Paul Kalanithi would’ve appreciated the cruel plot twist: A literature-loving neurosurgeon gets to finally delve deep into his own knack for humanistic writing, from his death bed, penning a book that would earn an outpouring of global adulation — but only after he dies.
“It’s not uncommon for those who leave legacies to not be around to fully appreciate them,” said his wife, Lucy Kalanithi. “But he had an inkling.”
Such graceful handling of the existential — “Paul didn’t ask ‘Why me?’” she said; “He would say ‘Why not me?’” — helped the couple get his posthumously published memoir, When Breath Becomes Air, examining the thin, raw layers that exist between life and death, out into the world where it would become a New York Times bestseller and inspiration to many.
For Kalanithi those layers separated death, triggered by late-stage metastatic lung cancer, from a promising life as a neurosurgeon, author, husband, father, brother and son. At age 37, it was a life lost far too early.
Kalanithi, who never smoked, left behind an almost-complete autobiography that he had somehow gutted out in the weeks, days and hours before he died. As she had promised him, Lucy picked it up, penned a heart-wrenching epilogue and brought it to fruition nine months later. The book breathed life into the experience of death in a way that resonated universally.
Lucy Kalanithi revels in the expressions of gratitude, in the form of letters or online outreach, that materialize weekly almost a decade since the book was published.
Paul wanted to build a life of meaning; he wanted to make a difference in the world."
“Paul wanted to build a life of meaning; he wanted to make a difference in the world,” she said. “He was able to do that.”
The book — which returns to the New York Times bestseller list often, including this week — set off a literary domino effect, ultimately leading back to Stanford Medicine with a homegrown storytelling movement created in his name. The Paul Kalanithi Writing Award is one of the top programs produced by the Stanford Medical Humanities and the Arts Program, better known as Medicine and the Muse.
It’s the stories and poems Lucy Kalanithi reads while judging the annual contest — now heading into its 10th year — that might make her the proudest, and most teary-eyed, about the unique life lessons he hurriedly left behind.
“It’s the idea that we’re not just here as doctors to learn medicine and science,” said Kalanithi, a clinical associate professor and internist at Stanford Medicine. “We’re here as humans to relate to our patients as fellow human beings.”
When Breath Becomes Air was translated into over 40 languages, spent 68 weeks on The New York Times bestseller list and was a Pulitzer Prize finalist. It inspired doctors, patients and everyday people worldwide to embrace their shared humanity — to more fully understand the human condition all around them.
It was that type of understanding that led Paul and Lucy Kalanithi to bring a life into the world knowing one half of that partnership would not be there in the flesh for long: Daughter Cady was born just nine months before Kalanithi’s death.
Never doubt that you've “filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests satisfied."
— Paul Kalanithi, to his daughter Cady
In his closing words in the book, written days before he died, Kalanithi told his daughter to never doubt that she has “filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests satisfied.”
Paul’s parents and brothers live nearby, helping with Cady and hosting regular get-togethers. The family visits him at his gravesite in the Santa Cruz Mountains often, as they recently did on Father’s Day. “I brought a branch from a lemon tree that Paul and I got on our fifth anniversary,” Lucy said. And in the eyes and laugh of her daughter, she always has a visceral piece of Paul nearby.
We talked to her about the difficulties of bringing the book to fruition as her husband’s health waned, about the literary legacy left by the book and writing award, and the importance of that close-knit family. This interview was edited for length and clarity.
Why do you think storytelling is such a powerful tool?
Someone asked me the other day, “How do you handle suddenly being in a room with a patient who you’ve got to give a terrible diagnosis?” It’s about being aware of the suffering that exists all the time. That way it’s not any different, right? You can recognize that, along with the suffering, there’s a lot of beauty and love. Part of what stories do is make us aware of everyone’s humanity and everyone’s suffering. Stories allow us to tap into a very present reality, to be present to anything. They are also an antidote to losing yourself in the suffering of the work, the work of being a doctor. It’s a way to remember why it matters.
Do you see that play out in your role as a doctor?
Yes. With small things, like putting your hand on a patient’s shoulder or just acknowledging emotion in the room, you’re saying that you will be with them no matter what happens. That feeling of being present to all of that, learning how to be a witness to suffering. It involves learning to see it, learning to put words on it and learning to understand the emotions around it. Those are the abilities you’re trying to develop. I’m always still working on it.
