When Breath Becomes Air

A post from Andy:
I never met Paul Kalanithi.
We knew each other for a total of four months, talked on the phone a bunch of times (more than once, while he was in the middle of a chemo treatment), and exchanged a flurry of emails on writers we loved, his upcoming trip to the Super Bowl, and the direction his book—the book we were working on together—should take in the end. The truth is, despite Paul’s incredible warmth, his sense of humor, and his willingness to engage so fully in the writer-editor relationship, I was a little intimidated by him, by the immensity of what he had accomplished at so young an age: Stanford neurosurgeon, father, husband, holder of many degrees, reciter of romantic poems, deep thinker, supremely calm, kind, and rational person—when it came to questions of mortality and, as Paul put it, what it means to live a meaningful life, I figured my job was just to shut up and listen for once. So I did. And on these subjects, Paul had so much to say. So many of the passages in his book will stay with me, will comfort, challenge, and inspire me, for the rest of my days. Here, a few examples, but a caveat: I could have quoted twenty more passages like this, passages so crystalline and beautiful, so essentially true, they make me want to weep.
On the duty of a doctor:

“As a resident, my highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness… The physician’s duty is not to stave off death or return patients to their old lives but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”

On the fleeting nature of ambition:

“Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals in life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after the wind, indeed.”

On facing a terminal diagnosis:

“I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I’m still living.”

On confronting mortality:

“Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany – a piercing burst of light, illuminating What Really Matters – and more like someone had just firebombed the path forward, and now I would have to work around it…The fact of death is unsettling. Yet there is no other way to live.”

On holding his infant daughter, Cady, as his own health faltered:

“Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks of her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.”

On time:

“Time for me now is double-edged: Every day brings me further from the low of my last relapse, but closer to the next recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time, it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. Even if I had the energy, though, I prefer a more tortoise-like approach. I plod, I ponder. Some days, I simply persist.”

When Paul died in March of last year, at the age of thirty-seven, we lost a remarkable writer, but we lost an even more remarkable person. Doing the last of the work on his book, When Breath Becomes Air, with his incredible wife, Lucy, was as heartbreaking—and yet affirming and fulfilling—as anything I’ve done. One of Paul’s last wishes was for Lucy to shepherd his book to publication, and she did. Boy, did she ever. She did it with such strength and grace, and in the process, even became a writer herself. Because Paul died before the book was finished, Lucy wrote the epilogue, and said what he could not. “Often I return to the grave after leaving flowers – tulips, lilies, carnations – to find the heads eaten by deer,” she writes. “It’s just as good a use for the flowers as any, and one Paul would have liked. The earth is quickly turned over by worms, the processes of nature marching on, reminding me of what Paul saw and what I now carry deep in my bones, too: the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this. What happened to Paul was tragic, but he was not a tragedy.”

Paul Kalanithi and Lucy Goddard Kalanithi, author of “My Marriage Didn’t End When I Became a Widow,” in today’s New York Times.

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My first thought is wow. My second is that the world is a more empty place because this wonderful, prolific man is gone. I am sad for his daughter and of course his wife but I am also sad for all of the people who will never be helped by his work.

I am off to order this book so that I can read it all. Thanks for sharing!


Thank you very much for posting this. As a mom to a child with a life-threatening illness, the excerpt about mortality really resonates. Paul’s book is going to the top of my reading list.

Libby Monaghan

I’ve been hearing about this book everywhere this week. Of course I will pick up a copy. What an incredible insight for us to experience. What a legacy for Paul to have left. But what a heartache is left in his wake.
Thank you for working on this and sharing about it.


Thank you Andy – you bravely traveled on a journey few of us get to traverse more than once – the blurred line between living and dying. You have given his family and the world a true gift. My reading begins tonight.

Laurie Mobley

Beautiful tribute that also offers a glimpse of how a book shifts from idea to existence. I find it comforting that my two favorite blogs – Dinner: A Love Story and Cup of Jo are champions of Paul’s legacy. I had been reading along and then connected the dots. I hope Andy will someday help Lucy publish. Her essay put grief in real terms – so needed

Kate on the Domestic Front

As soon as I saw this book was coming out, I requested a review copy. I didn’t know Paul, but his sister in law was a friend of mine from graduate school, and I’ve read all of his writings with interest and not a few tears. He seemed like a pretty remarkable person AND a pretty remarkable writer, and I’m looking forward to reading the book.


