When Life Meets Reality | Finding Grace When the Future Falls Apart | Lucy Kalanithi

Simple question, brutally hard answer. When life upends everything you thought would be coming in your future, what still matters? I have been wanting to have this conversation for a long time, ten years actually, and today I'm sitting now with Lucy Kalanathi, a physician and storyteller whose life and work, they sit at the intersection of medicine, meaning, and love. And Lucy is the widow of Paul Kalanathi, author of One Breath Becomes There, a book that many of you know well, and it's a book that has really moved me profoundly. One I've read many times, and often reread at the beginning of every year to kind of reorient me around who and what genuinely matters. And Paul wrote the main part of the book, or most of it as we'll learn, and Lucy wrote the epilogue, a piece that brings the story fully into the heart, including writing in vivid detail her husband's death scene, which she shared is exactly how he'd have wanted it. Ten years later, she's still living these questions, not as theory, but as life, just deeply invested in how we devote our energies and deepen our relationships and our love, and truly center what matters. And we talk about how our relationship with time changes when certainty just disappears. How values can guide decisions when plans fall apart, and what hope really means when winning is no longer the frame, and how to build a life that actually fits who you are, not who you thought you would be, or the life you thought you would have. This is a conversation about grief, love, and medicine, and parenting, and choosing what matters most when the future feels fragile. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. Especially around Valentine's Day. For this time, I was crying, and there was a knife in my hand, and the worst part is not the first time I've woken up like this. What if the killer in my house is me? First comes love, then comes Madder, the X's, the gripping debut thriller from Lea Dora Darlington, out now in audiobook ebook and hardback. The tax year end on April 5 is approaching. So don't let your 2025-26 tax-free cash iser allowance go to waste. Make the most of it with the 4.0 1% rate from Marcus by Goldman Sachs. The five time which recommended savings provider that's backed by over 150 years of Goldman Sachs expertise. Open your Marcus cash iser. Marcus.co.uk. Times ticking. Interest rate is 4.0 1% AER 3.94% tax-free variable includes a bonus rate of 0.74% tax-free fixed for the first 12 months rate correct as of 5th March 26. Your late husband Paul's story and necessarily elements of your story together are shared in his memoir when breath becomes air that became this giant global phenomenon really. He writes the heart of it, you write the epilogue for it necessarily. This book has, as actually meant the world to me, it's helped me think and feel and question what I truly want from and for my life. I often reread it in the beginning of every year which actually just did shortly before this conversation. Same same. It never ceases to move me and make me see things that I didn't see before and explore things that I hadn't explored before. For those who haven't been exposed to the book, for context for some of the early part of a conversation, can you share a bit more about this kind of incredible love story and what happened then also in the years leading into the book which was I guess about a decade ago. Yeah, thank you so much for saying that. That really brings to your smile and it means a lot to me that you've reread it as well. So yes, when breath becomes air was written by my late husband Paul Clonathy who was a neurosurgeon and writer, we first met when we were in medical school at Yale and he initially had thought he would never be a doctor. He thought maybe he'd be an English professor or a philosopher and then became really intoxicated by questions about meaning and mortality actually even as a young person was really in love with literature, got really interested in bioethics and thinking about the mind and the brain and then that ultimately led him into medicine to try to sort of grapple with really meaningful, meaty ethical and emotional questions with his patients and he became a neurosurgeon ultimately. He just loved people who were going through a crisis and thinking about identity and meaning and then when he himself was a chief resident in neurosurgery at Stanford which was about 10 years after we had met and gotten married, I'm an internist so I was moving along in that career as well. He sort of started to develop a set of ominous symptoms and started losing weight and becoming really fatigued and having back pain and initially we thought it was because he was a hard working surgeon. Right and Nuro is also like one of the most brutal ways that he can spend your waking hours on the plier. So it's like suffering is even in the best of conditions is a part of the experience. Right, right. It's like you yourself don't have a body you're like Justin or a surgeon. Yeah, yeah, so but his sort of started to disintegrate and he realized ultimately we realized that he had stage 4 lung cancer which was obviously totally upending and shocking and so in order to cope and face what was happening to him suddenly he was the patient on the other side of the table. He started reading voriciously again and then started writing initially as a way to process what was happening and then sort of as a new vocation as he became unable to work as a surgeon and he lived for 22 months after the diagnosis. He died 10 years ago or died almost 11 years ago. We had a baby during that time also who now is a sixth grader and then he finished almost finished the manuscript for when breath becomes there and had just handed it over to the editor and publisher and then died and so ultimately I worked on sort of like tying it together and then putting this capstone epilogue on it like you said which was about reflecting on Paul and what happened since his death and then also like really importantly told the story of the day he died which actually was like a very very Paul and I think if he could have told that story he would have so that's why I did and then as a grieving person it was really wild and incredible to do a book tour for him. There's like really helpful in grief and wonderful and meaningful to me as a physician to be talking about