Lucy Kalanithi: What Loss Can Teach Us About Living (The Perspective Shift That Changes Everything)

10 years after losing a husband, Lucy joins me to explore what grief looks like after a decade. He ultimately got the news that he had a chest X-ray that essentially looked like a cloudy sky. I mean, it was like dense with tumors. We both knew what it meant.

I never thought I was going to feel okay. It was like Paul died and I was like, "It's all over."

“What did being so close to death teach you about life and living?”

There's two big questions. What would be left undone? And how can I live most fully in the time I have left? "Hey everyone, welcome back to On Purpose, the place you come to become a happier, healthier and more healed. Today's guest is Dr. Lucy Kalanathy. 10 years after losing a husband, bestselling author and neurosurgeon Paul Kalanathy, Lucy joins me to explore what grief looks like after a decade. How love evolves after loss and what being so close to death can teach us

about being fully alive." Lucy Kalanathy, welcome to On Purpose. "Thanks for having me." "I have waited for this conversation since I read the book and when breath becomes air and I have read it, when I still lived in New York when I moved to the States. And it moved me so much because I didn't really come across a book like that that felt like it was written at such a

powerful moment and such a pivotal moment in someone's life. And then to have your

reflections within it as well, it's kind of left and imprint on me. And then my team and I was sitting down and we're thinking about books that had an impact on us as a team. And this came to mind immediately. And so I can't tell you how grateful I am for your time and energy for the trip over here. I know you've traveled here especially to be with us in LA and just want to start off by saying thank you." Thank you so much. "Tell me what is it? Feel like remembering Paul 10 years on?"

I used to think life was like a mountain that you climb like I'll follow the path and then I'll get where I'm going. And now like having lost Paul, having taken our daughter from being a baby to

“now being a seventh grader, I think of life much more as like a series of moments in a way. It's like”

that my marriage and Paul's illness and even medical school, right? Those were all mixed together medical school residency being married, losing him. That was like a chapter. And now I'm in such a different chapter. It's actually kind of amazing for the opportunity to like dip back in like to get sort of like talking about Paul in a way that's really embodied because you're also experiencing him and we're talking about him in like in a real way. And at the same time he's like sprinkled

through my life all over the place. Like you know I'll go through like a breakup and think like what would Paul say you know in the situation to me to him. And also just like what would Paul think of Katie? She's so different. She's such a like singular specific person, not a baby. You know?

So I guess like the things I can say about it are like 10 years on, you know, I never

“thought I was going to feel okay. It was like Paul died and I was like it's all over. Who am I?”

What happened? Like it's me and I'm here and I have this baby but I'm so lonely. How is this ever going to fill in? And my mom said like things will fill in. It'll become okay. And I was like I literally don't believe you. But it's like things do like things become okay. And then at the same time like even after you lose someone like they don't even remain static even though they're gone like you're not static. You can tend you to learn new things about them, you know with Paul

I hear from Paul's readers about his book and that sort of like an ongoing relationship with him through other people anyway. I guess it's all just like a beautiful terrible mix. Thank you for sharing this. Is there anything you understand differently about Paul? Yeah. I mean like the thing that makes me feel like when a person deters is actually a thing I don't yet understand which is you know Paul he was a doctor. He was like young neurosurgeon

really interested in meaning immortality. Like thought he would become a professor of philosophy or a writer and then sort of surprised himself by going into medicine and was incredibly intoxicated by neurosurgery because the brain is just an organ in our body like our liver like our heart that then it's also the seat of identity and he was so interested in okay if you're undergoing like brain trauma a stroke you know a tumor how does that alter your identity and meaning but

also how does like neurosurgery alter your sense of identity? It was really interested in patients who are facing like upheavals in meaning and identity then he himself became sick had to face this whole upheaval had to face the end of his life and I felt like as Paul was going through

him we had to do so many things together to take care of him to make sure the book got written

to cope to like show up for each other in like every way but I wonder whether like when if something happens to me and I'm sick and dying if I'll read Paul's book and see how much I didn't understand and see like new things in the words were like reflect on his experience and think like how was he alone in that and so like that sort of breaks my heart like what did I miss

“you know an answer to your question of like how have I gotten to know Paul differently?”