I just ordered this book for my son who is a third year medical student. Like Paul he is a deep thinker, a wonderful writer, and a person who cares deeply for the patients he cares for. I know he will be touched by Paul’s story. Thank you so much for sharing with us.

Jennifer James

Dear Andy,

Thanks so much for writing this piece. I am very much looking forward to reading this book–I have no doubt that it is going to (a) stay with me for a long time and (b) have an impact on how I look at the world. What a blessing to have such a gifted and generous man share his story and his words with all of us.
Also–your book recommendations are a highlight of this blog for me. Thank you so much for bringing book recommendations to the conversation.
Lastly, a while ago you posted a story about a writer you were working with who was working on a book of short stories, I believe. He had served in the military and your piece was about how he organized his kids in the kitchen around family meals. Would you mind sharing his name with me and if the book he was writing will be available soon?



I didn’t know him personally either but have trained with other physicians who have crossed paths with either him or his wife and agree on all of your observations. In his chosen medical specialty it is sometimes difficult to find anyone who embodies some of the qualities that are universally ascribed to him, much less of all them. I also love it when physicians can write so well and put into such eloquent words the difficulties many of us face throughout our training/practice but lack the ability to adequately convey to non-medical family or friends. Kudos to Lucy for having the strength and presence to finish his book.

Cherie Foster

Dear Andy and Jenny,
Have been a loyal follower for 2 years–my spine of Dinner A Love Story is cracked, I have given away about 30 copies as gifts and eagerly await new blogs. This post floored me. I already read the review of Paul’s book in the NYT earlier this week. As an intensive care physician, and a wife, his book interested me intensely–waiting for my copy. Dealing with life and death every day as a NICU physician, it is easy to become burned out–cooking has always been a refuge! It is amazing what cooking dinner for my family after a horrible day in the NICU can do–a real balm for he soul!
The link with his wife’s column in the NYT gutted me–should be required reading for every physician and loving spouse. EVERY day with our families is a gift. Thank you to you both for featuring the Kalanathis!


Thank you, thank you for the work you do. As the mom of a NICU baby, I can say that your efforts literally mean the world to us. Take care of yourself too.

emily collins

well, andy , this punched me in the gut. i only follow a half dozen blogs religiously, and DALS and a cup of jo are two of them. so i was already familiar with paul’s story. although i live in italy, i read his pieces for the nytimes, and also lucy’s. to discover that you were his editor… thank you for this perfect post. i have preordered the book on kindle, and i think i receive it tomorrow. having traveled through the tunnel of dealing with cancer and come out the other end, i know how much this book will mean to me. plus, the death of david bowie – gosh, what an emotional week! thank you.


Received notification that a copy is in our mailbox and I am anxiously looking forward to starting it tonight. Thank you for the preview.


Just finished reading the book….deeply moved. Finding meaning in the face of tragedy is that to which we all aspire and Paul did it with grace, dignity and bravery.


Andy, thank you for the empathy and generosity that is evident in your efforts to bring the manuscript to life.

I wanted l, if I may, to share my thoughts on the book as a reader to encourage everyone to read it. http://sitdaily.blogspot.com/2016/01/when-breath-becomes-air.html?m=1

This book may have been written by a dying man, but it’s not about death. It’s about living – and boy, what a living it was – in the face of death, which, after all, is all we do, all we can do. Some have asked if this book is too sad. To me, it wasn’t sad at all, but it filled me with gratitude and hope and joy to know that there are those who pursue life with the kind of zeal and generosity as he did. It’s also the most beautiful love letter from a father to a child I could imagine: about what he valued, how he lived to honor those values, and how she, his daughter, was the ultimate living symbol of those values.


I always trust your book recommendations. I was not disappointing by this one. I’ve been digesting it for days. what a great honor and responsibility to get it made.
keep them coming!


I’ve just read the book over the weekend and I was so moved. It is an incredible piece of work. I am in awe of what Paul achieved in his life and even how he was able to write the book – particularly when he was so sick. I am busy telling everyone I know to read this incredible book. Thank you for your work in making it a reality.