end of life and talking about health care and talking about being a person and threading that all together my careers become like much more storytelling and then now it's 10 years after Paul's book came out so it's another interesting moment to like dip back in and you know get to talk to you and a number of different things like in the course of my own evolution. It's such a beautiful story and you met you started out by saying you know like that Paul was your nurseurgeon scientist and also a writer but he wasn't a writer just because he wrote this book in his final days. This was a thread that I mean it seems like earlier in life this is that's actually the thread that he was following like a deep deep love and passion for literature and writing and it's almost like the left turn into medicine was almost like it sounds like only because he couldn't get what he wanted at least at that time through not understanding the actual organ that is the source of so much so many of the questions that he had is that in any way on point. Kind of it's really interesting you say that that like he was a writer first because I agree and then I also think he wouldn't have been doing the neuroscience work purely abstractly like it truly was related to people and patients for sure and so like you just said it was all really intertwined. He I think he ultimately didn't see those things as separate it was like science and philosophy and the humanities sort of all like circling around this questions of what does it mean to be human what does it mean to build a meaningful life like what does it mean to face up to suffering like all of those he was super interested in that question and so totally and literature he thought literature was like the way like the most honest way to look at what humans are up against. You know the book tells a lot of his story and and some of yours but you're also the one who was going through this you were living every minute every second of every day with him in the years leading up to and then the two years I guess he said two months of illness before he lost his life and then when that happens as you described he's almost done with the book he turns it in but the book still needs an end cap you know so you write this epilogue which is this is not a typical epilogue this is not an quote ordinary epilogue because you effectively tell the story of how this book actually came to be he was telling his story leading up to the final days you tell a story of how this book actually emerged from those final days and as you just described you write the death scene because nobody else can but you and I've often wondered what's like for you. Yeah I mean writing the epilogue actually was a big surprise to me I didn't the Random House editor Andy Ward whose incredible approached me and said we'd love you to write an epilogue and I was like what I'm not a writer and then I was like actually it's really important to tell this story and then it just kind of came pouring out of me and I was like oh this is why writers write it's like you know you write because you have something to say and then it turned out you know like just during grief it's like I'm a doctor Paul is a doctor we knew he had an incurable illness we knew he was going to die at some point way sooner than expected on the day he died I knew it was the day and at the same time when he died I was like totally shocked in a way because he just disappeared like he was there and then he disappeared and it's like you're in your same life where he used to be and then he disappeared and so the thing that was really interesting to me was the time that I felt most like myself during those like unspooling months as you're kind of like molding a relationship the time I felt most like myself was working on the epilogue because he and I had been like such so intensely partners everything from like talking about the emotions of it to like you know I was over here like managing all these medications so that he could focus and so that he could sit comfortably and so that he'd be able to write and so the book as a project still existing and then me feeling like I was still doing it in a way we were still doing it was truly helpful. Oh can I tell you something interesting. Yeah go ahead go. So it's the 10th anniversary of the book and so random house approached me about what I want to record the epilogue in my voice because initially we didn't and I had said no 10 years ago because Paul had just died and I was like both Paul's not here to do his bit let me I'm not going to do mine I'll choose the voice actors so I did and then they asked me okay now do you want to put it in your voice and so I said sure and it was so interesting I went to a studio at Stanford to record it this was about like a month ago and I didn't practice it or even really reread it ahead of time because I was like I know this so well and then it totally shocked me how emotional it was like to narrate and read through that day again and it really shocked me and the director said you know if you need to take a break you can and I was like I'm so used to thinking about this I won't need to and then I totally did but the really interesting thing was like reading it 10 years later I don't know you know how like Taylor Swift rerecorded a lot of her own songs to get her rights back they're called Taylor's version but there's a sort of interesting phenomenon where an angry song will have like other layers of like anger maturity or what I would say her voice is different she's different so that was kind of a strange experience to like read that in sort of this telescoping way of like I'm me now and I'm reading me then and at the end of the very last page the director had kept saying like picture that you're reading this to a small group like you're not reading it to a big group you're not reading it to like unnamed no one like picture a little group that you're communicating to which is weird because the whole epilogue in a way is like delivering bad news to the reader so there's like that piece of it as well sort of like a softness and like intimacy but on the last page she said get in your feelings whatever they are and make sure that you're reading it from you so I finished it and the last line is it's just something like you know Paul wondered throughout his life whether he could face death with integrity in the end the answer was yes I was his wife