“How Long Have I Got Left?”

Last May, my brother-in-law, Paul, who has a deep gentleness and a keen sense of humor, found out that he had incurable lung cancer. Out of nowhere, he was facing death. He was 36 and had always been healthy. Our family was floored.

This week, he wrote a beautiful essay for the New York Times about what the experience has been like. At first, he thought he had only a few months, but now, because of a new treatment, he may live longer. (Two years? Five years? Ten years? The doctors don’t know.) And that uncertainty is disorienting.

“The path forward would seem obvious,” he writes, “if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write a book). Give me 10 years, I’d get back to treating diseases [as a neurosurgeon]. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: ‘I can’t tell you a time. You’ve got to find what matters most to you.’ ”

We all know are going to die, and we don’t know when, but as Paul says, “now I know it acutely.”

Read his beautiful essay here, if you’d like. Thank you so much for sharing, Paul. We love you. xoxo

(Top illustration by Tucker Nichols for the New York Times)

  1. I just saw that Paul passed away. What a hard winter this must be for you, Joanna. I’m sending you love.

  2. Dear friend,

    Would you please update us on Paul and Lucy’s journey? Praying for Paul’s health, and that he would know the sweetness of God’s closeness during this battle.

    Lots of love from one Michigander-turned-Californian to another Midwest soul,


  3. Just amazing. Thank you for sharing. It reminded me of a commencement speech a friend of mine gave to the park city winter sports school. He was given a year to live and stole much more time than expected. It is the most inspirational piece I have ever heard. Grab a box of tissues and check out the speech.

  4. Wow, I have no words. In the depths of specialized surgical residency training myself, I cannot imagine what it would be like to be young and have dedicated so much of my life to training and then come right up against this kind of diagnosis. My thoughts are with you, Joanna, and Paul and your sister. My thoughts are with all of you and your family.

  5. Oh my goodness, Jo… This caught me off guard and I’m all choked up at work. Wishing the best for Paul and your family. Lots of love.

  6. Beautiful essay. I love the “I can’t go on. I’ll go on.” Keeping your family and Paul in my thoughts.

  7. Thank you, Jo, Paul, thank you for sharing. This helped so much.

  8. Thank you for sharing. My grandmother was diagnosed with stage 2 lung cancer in 2009, and since her treatment with CyberKnife, she has recovered immensely with few side effects. If possible, maybe look into the CyberKnife treatment, that pinpoints exact respiratory movement and delivers radiation directly to the tumor. Of course, all patients are different, but I hope this helps!

  9. Thanks dear Joanna, I’m a doctor as Paul and I can understand how difficult is, for a doctor, more than for every other people, receiving this diagnosis…
    I wish Paul all the possible best things! he must be an “Highlander”, during this terrible battle, as I always say to my patients
    Best regards
    Francesca (Italy)

  10. Thanks dear Joanna, I’m a doctor as Paul and I can understand how difficult is, for a doctor, more than for every other people, receiving this diagnosis…
    I wish Paul all the possible best things! he must be an “Highlander”, during this terrible battle, as I always say to my patients
    Best regards
    Francesca (Italy)

  11. I read Paul’s article from a different source, just a day after I found out my uncle was diagnosed with Stage IV pancreatic cancer, which in turn was almost exactly a year after my mother was diagnosed with lymphoma. His essay was beautiful and moving, and something I immediately shared with my family in hopes that they, too, could keep the tempered optimism Paul expresses. Tell him thank you.

  12. I read that on Sunday, and loved it. So poignant. So accurate. And so generous. What a beautiful circle of people you seem to live amongst. All the very best to you all.

  13. Go on Paul! Go on! I’ll be cheering for you.

  14. A moment like this makes us realize how fragile life is. I hope his strength continues to rise…

  15. I just wish I could say something meaningful, but everything sounds empty, so I just want to wish Paul and his (your) lovely family all the best and all the strength in the world.

  16. So well written and honest. My best friend is 31 and has been living with stage 4 breast cancer for 2 years. She is healthy but life is now an emotional roller coaster. I hope your brother in law continues to improve

  17. I read that and recognized the name. What an amazing article relevant to all of us and especially those who have a disease. It sums up the crux of life.
    I pray the medicine continues working.
    I live in the same area he does and feel, as a transplanted east coaster, the SF Bay Peninsula environment is unhealthful. Thank him for his honest and wise synthesis of his experience that likely enhanced the lives of all who read it.

