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When Breath Becomes Air

When Breath Becomes Air

When my sister’s husband, Paul, died last spring of lung cancer, our family was devastated. He had been diagnosed less than two years earlier, at age 36; he was a neurosurgery chief resident at Stanford, nearly done with his training.

During his last year of life, he wrote about facing death. His memoir, When Breath Becomes Air, comes out this Tuesday, January 12th.

I’ve read the book twice now — once as a manuscript, and again over the holidays as a hardcover. Both times, I devoured his story in almost one sitting; I couldn’t put it down. Although I knew how it ended, the book felt almost suspenseful in its gripping, race-against-the-clock questions about life, love, meaning and death.

Paul himself was an introvert. He was smart and lovely. He had a deep kindness and laughed at every joke. But since he was often quiet (and uncomplaining), I wondered — as I hung out in their living room across from him — what was going on in his mind as he grew sicker. I knew he was brave, but was he sad? Was he scared?

Reading the memoir was like hearing his inner monologue after all this time. I couldn’t believe the fascinating things he did as a neurosurgery resident (he once said it was like operating on pudding, yet a millimeter can cost someone’s life), which he rarely opened up about. He described what it felt like to transform from a doctor to a patient (“how little do doctors understand the hells through which we put patients”). I was gripped by his thoughts on accepting death when your life feels like it’s just beginning (“the fact of death is unsettling; yet there is no other way to live”); and how to create a meaningful life, even if you have only months left.

Needless to say, I would recommend the book wholeheartedly. Here is some advance praise from authors who have read it:

“This is one of a handful of books I consider to be a universal donor — I would recommend it to anyone, everyone.” — Ann Patchett

“Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.” — Atul Gawande

“[When Breath Becomes Air] split my head open with its beauty.” — Cheryl Strayed

People often asked how my twin sister is doing. Lucy has shared a few thoughts on Cup of Jo over the months, and today she wrote a moving essay about her experience:

At first I could scarcely grasp what widowhood meant; I was too busy looking for ways to comfort Paul even after he died. When the funeral home asked me to bring a set of clothes for Paul to be buried in, I wore them first, thinking I will make these clothes warm and redolent of us. I put a pair of our daughter’s socks in his pants pocket. On the day of the burial, I stepped out from the procession and moved ahead of the pallbearers, compelled to lead his coffin down the hill. I can’t take your hand, but I will guide you; you will not go alone. For several months, I slept with my head on the pillow he had died on, left his medications in their drawer, wore his clothes to bed. Still today, months after his death, I go and sit at his grave, absent-mindedly stroking the grass as if it were his hair, talking to him using nicknames only he would understand.

Lucy will be reading from Paul’s book (for which she wrote the epilogue) at BookCourt in Brooklyn this Monday, January 11th; I’m honored to be interviewing her on stage. We would LOVE to see you there, if you are free and would like to come. (There will be wine and cheese, naturally.)

You can find When Breath Becomes Air here, if you’d like. Thank you so much for all your kind words and sweet support over the years. My heart goes out to anyone who is missing someone today. xoxo

Lucy and Paul Kalanithi

Lucy and Paul Kalanithi

P.S. Two essays by Paul, published before he died: How Long Have I Got Left and Before I Go.

(Top photo by Stella Blackmon. Photo of Paul and Lucy by Ryan Padrez. Family photo by Team Draft.)

  1. I knew before I started that Paul would die by the end, but I was so wrapped up in his story that I forgot until the very end. So beautifully written, and Lucy’s ending had me crying. I finished reading this on a plane and had a hard time hiding my tears.

  2. Katie says...

    This seems too coincidental not to share. Stick with me, I can assure you it’ll all come together…

    A few days ago I downloaded Paul’s book “When Breath Becomes Air” to read while on vacation. The book had been recommended to me by a friend when I asked for life changing book recommendations. I started the book and was immediately hooked, I had the hardest time putting it down and finished it within days – the fastest I’ve read any book, possibly ever. His writing and story beautiful, heart-wrenching, and powerful. Life changing undoubtedly and unforgettable.

    While on vacation with my husband and almost 2 year old son, between reading sessions and enjoying other parts of our vacation, we decided to make some significant changes to my son’s breastfeeding schedule – moving more intentially towards weaning him (not completely but mostly). During this time I experienced some substantial hormonal shifts which were difficult to handle emotionally at times. Once my husband and I connected the dots I googled “weaning hormones”. I randomly came across your blog on the matter and your experience while weaning your son. I connected with your words and shared your story with my husband. Your link on the matter was the only one I shared with my husband. I also found your FB page and began following that. (Side note: Your words on this matter held true and as of last night, after nearly 2 years after having my son and no menses, it returned. The cloud that has lingered, drifting in and outseems to have lifted).