and a witness and that's the last line and so I read that and she was like oh that's not how I thought you were gonna read it she's like I thought you would read it maybe like more lately but you read it like really strong and I was like oh that's so interesting like I think that's me now you know so anyway that was really interesting you just wanted to share it with you yeah I mean how wild to actually have that experience and it's like it's the same words it's the same story right but you're a decade further into your life you're a decade further away from from his death right so it's like Lucy's version and it's like you're then also a witness to how you've shifted in those 10 years as you're reading this and it's like wait wait how interesting is this the way that I'm feeling while I'm doing this yeah yeah so that epilogue when I first got the book which is pretty much when it came out 2016 I read the main part of the book I was traveling I got on a plane and I started reading the epilogue I got like three pages in and I had to close it because I'm sitting on a packed plane shoulder to shoulder in a middle seat and I start weeping and I'm like this can happen on a cross-country plane because they're gonna think something really bad is happening here it's like close it up I come home and it absolutely wrecks me in the best of ways and thinking about and reflecting on it and having the chair that I got that I've reread both in a number of times now the core of the book put me so deeply into my head it was a deeply personal and powerful story but also there's a lot of thinking there's a lot of exploring the big question the big issues meaning value vocation calling and we'll talk about some of that the epilogue took me from my head and dropped me into my heart and I realized this would not have been the same complete experience without that because it did something so deeply beautiful and powerful that brought the whole thing home and I and that's why I think I keep returning to it and why it's so powerful for so many people because it integrates these two parts that we often um don't spend time together with yeah yeah thanks for saying that yeah so before any of this happened what did you believe sort of deep down about how life was kind of supposed to unfold and look and work you know I think I sort of had a set of implicit assumptions that were like somewhat unquestioned which was sort of like and Paul had these two as he describes but I think I sort of used to think of like life as a path like I'm on the path and it's like or sort of it's like a it's like an upward slope and it's like I'm gonna keep working hard and I'm gonna like climb the mountain and then I think just the real like obviously when something totally upends your life for in any way but certainly like Paul's illness and death excluded everything and so I think the way I think of it now it's like I'm much more aware of like unpredictability and finitude and I think of life now is sort of a series of moments you know like now I'm in this like middle school moment with my child or like when breath becomes there has been a moment or I and it's like other moments around the corner and I don't know who I will be or what the moments will be and at the same time I've come to really trust my instincts you know like it's like you can only make the best decision you can at any given point with the information you have it's like you're sort of just like hopping to the next like lily path that lights up so I feel like that's become sort of like I've I have a trusted place that I'm standing but then it's like I don't think you can necessarily like rely on knowing where you're going a hard part about that is you know part of the mountain top like path thing was entering medicine as like a young academic physician and thinking like my career is going to look a certain way and you like go on to the professoriate and my interest was health care value and like thinking about policy and delivery you know that has really shifted in a way that I've had to accept some pieces of like not being as hard driving as I plan to but at the same time I feel like another thing I learned is like you kind of can't have it all you sort of think you can but it's like something will always suffer if you're trying to have everything or like the flip side it's not even a negative thing it's like it's just that you must you have to choose what you value the most about who you want to be and what you want to have so like for me as a parent that's my number one and so just like ending up with career flexibility was more important than I thought and so I just think there's a number of things where you know you have to parse out like what trade-offs you're willing to make because I do think you can't have it all but you can have a bunch of great moments or you can choose and like build something and then go on to the next thing if you look at social media you absolutely can't have it all the fantasy world that's being sold to all of us but yeah I think that's a reality that's so often you face when you know you're in a moment where you or someone very dear to you um faces mortality and also when there's a a micro season where you kind of know something is reasonably inevitable right yeah but you don't know 100% but there's a fair level of certainty we have no idea if and when or what the shape it's gonna take is and that's like everything goes into the hopper of re-examination again yeah and we'll be right back after a word from our sponsors the tax year end on April the fifth is approaching so don't let your 2025-26 tax-free cash isa allowance go to waste make the most of it with a 4.0 1% rate from Marcus by Goldman Sachs the five-time which recommended savings provider that's backed by over 150 years of Goldman Sachs experties open your Marcus cash isa at marcus.co.uk times ticking interest rate is 4.0 1% AR 3.94% tax-free variable includes a bonus rate of 0.74% tax-free fix for the first 12 months rate correct as a 5th of March 26th a big shift is coming to global rugby enemies become friends in rugby's biggest tectonic crash it's North versus South England France Island Argentine Australia Italy Scotland the Wales Japan New Zealand South Africa pick your side and grab your tickets at ticket master from that she's too big to miss across the world and a big final in London the nation's championship is here value is is a word