  18. Out of a myriad of comments, I doubt you’ll see this one. I read this blog but never comment. I know cancer all too well. The effect it’s had on my life and those I’ve known is extremely heavy. I will say a prayer for your family, for Paul, and his family, and your sister.

  19. Wow, loved reading his article in the NY Times. Made me think of one of my favorite Pearl Jam songs off their new album, song is Sirens: “…It’s a fragile thing, this life we lead. If I think too much I can get overwhelmed by the grace by which we live our lives with death over our shoulder”. You know it’s pretty cool that your BIL spends his final days saving lives, making a difference. So glad he is feeling good and may he indeed find hope that he can hang on to.

  20. Wow, loved reading his article in the NY Times. Made me think of one of my favorite Pearl Jam songs off their new album, song is Sirens: “…It’s a fragile thing, this life we lead. If I think too much I can get overwhelmed by the grace by which we live our lives with death over our shoulder”. You know it’s pretty cool that your BIL spends his final days saving lives, making a difference. So glad he is feeling good and may he indeed find hope that he can hang on to.

  21. Fabulous essay. Thank you for sharing this- as it must be so hard for all your family. He is so brave. We are so much stronger than we think we are- he is showing that daily!
    Reminding us once more- do things every day that make you happy.

  22. What a beautiful essay, thank you for sharing it. My own mother’s lung cancer is being managed at Stanford Oncology with what might be the same little pill. She was diagnosed six years ago and she’s still here and healthy and strong. All my best wishes to you and your family.

  23. RR says...

    This was beautifully written essay. It makes you think about what each day means. I’m sorry for Paul’s illness and wish your family peace.

  24. I’m another who read Paul’s article and found it profound, and who reads your blog enough to quickly recognize “Oh, her twin’s husband” when I skimmed and saw this post’s pictures. Learning that they are the same person, I feel all the more how painful that this intelligent, strong, caring and philosophical person is facing this prospect, and I am so sorry for the pain of all you who know and love him. But also, I think, how lucky that you know and love this wonderful writer and person. You have such a great family.

  25. This was a beautiful post and a beautiful article, thank you both. I have a lot of hope for him.

  26. The question, O me! so sad, recurring—What good amid these, O me, O life?

    That you are here—that life exists and identity,
    That the powerful play goes on, and you may contribute a verse.

  27. Thank you so much for sharing your brother-in-law’s essay. It is so incredibly moving and beautifully written. Sending lots of love to you and your family.

  28. D says...

    Check out this organization that works to bring awareness and raise funds for lung cancer research:

    Thanks for sharing the essay. I found Free to Breathe after my mom passed away. Now I have Team Mindy.

  29. I read that essay on Sunday and found it deeply moving. So sorry that you and your family are going through this. Thoughts are with you all.

  30. As a longtime reader I am so sad for your sister and your family. Good thoughts are going out into the universe for your brother-in-law.

  31. His words were so inspiring and his perspective (a physician faced with a dire disease) unique. My own father (whose name coincidentally was also Paul!) was a hospital administrator and when he was diagnosed with terminal cancer he echoed a lot of your brother-in-law’s words. When you’re part of the medical system, you want to believe in it. The science though is so, so inprecise and it truly is nearly impossible to pinpoint how long someone will live. Yet, I remember that being the big question I kept asking my dad, “How long do you think? What do YOU think?” until finally he just arbitrarily said, “If you want a number, let’s say 300 days”. (Optimistic, because his doctors estimated 90). When he finally passed, I did the math with a tool online, and his guess was only off by a few days. Odd, right?

    Best wishes to your family – so happy to read that he has been able to work again and is finding ways to keep going. It makes all the difference.

  32. I wish for your brother in law to live many more years. His journey so far has given him more wisdom than many people.

  33. Thank you for sharing this touching article, my prayers are with you.

  34. I’m so sorry to hear this, Joanna, but such an inspiring story. My best to your sister and Paul!

  35. There are so many comments here, and I know mine is just another one. But I just couldn’t mute the feeling that his words awoke in me. Perfect writing! I hope that the years multiply, and that he keeps “going on”… operating, writing, living

    Thank you so much for sharing such an intense experience!