    Anyway, fast forward to today, I hop onto Pinterest to pin “When Breath Becomes Air” to my page “Books Worth Reading” and find the image I like best to pin. I notice the image I’m drawn to is from your blog “A Cup of Jo”. I click on it to see what you had written about this book that I just finished and was touched so greatly by. I start reading and am completely struck by the fact that you’re Paul’s sister-in-law!! What are the odds?!!! I don’t know if this sounds as wild to you as it felt to me but my husband, sister, and I all thought it was pretty wild! Not sure if it’s a coincidence or the connection to/with something higher…

    Whatever it is, I’m happy it happened and grateful to have my life touched by the words and wisdom of you both. Thanks and gratitude from me to you and your family. Through life’s struggles and hardships we are given the opportunity for connection and meaning. I appreciate the insight and vulnerability you and your family have openly given to those willing to receive it.

  3. Bhumi says...

    Joanna,

    I read this entire book in one sitting. Without a double, it is one of the best books I have read in years. My heart aches for Lucy and their sweet little daughter. I will keep them in my prayers.

  4. Nicolette says...

    I finished reading this book last night and balled for hours. What an incredible perspective on life, death and the moments strung between our beginning and inevitable end.

  5. Cynthia says...

    I’ve just finished Paul’s book in one sitting. The book has been all over social media and then I saw this post back in February. Being a longtime reader of the blog made me more personally invested in Paul and Lucy’s story. I am starting medical school in July and only hope that I can be as passionate and caring as Paul was.

  6. sue says...

    What a love-filled post. Will get the book to help fill in the gaps of understanding. My husband spent 10 weeks in Stanford’s cancer ward. For the widowed among us, I would also recommend an online support group widowedvillage.com where we share our stories of love and hope alongside the grief.
    Vetted and safe. 24-7 live chat with those who “get it”, blogs, discussion groups. For all who’ve lost a life partner, regardless of time or circumstance.

    • sue says...

      sorry, “dot org” –widowbrain…

  7. Anna says...

    I just finished reading Paul’s book. I feel a deep sense of sorrow even though I never met Paul, never even heard of him till I read the book review in New York Times. What a great loss to science and medical community. We need more doctors with compassion and empathy. He seemed to have had that, along with skills of a superb surgeon. I can only imagine all the contributions he would have made to humanity. My most sincere condolences to Lucy, Cady and the rest of the extended family.

  8. Katie M says...

    I just finished his book recently. I work in a hospital and appreciated the patient perspective. We truly don’t know our patient’s stories and its hard to see people die young. I recently heard an author say that fear is the #1 trait of people in our society and courage is the least had. Way to go, Paul, for daring to be great.

  9. Chella says...

    I just finished reading the book yesterday…and I haven’t stopped crying…the book brought lot of emotions I had kept hidden, to the surface & exposed itself. It’s a book that I’ll never part with & will come with me to wherever I am. Lucy & Cady, I feel I know you & your family well and thank you & Paul for sharing your life with us.

  10. Annie Sun says...

    I was lucky enough to get a free copy from Goodreads. Initially I didn’t think much of it since i just…didn’t know one way or another. Now, both Paul’s and Lucy’s words will always stay with me for the rest of my life. So full of depth, truth and wisdom about life and relationships. One of the rare books that is hard to not read a second time. It became one of my most cherished book that brings me calmness and guidance, which I haven’t have one for who knows how long.

  11. Reading this brings tears as it has been 18 years this past week. While my life has grown and changed and I have experienced blessings, there is always that tug on my heart: graduations, birthdays, and little moments that I know he would have enjoyed. Grief is a wiry emotion. It never fully leaves it just folds itself into everyday life. Thank you for sharing your story. I might not know all of your details but I do know the path you are walking. It can be rocky and hard for other to understand at times yet it’s a path worth walking for your daughter and for you. My deepest sympathy and prayers for you.

  12. Jamil saleh says...

    Lucy, your courage to share Paul story with us is a special gift you are giving to all who have say goodbye to a love one early in life. I cried a few times and have taken a few strong breaths to give thanks to you and Paul. The book is a brilliant read and a reminder to cherish life and all its challenges. May the heavens rejoice in the glory of your and Paul gift to us.

  13. Katherine says...

    I just finished reading my copy and have it all marked up to give to my husband (who is about to start residency himself). It was powerful, tender and beautiful, as were your sister’s words at the end. His story will no doubt help so many people, it has certainly blessed my life to read. Thank you to Paul and Lucy for sharing their brave and beautiful story and by so doing letting us honor them and Cady. Sending love and warm wishes to you all.

  14. Monika says...

    I can’t read it yet. I will, someday, I promise. I want to! But I’m simply not whole yet. My father died of terminal brain cancer, glioblastoma, less than two years ago. The feelings of guilt, helplessness and sheer grief are still on the surface, just beneath the scab. But I bought the book, so it’s here when I’m ready…. I read your blog entry when you talked about their first house in California and recall the sweetness that last picture exuded, long before cancer invaded their world so harshly as to change it so drastically. Condolences to all and thank you (to both) for writing so beautifully.

  15. Kim says...

    I lost my husband to Stage IV lung cancer on January 2, 2016. He was only 53 and never smoked. Our girls are only 12, 11 and 8. Not a day goes by that I don’t miss him fiercely. I just ordered this book from Indigo, I don’t think I’ll be able to read it yet but it looks intriguing.