Yeah I mean when someone dies like stories come rushing in and then I think reading his book at different phases of my own life I even get different things even though I knew him so well and then I think you know just the process there's a flip side which is like how to not flatten someone after they die like I think like when someone dies there's sort of suddenly they become like so amazing and perfect and I can't believe we lost this person and all those things are true

but at the same time it's like he like you know left his socks on the floor and it annoyed me like you know just he was just a regular person and he was funny and he drank too much whiskey and he like just he was like textured you know and so I often think about like all the things I do remember about him how do I keep those like in memory and keep him like complicated instead of like mythic both of those answers to what you said you almost feel like you don't understand

which maybe you never will until we're all in the same position and going through something similar

and when we're facing not lost through someone else but loss of our save there may be certain things that we miss on that journey and we we don't recognize and maybe we shouldn't until sure yeah yeah yeah exactly but then on the flip side the idea that you're saying that it's almost like sometimes we don't celebrate people until they're gone sure we only see all the bad things yeah and then as you were saying on the flip side

when someone goes we only see the good things and we don't and it's so fascinating how the mind does that right I guess he would know as a neurosurgeon like you know why we why we do that yeah yeah good question yeah and where that comes from like why is it that we kind of really like what's the neuroscience of grief the neuroscience of that grief of how we block people's good things and they're alive and block people's you know bad things and they're gone

“and right or is it about remembering like remember to notice when you have your person here”

and then yeah when they leave remember to yeah don't forget when you hear the age old phrase time heals all wounds how does that sit with you I mean it's sort of like simplistic and it actually makes it sound like the wounds will then go away and so I don't believe that part but I do believe I do think time heals all wounds in a certain way Prince Harry was writing about grief and he said something like um grief is a wound that festers I was sort of like

oh I don't agree with that because of something festers it's like intended right and so I do think

like there will always be a scar there will always be something that looks different feels different

something you're carrying something you're literally carrying on your body like that's also how grief feels I think if you can sort of think to yourself like it's going to be okay in some way you just don't know what okay means and like sort of let the pain move through you you will end up somewhere you know that's different and better than you thought yeah it's it's interesting how all these statements have stood the test of time but they have so much nuance when you're actually

“living them yeah yeah and some of them don't work right like or you you have to decide which one's”

work for you like if someone sends you a card with something on it or if someone says you know everything happens for a reason you don't believe that it's not helpful but you're right I think many of those like things in literature things like that hold up what do you feel about that one everything happens for a reason I don't subscribe to that necessarily but I think more than I did before I think when hard things happen I do believe something beautiful will come out of it

something even if the only thing that comes out of it is that you suffered which connects you to every human being everywhere across time ever and then potentially deepens your empathy for other people or deepens your ability to be a friend or you know whatever it might be so and then I think like suffering have you read man search for meaning yeah of course yeah no no no no no no yeah you're saying yeah I'm not surprised you read it that's why I say and like Victor Franco who you know

he talks about witnessing all of these people and how they survived the unservivable and he ends up talking about like how purpose or relationships like you wouldn't survive just because you had those but you could only survive if you had something you were waiting for

or someone who was waiting for you on the other side and ultimately he ends up talking about how

suffering is actually a really meaningful part of our lives he says like his construction is that meaning comes from three things and he says he conceives of work and love and suffering and I love that he says work is like the things you do and create you know like the imprint you leave on the world maybe love is like all the types of love between people and then gratitude also and just like love writ large and then suffering he talks about how like suffering is not the sort of

like side event that you wish would go away it is here it will be here whether something beautiful comes out of it whether it connects you to other people or whether just like the pure achievement