  36. There are so many comments here, and I know mine is just another one. But I just couldn’t mute the feeling that his words awoke in me. Perfect writing! I hope that the years multiply, and that he keeps “going on”… operating, writing, living

    Thank you so much for sharing such an intense experience!

  37. I have been quietly reading your blog for years now and cried reading this. I am so sorry.

  38. I asked several people around my household about this article and they too strongly felt they had a need to have their remaining life expectancy quantified in the face of terminal illness. I think it is human nature to seek out time frames even in mundane matters. As a patient I would want to know the doctor’s professional opinion about my life expectancy so I could make valid decisions about the course I wanted to choose for treatment and life.

  39. i’ve often thought the same things and wondered, “what if”. i wish paul and your family well. his story makes the unimaginable push me forward to enjoy every new morning a bit more.

  40. I wish I could have let a comment for Paul on the article. This was beautiful. I sent this over to my family as my Dad was just diagnosed with pancreatic cancer last summer. It articulated very the feelings that come along with timeslins and death.
    My thoughts are with Paul, your sister, and the rest of your family!

  41. Joanna, you and your family have all my love and support. I can’t stop thinking of you and praying for you.

    All my love,

  42. Joanna, you, your family, and your brother-in-law are all so brave. Paul’s essay shows so much honesty and strength, and your sharing is selfless. Thank you for opening up such a large topic of concern for so many. Thinking of you all…xoxo

  43. This article moved me so…cannot believe this is the man you has shown up in your blog these last years. Thinking of him and your sister.

  44. so sorry to read of paul’s illness. so sad. sending love. x

  45. So touching. Beautiful essay. My thoughts are with you all.

  46. Paul has a life time, a beautiful one.

  47. Beautifully moving essay, thank you for sharing, it’s changed my day already. I’m going to call my Mum.

  48. Wow.
    I read his essay and apprreciate his candor immensely. I work in a hospital, in and out of the critical care setting, and understand how we can so quickly forget that life is precious and as his doctor told him, ‘you have to figure out what is most important to you.’
    Thinking of you and your family as you walk through these days with your brother in law. I can’t imagine.

  49. a beautiful, heartbreaking essay, I hope very hard that Paul will live for many years to come, he seems like an incredible person and for your sister and all your family much love during this very hard time, you have made all your readers feel a connection through your writing, so I am sure all of them are sending their love.

  50. Stunning essay… inspiring, hopeful. I can’t wait to hear how well he’s doing in ten years♥

  51. Thank you for sharing and thank you to Paul for writing such a touching essay. It’s also nice to read all the sweet comments here. Best wishes.

  52. Joanna!!!!! so incredibly sad to hear this!!!! it must have been traumatic having a baby and moving into a new home while your twin sister is going thro all this!!!! I am so sorry!!!!

  53. my wonderful, intelligent, sensitive mentor (and subject of my dissertation), always upheld the ability “to live in doubt” as one of the greatest virtues and strengths a human could attain.

    He expounded this theory in his fiery first book, “The Impossible Theater: A Manifesto.” It’s awfully heady and dense with academic references, but maybe you’d enjoy checking it out! (Incidentally, my mentor died last spring, five weeks before I defended my dissertation on him. I think of him every day, and strive to live up to his ideals.)

  54. A beautiful reflection! All my best to Paul and your family.

  55. I read this beautiful, amazing piece yesterday and recognized Paul’s name from the earlier days of reading your blog. I couldn’t (and can’t) stop thinking about it — as a medical student, where it’s easy to get lost in the day to day studying and endless facts and details, stories like his bring me back to what really matters in medicine… and in life. I’m wishing with all my heart the very best for Lucy and Paul. I hope he knows what an impact his writing has made to so many people.

  56. Oh Joanna, I am deeply sorry to read this about your brother in law. We never know when in whatever mode we are currently in. Everyone has to choose what they feel is right for them. A distant uncle of mine went to Mexico and is still alive and kicking what was then Stage IV over a decade ago! Much prayers to Paul and your entire family.

  57. Love and prayers to your sister Lucy. She should write an essay too. What it’s like to be the wife and life partner of someone in this position. God bless her.

