12/20/2025
If you haven't read Paul's book yet, put it on your future list.
I can't stop thinking about this touching photograph. Lucy Kalanithi and her daughter Cady, five years old, lying against Paul's gravestone in the Santa Cruz Mountains, with the Pacific Ocean stretching out behind them. Cady probably rubs the grass as if it were her father's hair. She doesn't know this is tragic.
I mean, Paul Kalanithi was thirty-seven when he died on March 9, 2015. Thirty-seven. A neurosurgeon at Stanford, finishing the final year of his residency, standing at the threshold of the career he'd spent a decade preparing for. A man who spoke multiple languages, who held degrees in English literature, human biology, history and philosophy of science and medicine. A poet who became a surgeon because he wanted to understand what makes life meaningful when death is the only certainty. A husband. And for eight months, just eight months, a father.
Stage IV metastatic lung cancer. Diagnosed in May 2013. He'd never smoked a cigarette in his life.
One day you're a doctor who treats the dying. The next you're a patient trying to live. And just like that, Paul wrote, the future you'd imagined, the one you'd deferred gratification for, the one you'd worked brutal hundred-hour weeks for, evaporates. Flattens from a ladder you're climbing into a perpetual, uncertain present. How you live when you don't know if you have three months or ten years.
I think what breaks me most about Paul's story wasn't the news of the cancer itself, though God, lung cancer at thirty-six is its own kind of cruelty. It's the question he and Lucy had to answer together, the one that would have made me run screaming: Should we have a baby?
They'd been together ten years. Met at Yale Medical School. Got married. Started their residencies in California, Paul at Stanford, Lucy at UCSF, with that unspoken agreement that someday, when the training was done, when life was less chaotic, they'd start a family. And then the diagnosis came and made "someday" a concept that might not exist.
Lucy considered how having a child will make his death more painful. Paul said they should. I had to put the book down when I read that. Had to walk away and stare at nothing for a while. Because what Paul understood, what he was trying to tell Lucy, tell us, tell anyone who'd listen, is that life isn't about avoiding suffering. It's about creating meaning. And meaning doesn't come from playing it safe, from protecting yourself from future pain. It comes from loving hard, from choosing connection even when, especially when, you know how it ends.
So they decided. Yes. A baby. Now. While Paul still had time. Elizabeth Acadia Kalanithi Cady was born on July 4, 2014. Three days after Paul got out of the hospital following weeks of brutal treatment. He was forty pounds lighter than his diagnosis weight. Skeletal. Exhausted. Unable to read, barely able to hold his head up. And then Lucy went into labor and for two hours they waited and then there she was. Paul held his swaddled daughter in one hand and Lucy's hand in the other, both of them staring down into what he called "the face of life."
He had eight months with her. Eight months of the kind of joy he said he'd never known in all his prior years. A joy that didn't hunger for more, that just rested, satisfied. When I think about that, a dying man holding his newborn daughter, knowing he'd never see her first day of school, never teach her to ride a bike, never walk her down an aisle, I don't know whether to weep or rage or fall to my knees in gratitude that he got even those eight months.
Here's what Paul did in the last two years of his life, while fighting cancer, while raising an infant, while his body betrayed him in ways I can't bear to detail: He wrote. He wrote When Breath Becomes Air. The book is structured in two parts: before cancer, after cancer. He asks the questions we're all too scared to voice: What makes life worth living in the face of death? What do you do when the future is no longer a ladder but a flat, endless now? What does it mean to have a child when one life is beginning as another fades?
And he doesn't give the answers. He can't. Because there aren't any. What he gives instead is his struggle. His honesty. His refusal to look away from the hardest truths. He writes about treatment failures and false hopes. About learning to find meaning not in cure but in connection. About how identity fractures when you can't be the surgeon you trained to become, when your body can't do what your mind still wants.
Paul didn't finish the book. He died while working on it. Lucy had to shepherd it to publication, had to write the epilogue that explains what happened in those final months, how Paul faced death with the same fierce intentionality he brought to everything else.
Paul Kalanithi died on a Monday morning in March. Lucy wrote in the epilogue about how, after he took his last breath, she lay next to him, resting her hand on his unmoving chest. How she thought about all the times she'd fallen asleep to the rhythm of his breathing and how strange it was to lie there in silence. Strange. That's the word she used. Not devastating or unbearable or soul-destroying, though it was surely all those things too. Strange. The absence where presence used to be.
I think about Lucy often. About how she's had to build a life in that strangeness. How Cady is now in sixth grade, a funny kid, Lucy calls her, who visits her father's grave and doesn't think of it as sad, just as where he is. How Lucy has had to answer questions about Paul while also allowing Cady to have her own relationship with his memory, separate from Lucy's grief.
In the end, Paul didn't get the career he trained for. Didn't get to see Cady grow up. Didn't get to read the reviews of his book or accept the awards or know that his words would reach millions and transform lives. But he got to love. He got to create meaning. He got to look his daughter in the face and feel joy that rested, satisfied. And maybe, maybe that's everything.
BOOK: https://amzn.to/4p6l6eM
You can listen to the Audiobook through the same link above.