“of just persisting alone I think there is like actual meaning in that and so I think that”

idea of like everything happens for a reason it's like a reason will be found but only you can find it

no one can tell you what it is and no one can tell you that it's okay like that's only yours and maybe it takes years I appreciate that the idea that there wasn't some predetermined reason or some reason that had to be the way it was a journey of discovery yeah and I think some people think that and that's also like a beautiful story or a beautiful you know what for you was actually helpful as you just talked about the need for relationships the need for meaning

what was useful to hear from your relationships at the time yeah and what do you find useful now yeah and helpful this isn't about other people actually but this was a really helpful thing for me is so Paul got sick and we were both doctors and there was something in that that was immensely helpful and obviously like the privilege and logistics and all of that kind of stuff that came out of like being a healthcare person and a doctor was very helpful but the thing that was the most helpful

was having spent years and years taking care of sick people and their families and thinking like terrible things can happen to wonderful people whether it's like a car crash or sudden diagnosis of cancer

“and so when he was diagnosed like at one point I was like whatever you need to do to cope go for it”

like would you like to punch a wall we have all his walls like they're all yours and he was like I don't need to and I was like I don't need to either like what's that about and I think it was kind of like okay turns out like it's our turn to like be the people who are doing this so it was really helpful to sort of like have that perspective and Paul in his writing wrote you know like people often ask don't you ask why me and he said well why not me do you think is really beautiful and in terms of like

what was helpful for us in terms of coping I felt like the most important thing was just to feel

witnessed I actually didn't need anyone to try to fix it to try to like say something that was going to fix it or that it was okay like one of the best condolence cards I got after Paul died was it just had this socks really big and I was like oh so amazing like and it also wasn't like too flowery or too like perfect or whatever it's just like this is how it's for some fields it's definitely how I feel also it's still funny like even when you're dying you're still you you know like

you're still funny like one thing that did that was really helpful for Paul actually when he was sick you know he was a 36 and 37 year old neurosurgeon right so he's used to being like like healthy dominant in charge in control and then like loses all of that in instant so when people would come to visit and hang out they'd say like come coming to visit like what can I do that's helpful and I was like just come and hang out and like be just like be you like be funny

“like ask Paul for career advice you know if that's what you would do anyway like just because he's”

dying like doesn't mean he doesn't want to know it's going on with you he's not like radioactive he's not different you know I think illness can be so flattening it's like people get sick and it's like humor zips out of the room like sexuality zips out of the room and like you're just like I'm still me like I'm still me just the same and losing all of these abilities but also still have all these capacities so I think just like making room for people's full self and people to be like a

gentic and be that's a word to be an agent and like be a full person I think we all lose up how is when

a lot of people become distant totally because you don't really know what to do yeah and I think like showing up is half the thing and then also it's like I do think there's something to like being specific you know like people often say like let me know if there's any way can help and you really mean it yeah and I've done that but I think when you're the sick person it's like you are quite overwhelmed and so it is useful to just like keep offering a little thing with no pressure like I had some

“friends whose baby was in the hospital and the husband was like the best thing anyone ever did for”

us was say like I'm at the mall next door getting a burger like what do you want on yours I'll drop

it off in twenty and they were just like the works thanks and then like they had talked to the first

like just like you know that kind of stuff hey like do you need babysitting this week like let me know yeah like I'm dropping off food do I mean to bring the doorbell or just let you know just text you when it's there just like something that has no pressure but also is like present and keep doing it what do you think most people miss and tell about grief one thing is like oh if I say something I'm gonna remind her or if I say something on I make her sad and I think when you're

a grieving person you're thinking about it all the time it's present for you all the time and so I think if somebody says like hey I heard what happened I've been thinking about you you know hey I heard what happened like how are you doing today um is there anything you can do it doesn't remind you it just makes you feel seen and connected at a time when like it's really hard to feel connected

my mom said this amazing thing when we were growing up she used to say when and out describe

and it basically meant like even if you don't know what's happening for you or even if you don't know the perfect perfect thing to say like you can just describe what's going on so you can just say like I heard that someone so died it's really sad of in thinking about you so much I wish I knew the perfect thing to say and I don't but I want you to know I love you and like that does not sound so cozy and it's like they didn't have to say a special perfect

wise thing they just described you know so I think that's also really helpful describing what you're going through is sometimes better than trying to say the perfect thing