  58. Oh my. This hurt the heart to read, but was so moving. I have seen friends and loved ones beat vicious diseases, and hope that Paul has an equally positive result. Thanks for sharing this – you are all in my thoughts and prayers.

  59. Beautiful! This is really moving. Reminds me of the book, The Fault in Our Stars. Cancer really is disorienting, especially when someone you care about suffers from it.


  60. That was breathtakingly and heartbreakingly beautiful. It was also inspiring beyond words. There is a certain clarity that seems to come with this certain type of diagnosis or even just crisis…but it reminds me to embrace life before it hits that point. Enjoy life without a crisis ticking away in the background, counting down to who knows what.

    I need to wake up EVERY morning thankful to be alive. I need to write those heartfelt letters to long lost friends TODAY. And I need to ignore the numbers, ignore the negativity, and simply live each day as it comes.

    Thank you for sharing this article and opening your heart and your family to the rest of us. You are all in my thoughts.

  61. I’m so glad I clicked over and read Paul’s essay. My husband was diagnosed with leukemia six months ago. Best wishes to your family.

  62. As a young cancer survivor (36) who is facing pretty grim statistics- thanks, Google- I, too, have had similar discussions with my oncologist. Your brother-in-law’s essay resonates deeply;I sit here, only wishing I had some sort of advice or piece of wisdom to offer. I read once (and agree) that when you first go through the diagnosis, it’s similar to “trying to play catch with a watermelon, when you’re used to playing with a softball.” I’ve had 4 years (cancer-free) to process all of this, and while it does get more manageable in many ways, the thought patterns tend to change when grappling with how to actually go about getting back to “life”, motherhood, etc. As I inch closer to that *magical* 5-year mark after my last occurrence of cancer (the milestone which most of those statistical figures reference), I have cautiously begun to ponder the future, once again. I will carry with me Paul’s insights, as well as his willingness to share them with others. Thank you, Joanna, for sharing. My best wishes to you and your family.

  63. Beautiful, moving, heartbreaking, inspirational! Thanks for sharing, Joanna.

  64. I hope years from now, you will be able to post a new essay by your brother in law, about what he do with the time/years he had left.

  65. What a moving and enlightening essay… sending my thoughts to Paul and his family.

  66. As someone who lost both parents to cancer, this post left me in tears.I am so touched by Paul and what he is going through. His essay was so beautifully written. I wish him and your family all the best.

  67. Joanna,
    I read your post this morning and cannot stop thinking of your family. I am praying for the best of circumstances for Paul. My heart goes out to Lucy and Paul and your entire family. Paul’s essay is truly beautiful. I would love to read his book.

  68. I was so touched by that essay when I read it last week, without realizing your connection. My thanks for sharing.

  69. What a beautiful and poignant essay, thank you for sharing. My thoughts are with Paul, Lucy, and the entirety of your family in this heartbreaking period.

  70. This comment has been removed by the author.

  71. Wow.

  72. Such a touching article Joanna. Thanks for sharing. Wishing him and all of you the best.

  73. Such a touching article Joanna. Thanks for sharing. Wishing him and all of you the best.

  74. Sending lots of good thoughts to your brother in law! I’m so glad he is with the right doctors and is fighting hard. A close friend in Atlanta went in for back pains and walked away with a 2 mos left lung cancer diagnosis. She refused to take no for an answer though and eventually found a doctor in NYC, where she flew monthly for treatment. Almost all of her FIVE YEARS were good ones. She just refused to take no for an answer- it was remarkable.

    KK @

  75. Thank you so much for sharing. My 26 year old fiance was just diagnosed with cancer on Friday and had surgery today. His prognosis is positive and it is very treatable so I know it in no way compares to what you are going through with your brother in law but it was incredibly meaningful to see this post on today of all days.

  76. This comment has been removed by the author.

  77. I said a prayer for Paul. Thank you both for sharing.

  78. Love and prayers to Paul and all his loved ones. Thank you for sharing.

  79. Trying to find meaning in the senseless is the greatest form of bravery. This made me cry and I don’t even know him. I will think of him today, tonight, and probably every time I read your blog. It’s apparent….with love like yours, 10 years sounds quite probable. My best to you and your family.