that you just used and that was a word that um actually Paul brought up in the book a number of times it sounds like his oncologist kept bringing it back up to him saying like focus on your values um talk to me more about this notion of value because I think we've all done values exercises in our work in our jobs and stuff like this but in your mind what actually what is that and why does it matter so much oh great question I mean I think the real upshot is like living in a way that's true to you so like figuring out your core values is a part of that figuring out what you value in your life but I think the main thing is like building a life that fits who you are and then for the oncologist like what she's building around that is like building health care building health care for Paul that fits around like how to help them achieve those things and also figuring out like with whatever time I have how do I use it well right yeah and it's not to say like you know thinking about this thing of you can't have it all it's not to say like definitely put aside your career like there's that thing about like no one on their deathbed wishes they worked more but I actually don't like I sort of don't agree with that either it's like if you're building something intensely meaningful like then maybe your work like really is what takes you to your highest value you know of course and maybe it's your family and maybe it's you know whatever but I think that's on each of us to figure out yeah there are these common tropes which which do you say like okay we should all value this in a particular right this should be the single most important thing and maybe for many people that actually works but if it doesn't work for you and then you're trying to hold yourself up to you know like this standard of what I should care most about I feel like that just later shame into the the equation along with everything else sure yeah like am I doing it right and it's like well you're you so you you'll know yeah like if you really listen to it yeah 100% part of this conversation is also it's the notion of time in moments like these how does your sense of time change when you have a high level of expectation that you know like our time is going to be way shorter than we ever imagined it would be but we don't know what that means right you know so how do you sort of like look at time differently now yeah time is weird first of all like speaking for Paul and you know this reflex and is writing too but for Paul like as a surgeon he sort of thought of time as like 15 minute increments maximal efficiency how much can I do in a day like you know what am I doing in the next one year five years like career arc then later I'll be a writer like it was all sort of like planned and assumed and like maximally efficient and then he got this up ending diagnosis were suddenly like his survival prognosis is like A unpredictable and B likely an order of magnitude shorter than he thought it would be and especially then and later when he was dying and time was really short he ended up saying this interesting thing where he said like I used to think of time as linear and now time feels more like a space which is to say like time sort of doesn't exist or like only this moment exists and there was a really interesting version of that for me as a very young mom or like a very new mom when we had our daughter and Paul was super sick and he died when she was eight months old and I like distinctly remember thinking this time is really intense like there's all the diapers and the sleepless nights and like this is like I kind of want this like infanthood grind to be over but the closer this is to being over the closer we are to Paul not being here that sort of disappeared it was just like I'm in the moment of like baby Katie Paul and me and it did turn out to just be a moment and so the like hyper intensity hyper saturation of that was like really really noticeable and then I think for me time now like time sort of like overlaps with selves in a way or like becoming like I think I think less about time and more about identity like I was actually just listening to this thing yesterday that I re-found as I was talking through this with a friend but have you ever seen Dan Gilbert's TED Talk? Yeah the original one like from like 20 years ago or something like that. Yeah it's basically about how because this is really interesting about time too basically what he says is like we all have this illusion that the self we are now is like our fully formed self like everything led me to this moment and now I me and I'll go forward as me and so when people are asked how much do you think you're going to change an evolve in the next decade people are like well not a lot because now I'm me and then if you ask them how much they've changed over the past decade they say they've changed so much in the last 10 years and then it turns out if you ask people at any age they all say the same thing which is to say everyone thinks they're not going to change anymore and then everyone does and I think that's really interesting actually because that's sort of like I don't know like collapses time and speeds it up all at once and just I don't know that's the way in which I think time and selfhood are the same thing for me like we're sort of like constantly evolving through time but also through selves I mean the one hand is terrifying the other hand is really freeing totally totally you know it's like both at the same time I'm buying this house all retiring and then you're like no you won't right it's like enjoy it now yeah but it is I mean when both of you move through a moment like that also it's just when all of a sudden time is compressed and you just have no idea you know you I mean everyone everyone always references the famous Steve Jobs you know like commencement talk at Stanford you know like about how his illness was the thing that sort of like made him really reexamine time and and focusing on so much of what was just really reexamine meaning and a sense of who he was and why it was here so I think you know it's all folded into the same thing and but we often don't think about any of these questions and listen until we hit a moment or diagnosis or really close to somebody who gets bad news and we're like oh oh right you know like I'm long time New Yorker I was in New York during 9-11 I knew people who went to work that day and didn't