That Paul accomplished his literary goals to some degree seems miraculous. He wrote a piece and shared it with friends, and one sent it to The New York Times, right?
Yes, they published it; it went viral; and, all of a sudden, he was talking to agents. The piece came out in January of 2014, and he died in March of 2015. He was piecing it together as he was starting to feel very sick and dealing with all of these medications and their side effects. We got a special recliner so he could be comfy in different positions and be able to write when he wasn’t knocked out by pain medication.
It must’ve been disorienting watching him write about it as you both lived it.
The manuscript was helpful for us to have conversations about cancer — to give just a little bit of remove from it. In Viktor Frankl’s writing, I ran across a quote from Nietzsche that says, “He who has a why to live for can bear almost any how.” That was true for Paul. The book gave him a reason to be engaged in the world, the world of ideas, a reason to still be a scholar, a teacher, a writer, still something that’s immensely meaningful, intellectual and vocational. I think it would’ve been infinitely harder to go through that experience not having the book as an outlet.
Was that parallel in some ways to the decision to have a child?
It was a very intentional choice. Having a child was such a stroke of luck amid all the hard choices. I can’t believe how lucky.
Did Paul accomplish what he hoped to with the book?
I think the real mission was to wrestle with mortality and be clear-eyed about the fact that he was dying. I believe he did that, and I think he thought he did that. What was really beautiful is that he was able to return to his first love. He spent so much time as a young person in this world of ideas, reading books. Then he became obsessed with going into medicine so he could really be inside the messy, visceral, emotional reality of it all. Then, when he got sick, the only thing he could do to cope was put words back onto it, to step back and look at it with a bit of remove and bring back a philosophical eye.
The writing award named after Paul, which encourages honest sharing, has grown in participation. Is there an entry that exemplifies what Paul stood for?
There’s a palliative care doctor at the University of California, San Francisco, named Mike Rabow, who hadn’t shared his multiple sclerosis diagnosis with colleagues. He entered a beautiful, heartbreaking poem depicting how he and his wife navigate their reality. And he decided that if it won, that meant he should share his story with people more widely. It did, and he has.
Paul wrote in the book that he found poetry more comforting than scripture. I think it’s the idea of seeing other people struggle, realizing you’re not alone in wrestling with anything you’re wrestling with. Whatever it is, someone else has wrestled with it before you. It was such a salve for him. And it’s amazing to have this group of people who are doing the same thing — and doing it partly in his name.
You have a 10-year-old daughter now, and Paul’s brothers and parents are very much a part of her life. That must feel special and essential.
With Paul’s family being so present, it’s like he’s implicitly present. His brothers crack jokes about Paul and keep his presence more real than mythical. Cady has eyes that look so much like Paul’s, and she’s got his wicked sense of humor. She’s exceedingly clever — terrifyingly clever — it’s like yet again I’m outmatched (laughs).
The family pays a visit to him often at his plot in the mountains, right?
Yes, very often. On Father’s Day, along with the lemon branch, I brought a can of Guinness. After taking some sips, I poured it out below where his parents had laid out flowers on his grave. On our anniversary every year I bring some Madeira wine — Madeira, Portugal, was where we honeymooned — and two glasses.
Looking back on 10 years, what reflections stand out the most?
It’s amazing to see that he was able to leave a legacy like he wanted to — especially in literature, which meant so much to him. It’s also so wild that when someone dies, they just disappear from your life. It’s so disorienting. Especially when it’s your partner and you’re going through this thing. Even now, this much later, it often feels like he’s everywhere and nowhere all at once — and Cady and I are building from that.
For me as a wife, it was amazing to continue this project. Sort of for him, but also with him. It was really, really comforting. It gave me a way to talk to and connect with people about him and the book and to grieve. When you lose someone, you’re not done grieving after a year or even 10 years. Just to have a way to connect to Paul, it’s truly been a gift for me.
Read more about Paul Kalanithi
- Before I go: Kalanithi's essay for Stanford Medicine Magazine
- Obituary: Paul Kalanithi, writer and neurosurgeon, dies at 37
- Strange Relativity: An award-winning Stanford Medicine video
- 'I love Paul forever': An essay by Lucy Kalanithi five years after his death
- Lucy Kalanithi podcast: Looking back five years later
Entries for the 10th Paul Kalanithi Writing Award can be submitted from Nov. 17 to Jan. 10. Go here to see the submission guidelines and past winning entries. Go here to watch the reading of the 2025 winning entries.