  80. Hi Joanna,
    I too read this article over the weekend and realized the name sounded familiar. It just so happened that i my own brother in law passed away from lung cancer 7 years ago, and the anniversary of his passing was this past Sunday. It was a bitter sweet day remembering him and reading this piece made me miss him some more.
    Life is such a strange thing. I wish you and your family the utmost health and a speedy recovery to Paul.

  81. brilliant essay! makes you think about what’s important. Thank you Paul and good luck to you – go on!

  82. J says...

    I read this article over the weekend and was so touched. Sending the best healing thoughts to Paul, and much love to your entire family.

  83. I just came across this quote and then read your entry today. I had read Paul’s essay on Sunday and was quite moved. I did not realize the connection between your families. Anyway…read the quote, thought of your brother in law (and all of us) and saw the entry…so am sharing. May tape it up on my mirror for awhile….

    Here dies another day
    During which I have had eyes, ears, hands
    And the great world round me;
    And with tomorrow begins another.
    Why am I allowed two?
    G.K. Chesterton

  84. May it help you all, in some small way, to know that so many of us are thinking of you all and hoping for he very best.

  85. May it help all of you, in some small way, to know that so many people are thinking of you all and hoping for the very best. The article was powerful and heartbreaking on so many levels. I will keep you all in my prayers.

  86. Lovely essay Joanna, thanks for sharing. I too have been a fan of your blog for years, and was so saddened to read about Paul’s illness. Cancer is just the absolute worst. Sending prayers and good wishes to Paul, Lucy, and your family. xo

  87. My heart goes out to you, Paul, your sister and your family! We had a family friend with a very similar situation and it was heart breaking. What they thought was 2-3 months ended up being almost 10 years. There are no words, but my thoughts are with you and your family.

  88. a wonderful article, thank you Paul for writing and sharing it. My thoughts are with your family.

  89. As the daughter of a headstrong nurse who lived for six years with a cancer diagnosis, I thank you for this. Paul’s article so eloquently describes a journey that is so difficult to traverse or (as a bystander) understand. My mom rallied and lived an awesome full life well beyond the 3-5 months she was initially given. Sending positive thoughts to you and your family, Jo and Paul.

  90. Hi Joanna…Paul sounds like an incredibly kind and brave person and he’s such a gifted writer. I’ll keep your family in my thoughts and prayers. As a cancer survivor, this article really hit home for me. Thanks for sharing. – Donna

  91. Oof. So eloquent. My thoughts immediately are for Lucy. What would her essay read like?

    Big love to you all.

  92. When I first read the article this weekend, my heart stopped. I recognized Paul’s name from reading your blog in the early days. What a beautiful piece and an incredible perspective – I hope he realizes how moving his writing is and how many people he touched. Go Paul! Keeping you all in my thoughts.

  93. So sorry to hear this. His article is very touching. Much love to your family at this time.


  94. Dear Joanna, Paul and Lucy,
    My Facebook wall was full of links to Paul’s piece over the weekend, all from my med school classmates now residents. It struck a chord with all of us; you wrote so eloquently, capturing the perspectives of patient and physician all at once and very poignantly. I thought the name looked familiar, but didn’t put 2 and 2 together. While I am sure you are getting much response to your piece, I just wanted to reiterate how many people your piece has resonated with, what a difference it has made in our lives. I wish you all the best in your ongoing treatment. I live in The Netherlands now, and we say “sterkte” when you are facing a challenging time, which loosely means strength but, to me, is a beautiful sentiment which can’t be directly translated. Sterkte, Paul. Sterkte, Lucy. Sterkte, Joanna.

  95. So sorry to hear this, Joanna. He has a lovely perspective on life as a whole–we feel we can’t go on, and yet we do. I am always grateful for people who write beautiful truths. Prayers for Paul and the rest of your family.

  96. Paul’s story is my mom’s story…right down to the targeted therapy. Her results have also been positive. I sent her his article which she greatly appreciated. It put into words things that only one in their position can articulate. Thank you to Paul and thank you to you for sharing.

  97. I’m so sorry to hear about your brother-in-law- he sounds like a beautiful person. Prayers for him and your sister and your whole family.

  98. gw says...

    Courageous, moving essay. My thoughts are with your sister and Paul.