come home you know who are my to or young who are like in the early states super ambitious building huge careers and that's a real reckoning yeah right you're just like okay I don't ever leave the house planning not to come home that night sure but here's somebody who I know that is exactly what happened then and when it's it's that close to you or when it's you and you have some window like some time to reflect on it I wonder why sometimes we we really never do this thinking until something like that happens and and then when you read the story of Paul it seems like he was an extreme outlier because it seems like he was just living these questions all the time voluntarily but do you think we are sort of doing it all the time and maybe we should just recognize it because if you're parenting you know I think parents think about that a lot like I just said this little thing but maybe I just said a big thing like I need to think about what I'm saying to my kid or like I'm choosing between two jobs I really have to think about like what are these jobs mean so I actually you know don't you think we kind of are like we should give ourselves credit for it at best you know or maybe what I'm trying to to get at is maybe we do maybe you're right we are thinking about it all the time but we're not thinking about it we are always assuming that we're gonna have a significant future yeah so you know it's like if I make the right choice now or if I make the wrong choice I can fix it you know a couple of years down the road I'll correct course you know and for many people you will you know and you'll have that but there's them I'm right are also and the and I just turned 60 last year and I'm sitting down to write the next book and then re-listening to I want to call it your own Paul's book because I really do see it as like this complete experience and one of the questions in my head is what is the book that's important for me to write now um part of it is if I assume that I've got decades left I'm gonna make one choice oh so interesting if I assume that I have months left or a couple of years left I'm gonna make a very different choice oh sure that's really interesting and that was like surprising to me I was like huh huh like if this were the last book right like and you know it's like the classic last lecture type of thing you know but um so the assumptions that you make about how much time you have ahead of you for me at least it really changes the decisions I make about how I'm gonna allocate very big chunks of my energy today and then tomorrow and like next month um and like I wonder how different would your life be if you looked back over a decade if you were making decisions based on the assumption that I don't have a lot of time but then you end up actually having that time and then you know versus if you just assumed oh I got plenty of time like then a decade down the road you're like huh how do I feel about the way that I've lived this last decade that's really interesting that's really interesting and I also think there's another piece of that which is like it's like so much of our identities our present identities are tied up in this in the idea of our future selves what you plan to create like whether it's like you're going through school working really hard because you're gonna be this thing or you're raising a kid or whatever and so I think like yeah that's so interesting is like what assumptions are you making about who you actually are even right now based on what you think you'll do the stuff that spins my head all the time would you choose for the book the long view or the the other one literally I was sitting at a cafe at 7 30 in the morning um this morning looking at two possibilities uh-huh and one is actually one that terrifies me but it would be really fun to pour myself into its fiction which I've never written before the other is much more of it's a little more like memory which I've also never done before but I've spent 20 years writing non-fiction so that's just much more comfortable it's a no-o-bolt domain for me I know how to do that interesting and probably what I feel would be really important to say isn't that book but the cult of fiction is much stronger for me right now so I'm doing this dance I'm trying to figure out what do I do here and then the big question drops one thinking about this I'm like is there a way to put all of the underlying ideas insights concepts things I might want to share into the context of a novel in fiction yeah my sister says all fiction has been leave-ailed memoir which makes sense right yeah that's very interesting my mom actually has a good way to make decisions like if you're trying to figure out how to trust your intuition you actually just do a coin flip and you're like heads is fiction heads is my fiction book and then you flip it and then if you get heads just like feel your body for just a second what did your body do were you like oh shoot the memoir thing was where I like or you like yes fiction you know what I mean like do this tiny coin flip and then like listen to yourself yeah I like that I'm gonna have to try that let me know so for you as you sort of moved through your career over the last decade or so and you're thinking about okay so how do I actually want to allocate my energy has there been a meaningful shift in how you thought you would be building your career before and after and how you've actually like ended up making choices and building it yes so I'm an academic physician I'm a on faculty at Stanford in the School of Medicine and the really practical change actually as a clinician as I moved from primary care which is my love to urgent care so that's like a super practical nuts and bolts decision because for the most part I'm a solo parent and so that gives me time with my kid inflexibility and headspace and but then the real change is that 10 years ago or a little before that I was in a health care delivery systems fellowship at Stanford really thinking about how to ensure health care value which is like the quality over cost equation and health care around health care delivery like how do we change health systems and implement new delivery models that will be higher value for patients and then going through that like taking care of Paul when he was sick doing a book tour for Paul thinking a ton about end of life care and palliative care and caregivers family caregivers the thing