he wasn't a famous writer, and then now it appears that he's a famous writer, so it'll be interesting to see what kind of relationship she develops with him and his legacy at various stages in her life. She's a really sweet kid and she really looks like a mix of me and Paul. I'm sure it's easy for me to notice things in her that seem similar to Paul, but it's like, she's got these kind of fiery, dark eyes and she's unflappable and she's really funny and she loves books. There are pieces of her that remind me of Paul. At the same time, she's not replacing Paul. She's her own person, and now that she's starting to talk and be willful, I feel like I'm getting to know her. She's turning from an infant into a little person. She's doing great, she's really thriving. We have a really wonderful community and family, and so I feel like even though Paul's not here, I feel really happy about all the support that she has and that I have.
To that point, how are you juggling all the press for the book and then being a doctor, and having a family?
Well thankfully I work at a really amazing Institute at Stanford that thinks about healthcare value. I've worked there first as a Postdoctoral Fellow and then now as a Junior Faculty Member, ever since Paul got sick. It's a really humane place to work and they've been really supportive of me and Paul and our family and let me have a flexible schedule and then now I still have a flexible schedule to be able to do this work on Paul's book and then I'm ramping up my commitment to them again. So thankfully I'm not juggling too many things at once, and then I have a lot of help taking care of Cady, even though I've been on this leave from work, especially now with publicity, been working on behalf of Paul kind of full-time on the book, so that's gone up and down, but I have a lot of help balancing it.
It's all kind of a joy. Cady's amazing and the book - I'm really glad that the book is happening for Paul and I'm really glad that I got to work on it. I raised this a little bit in the New York Times piece, the idea of carrying something forward for Paul but also kind of molting Paul at the same time. I think this is like a way to stay connected to Paul but then also stretch me into the future.
Yeah, that's great. Besides getting to know Paul, what do you want Book of the Month readers, or any readers really, to take away from this book?
I guess, I'm really grateful. I want to express gratitude that people are reading it. And it's amazing that it's being featured by you guys, and Paul dreamed of becoming a writer, and it's really amazing. Then I guess, one of the things that's been gratifying, or that I think the book has the potential to do is help people reflect on their own situations. Whether that's their own illness, or their mortality, or their choices, or sick or aging family members, I think it's an opportunity to start personal conversations. I think illness and death are really hard to talk about, but I think this book sort of is a little piece of this larger opportunity for us to be talking to each other in a realistic way about our healthcare and our lives and our ability to take care of each other and the resources we need to be able to do that in our communities and in our families. So I think that, insofar as I picture discussions that come out of this book, I think they are actually not necessarily going to be about Paul, I think they're going to be about the readers own lives. I think - I'm really proud of Paul for being able to be kind of like a springboard for people to then bring up important things in their own lives or in their family.