  99. Wow. Thank you for sharing this. And at the same time, I’m so sorry. I’m reading the Fault in Our Stars right now, so reading your brother-in-law’s story is particularly poignant to me. After reading that novel and Paul’s story, wherein both speak so much of the uncertainty of their death, I’m wondering if the uncertainty could be a kind of gift. Like the rest of us, he doesn’t know when he’s going to die. I think, for me personally, that kind of knowledge would be too crippling, too overwhelming, and just so limiting, rather than never knowing.

    Of course, I cannot speak from experience; it’s just a thought, a hope really. I hope he gets those 10 years.

  100. Joanna, it is posts like this, that cut to the core of our humanity, that keep me coming back to your blog every day. Thank you so much for sharing this…what an amazing perspective.

  101. What a beautiful article. Thank you for sharing.

  102. hope and prayer for you family. thank you for sharing.

  103. What a beautifully thought provoking article. It is a good lesson for all of us. Thank you for sharing.

  104. Beautiful essay… I’m so sorry to hear this news. Sending lots of love and prayers for Paul and the whole family.

  105. Hi Joanna,
    I read Paul’s piece last week and did not realize the connection to you. I remember reading about Paul in some of your past posts over the years. I’m very sorry and will be thinking about your families. I also wanted to reach out because I work for First Descents, a non-profit that specifically serves young adults (ages 18-39) with cancer. We provide free week-long kayaking, climbing and surfing programs to young adult cancer fighters all around the country. It’s an amazing way for people to connect through a shared experience. This is open to everyone else reading Cup Of Joe as well. Unfortunately, it often seems like everyone has a connection to cancer somehow. is the website.
    Good thoughts and love.

  106. This sparks so many thoughts. Very moving! I wish your family all the best.

  107. Joanna, thanks for sharing this article by your brother, who is an eloquent voice for a very stigmatized disease. Many people don’t realize that anyone with lungs can get lung cancer – not just smokers – that it can affect people of all ages, and that it claims more lives than breast, prostate, colon and kidney cancers combined, making it the leading cause of cancer deaths. I am certain his article will be a source of hope for many people struggling with disease. Wishing him and your family the best.

  108. Thank you to you and Paul for sharing such a personal story. For what it is worth I’d encourage Paul to research a woman named Diane Legg. She lives down the street from me and was a diagnosed with lung cancer when her youngest of three boys was one – in 2004. She is a champion of lung cancer research, has advocated for 10 years for those who have been unable and has found a way to outlive a bleak prognosis. She is well known in the Boston community and together, I am sure she and Paul could continue to make personal strides and raise awareness of the disease. Good thought and prayers are with your family…

  109. My heart aches for you and your family. What a difficult place, emotionally and physically, to not know, constantly floundering between the options of how best to spend the time left.

    I can provide no suggestion. I can only offer my sympathy and prayer.

  110. My dad has an aggressive form of cancer and has already lived much longer than anyone really expected (even though we didn’t talk about it). The not knowing is so hard… it means you go through cycles of grief and business-as-usual all the time. You can’t ever settle. Love to you and your family xoxoxo

  111. Wow. Wishing Paul and your family all the best.


  112. thank you for posting this today… i found out this morning a very close relative was “given” 4 months to live. this article is helping to soften the blow… I will share it with her, in hopes that she finds some comfort in it.

  113. Oh my. So damn devastating yet beautifully written, this was deep… Thank you for sharing such a personal part of your lives. All the best to Paul I believe he will live a beautiful life still, absolutely.



  114. I’m so sorry to hear this, Joanna. It’s hard to fathom getting news like this from a loved one. Thank you for sharing this with us. Love and good thoughts to you and your family.

  115. Such a connected world we live in. My heart went out to the “unknown” gentleman who wrote that beautiful essay in Sunday’s paper, never realizing I would open your blog to read this today. I said a prayer for him on Sunday, and do so again today. His dignity and honesty in turning his face to the situation we shall all one day face was inspiring and helped to assuage that too often unacknowledged fear that hides in us all. May God Bless him. xo

  116. That is so wise and heartbreaking to read – wishing strength to all of your family, and especially your sister

  117. “The angst of facing mortality has no remedy in probability.” Such a beautiful essay, and yet such a terrible thing to happen to someone so young. Thanks so much for sharing, Joanna — and prayers for Paul and your whole family!