that's kind of twilight intertwined for me is the places in medicine where the business case for improving something the way we do something intersects with the moral case or like the human humane case and so that is so many of those same places the way we do end of life care in America the way we recognize and value caregiving the way it should be valued the way we take care of health care workers and their moral distress and ability to do their job in a loving you know protected way that's been really interesting and I've also become so much more of a storyteller I think I used to think there's my doctor self and I'm sciencey and I'm smart and I'll translate things for people and now I do feel like I'm more of my full self in every context sort of just by practicing that as a speaker and thinker in these same domains where I had this academic expertise but now I'm bringing a personal story and I'm like sharing it in you know professional context also and I think maybe that's a characteristic of like good leaders generally actually is like to step into yourself in leadership contexts and so it's sort of a broader lesson to me and then I think you know as you go along in medicine certainly and you sort of have some more gravitas you can also become more personal so now I like hug my patients or I tell them I don't know the answer let's look it up together and I think when you're a younger physician you sort of think you're supposed to have a facade of I know everything and you know trust me because like I look young but I'm smart and so I think just sort of growing into all of that has been meaningful so now I'm fully formed and I mean I'll go forward as this self forever and 100% guaranteed I'd take eight from now if we ask are you will be absolutely safe don't change whatsoever right it is really interesting right you know because you have this experience and it really it shifted a lot of the way that you see things but also the way you want to devote a lot of your energy and then the storyteller part of you taps in and says okay yes there's a ton of data here we can look at all of the business cases we can look at all the studies we can look at all the research but let me tell you a story totally and like nothing it's been my experience you can share all the data in the world but it's the story that really insights change right even if you're like stuck to numbers you have to tell a story you're correct yeah I totally agree yeah and we'll be right back after word from our sponsors a big shift is coming to global rugby enemies become friends in rugby's biggest tectonic crash it's North versus South England France Island Argentine or Australia beaches Italy Scotland the Netherlands Japan New Zealand South Africa pick your side and grab your tickets at ticket master for matches too big to miss across the world and a big final in London the nation's championship is here the tax year end on April the fifth is approaching so don't let your 2025 26 tax free cash isa allowance go to waste make the most of it with a 4.0 1% rate from Marcus by Goldman Sachs the five time which recommended savings provider that's back pay over 150 years of Goldman Sachs expertise open your Marcus cash isa Marcus dot co dot UK times ticking interest rate is 4.0 1% AR 3.94% tax free variable includes a bonus rate of 0.74% tax refix for the first 12 months rate correct as of 5th of March 26 what do you think patients and families most need from clinicians now in moments when the news isn't good how would you approach things or how would you serve let's say like this is what i would love to see change in these moments or these are some of the like the key the key insights or key qualities of this type of interaction that maybe isn't happening all that much but would really make a difference yeah i mean it's like some of the words that come to mind are like witnessing selfhood support you know Walter Cronkite said the American healthcare system is neither healthy nor caring nor system and i think people in the healthcare system suffer including clinicians because of like cultural taboos that follow you into the hospital walls or because of like time constraints or because of like obviously money stuff and i think medical schools are changing so much in terms of training students to literally in the humanities actually but also training people how to do those conversations like you're talking about delivering bad news or coming back to hard questions or helping somebody discern what's important to them and like there's all kinds of decisions in healthcare where it's not just end of life care it's like do you want to have dialysis in a dialysis center or at home do you want to have knee surgery or not so many decisions really do have to be made in the personal context so i think asking what do you really care about and how do we help you get to that i think so many of those conversations like delivering bad news conversation it's not just one conversation it's multiple and it's like multiple people across a family so like making space for everybody in time and then i think like as a practical pearl for people who are going through a hard medical issue the field of palliative care is so incredible so like for anyone who has like not just a terminal illness but like a curable illness that's really hard to do you know like lymphoma and really intense chemo or Parkinson's or heart failure or just anything that is tough to manage in terms of like thorny medical decisions or symptoms or existential distress literally ask for a palliative care team to be part of your care and they like work alongside the other specialists and they are part of a medical field that's like board certified and fellowship trained and everything to focus on quality of life alongside the rest of your medical care and it includes social workers and chaplains and nurses and clinicians and that's just so weird because like that grew up out of an unmet need and it's like if you could strip down the healthcare system you would start with that and then build a bunch of like medical specialties around it but those guys sort of popped up in the middle of the healthcare system to say like what are we actually doing here and so they sort of act as a they can be sort of like a human quarterback so that's something i would encourage people to check out as palliative care and then hospice itself is a little subset of that for people who are really really sick and dying but palliative care could be for anybody who has something chronic or something thorny i think a lot of people if they even have heard the phrase or if they know what palliative care is or or think they know it is it's kind of very often automatically equated with hospice well this is what happens when like you know there's no other like you're basically on your way out rather than ascent i like this reframe that says no this is actually it can be related to that but these are people who basically focus on quality of life throughout whatever the treatment experience is which is super powerful yeah thanks for clarifying that where does hope come into the conversation yeah hope man i mean i think of hope as like so much of the time when you talk about hope especially in cancer right where there's this battle metaphor of like we're going to fight we're going to win we're going to beat it which can be like really flimsy and confining actually when people are actually going through it it can feel constricting or intimidating to have to win the battle because if you have to win then you could also be a loser and so i often think about hope like okay you're not only hoping to win when they ask people even as they're dying like what are all the things you're hoping for it turns out there's like a whole group of things that people hope for so it's like obviously people hope to live a long time and feel good but they also hope to feel spiritually at peace or mend relationships or make things smooth for their family you know so i think of hope as like really multifaceted because oftentimes there are many things you can hope for and many things you can achieve so the question is like if you're hoping for something or if you want to you know like do everything you know families like often come in and say do everything do everything for my loved one and the question like remains like do everything in service of what thing like is it dignity is it time is it being pain-free is it being lucid is it going home any whatever it might be so yeah hope is rough because and sometimes you just have to hope for the best and prepare for the worst you know one of we talk a lot about prognosis in medicine and how to prognosticate and how to help people you know have a realistic sense but also hold on to hope and like one of the frameworks i like the best is thinking about what's the best case that we're hoping for what's the worst case that could happen and then what's the most likely case and oftentimes those are three different points but they give you just a bit of a sense if you can like emotionally scope all of those and logistically scope those that's hard work but it helps you to do that you know so i think that can be helpful yeah it's so interesting the way you lay that out somebody who's been entrepreneur for most of my adult life as just an exercise oftentimes when you're thinking about like as a founder a new idea you create proform as financial projections and you have a worst case scenario best case scenario and then like the middle scenario so it's kind of the same thing you're talking about your prognosis yeah but instead we're talking about life instead of a business um you've mentioned a number of times that you and Paul eventually decided to have a child when he was in his final months of life a lot of people would probably hear that and like an eyebrow would get raised take me into this experience and decision sure yeah i mean i feel like i would raise an eyebrow i'm afraid about someone doing that i hadn't come up against it it's like one of those things you just never know and i actually wondered when breath becomes air came out i was like i wonder if people will judge us for having a kid there were a couple things in the book or like Paul writes about how our marriage had been on the rocks for a while and i was like wonder if that'll come back and it's like it turns out that all of those things like the hardest trickiest or when Paul writes about religion like moving between like atheism agnosticism Christianity all of the thorniest bits are actually the parts that people come up to me and relate to so anyway that's an interesting like experience but um yeah so we had always wanted to have kids and thought that was actually around the time when we would think about it which was toward the end of Paul's residency when i was also done training and then things would sort of like ostensibly get easier and that was right when he got sick and we actually talked about it within a day or two of him being diagnosed looked at each other and said like is this something we should think about and there's a practical piece there which is you have to like think about fertility preservation immediately before you start your treatment but we both had the instinct to still try and Paul was more certain than i was and i was like really embedded in the practical piece and also thinking about i think i'm going to be a solo parent at some point going forward so what will that mean for me i read Andrew Solomon's book actually far from the tree which incredibly helpful thinking about parenthood and identity and like all the ways that your kid could be different or different from you in unexpected ways and how parents come to terms with that and find it meaningful ultimately because like having a kid also introduces a ton of uncertainty and work and just grappling with that the real solidifying moment of that choice actually Paul writes about it in the book was a conversation we had where i was thinking about his experience and said don't you think that if we have a child then saying goodbye to a child will make dying even more painful for you and he said wouldn't it be great if it did make it more painful which was so like really surprised me and then just sort of crystallized everything and i was just like oh of course nobody is having a kid because they think it's going to make things easy and there's a million things we do in our lives that make things like great and hard at the same time so many meaningful things we do you know become a health care worker have a child climb a mountain to the top and then come back to how I'm at the very same day like we do all these things because they're beautiful and hard just Paul like indicating that that actually was all okay with him and actually was great with him suddenly the answer was yes when when your daughter is born and she's with the both of you for i guess another eight months before Paul passes then you're also it sounds like there was just this kind of crazy whirlwind because at the same time you lose your husband he's turned in this book you're being tasked with then or are invited to then say like well bring the book home for us and then not too long after it's out there in the world and at the same time you know you've just lost somebody there's grief there's mourning that's a part of that and i guess i'm curious how grieving mourning his loss while also being there for this beautiful baby change the quality of these parents and not that you could ever have anything all that else to compare it to right yeah you mean change the quality of parenting or change like just what grief was like of grieving yeah i mean i think working on Paul's book and doing the book tour was like absolutely not positive i mean partly as a way to be out like physically out in the world and talking to people and like i said i'm like it's like i'm a talker like that's how i process and that's what i want to be doing and like be with people and then also like there's a piece to grief where when somebody dies and it's a year has gone by let's say that can truly feel like a millennium and a millisecond at the same time and oftentimes people don't really enter into it like oh it's been a year like she must be doing great and it turns out like that's so short and you're still living with the loss all the time and Paul's book gave me sort of a hook for people to talk to me about Paul at a time when i was still wanting to and you know i mean i'm still still wanting to but it's like it can be so hard for us to figure out how to relate to someone who's grieving and say like what if i remind her what if she starts crying what if my thing that i say is not perfect and it turns out like just saying anything is almost always the right move and you certainly aren't going to remind someone of their suffering they like they know and so it just turned out to be really nice for me and then raising Katie like through that like she's just getting a sense of like i mean she's actually sort of always headed around her she's always had pictures she's always had Paul's brothers those cousins the grandparents Paul's like presence in family is like all over the place in our lives and at the same time he's sort of everywhere and nowhere and his book is there like waiting for her when she wants it but it'll just be interesting to see her like grow into forming her own relationship with Paul yeah and i'm like letting her like take the lead for the most part on that just like whatever she needs i'll give her it's interesting because like as a parent one of the great lessons you learn is like your kid is not you surprise and like her experience you're like a so she but like her experience is not my experience you know so i don't know what it's like to lose your dad when you're little but at the same time she sort of accepts it and i think she'd like love to have a sibling maybe as much as she'd love to have a dad like it's like she's the one determining like what it all means to her i think it was i can't remember if it's the final words and pretty close to the final words of the book is a short personal message from Paul actually to her you know she's only a couple months old at that point and years later in an episode of your podcast um gravity which i think it was 2021-2022 you had her read those words out loud to you what was i like yeah i just um i need to go back and listen to that yeah i had her read allowed the words that are like written in the second person to her by Paul at the end is the close of the book and it's like her little cute voice reading it and i was like hey i'm recording this podcast for people to hear like do you want some m&m's we can have m&m's after you record this are you willing to do it it's like people are gonna hear your voice and she's like okay and but they're like gravity of it obviously like didn't hit her she was like roughly five or six but it's lovely that it's in her voice i mean that's the most intimate thing that Paul left to Katie it's like that paragraph as a parent talking to a kid it's really meaningful and i really love it and it's interesting because you said that thing about how like the part that Paul wrote for you know the book Paul wrote is like cerebral and a lot about like ideas intellectual ideas and philosophical concepts and you know literary illusion and all that stuff and then you said like you drop into your feelings more in the epilogue but i actually think like that last part of the book is where like Paul drops into his feelings you know too and then like takes the reader and there's like a tonality yeah it's a very different shift yeah it was beautiful actually hearing her share his words yeah cool you kind of you kind of got a sense too that like she was just kind of having fun reading it but at some point she's going to read it again and it's going to land differently yeah she said there's he uses the word ledger and like in the middle of it she's reading it says like give a ledger of what you've been and done and meant to the world and she's like what's a ledger and then i'm like it's a list and then she keeps reading it's like so goofy right it's like let's look it up first yeah yeah yeah no it's really beautiful it feels like a place for us to come up with a circle in our conversations i always wrap the same way in this container of good life project if i offer up the phrase to live a good life what comes up hmm to live a good life i guess for me it's like stick to who you are and look out for other people hmm thank you thanks a million hey before you go be sure to tune in to next week's episode for a powerful conversation with Brad Stolberg about what excellence really is and is not and how pursuing it can help you feel more alive and not burned out and don't forget to follow good life project in your favorite listening app this episode of good life project was produced by executive producers Lindsey Fox and me Jonathan Fields editing helped by Alejandro Ramirez and Troy Young Christopher Carter crafted our theme music and of course if you haven't already done so please go ahead and follow good life project in your favorite listening app or on youtube too if you 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