“or the right thing yeah absolutely yeah to just be like this is the worst thing ever”

yeah yeah this is hard yeah this is this is really difficult yeah it's so much more I don't know there's something about it that opens up the heart rather than closes it totally yeah just it's almost acceptance yes yeah yeah can I just come say would you this look so hard yes exactly yeah yeah to admit that to ourselves that's what we struggle to do what was I've it's been really interesting as I was preparing for this interview I've had friends who I mean I've lost friends

to cancer over the last few years I've lost spiritual mentors plus friends and different scenarios but had a friend recently who is going through it in the States his partner's a doctor but he's not yeah and his partner wasn't as supportive as he wanted them to be because to him cancer felt like the big sea word that was scary from the moment he heard it but her take was you're going to be fine there you figure it out and I was wondering what were the kinds of conversations you

both had as both being doctors and what was the most important conversation you think you had at

that time the way Paul got diagnosed was he'd been getting sicker and sicker and then he ultimately got the news that he had a chest x-ray that essentially looked like a cloudy sky I mean it was like dense with tumors we booze knew what it meant you know we're going to the hospital tomorrow for for a CT scan it's going to show you know metastatic cancer and it was so interesting because as we were packing for this hospital stay he was going to go and get expedited work up I was packing

like practical things like phone charger insurance card like fuzzy socks or whatever and he packed books it was so interesting he packed um being in time by hi-digger and mere Christianity by C.S. Lewis and then a novel called Cancer Ward by Sulson it's in and it was the sort of like immediate recognition of like the doctor stuff is not going to help me like I need to turn to words and literature and or just need to turn to like the human experience of this and for him that was like

“oh I'm back to literature so that was really interesting I think one of the most important”

conversations was right away which was we ended up looking at the CT scan ourselves and sort of like wordlessly absorbing this diagnosis of like it was like looking at a patient scan and then you're like oh my gosh it's you like it's you and then we like got into the hospital bed together

which was really beautiful like beautiful and felt so sort of like shocking at the time but then there's like all these layers to that like the biggest one is like I love you into a future where

I will not be there like that's amazing that's such a like an amazing kind of love and people have it

right people have it for their children people have it for their spell it's like I love you forever independent of my existence right but he also was saying with that sentence like it was so stark that it was kind of like okay I'm gonna go I'm gonna go there immediately and then implicitly tell you like we can talk about anything and that was really helpful like super super helpful

“and I think like the battle metaphor for cancer is so pervasive like it started with like”

Nixon's were on cancer but then now it extends to like individual level like we'll beat it we'll fight it we're gonna win survived it yeah surviving and I think that metaphor is so flimsy you know

interesting like it's sort of like there's winners and losers and there's like one thing you're

supposed to do here and it's just like survive at all costs and I think there's like when you survey people with cancer there's like so many things people hope for it's like people hope for dignity people hope for like functionality as long as possible people hope that their loved ones will be okay I don't know there was sort of just like this panoply of hopes that I think like we knew to like side stuff the battle metaphor which was really helpful and then I think part of that was just

“we knew how sick he was we couldn't get away from it we could not escape like understanding how”

sick he was which was like the worst part but in some ways the best part because then we could decide what to do what I'm hearing you say is that it's it wasn't the the doctor conversation or the medical conversation because that was almost accepting what was in front of you but it was the conversations that you both allowed each other to have beyond the knowledge that you both were aware of.

Luckily and at the same time like I mean it sounds easy and it like totally why it was so so painful and like so confusing and just so like it took months months for us to like even feel like we had our feet on the ground you know and then things are like it's a constantly shifting landscape you know and he's going through his emotions you're going through yours like yeah I can't imagine that they are lying every day and really when I wonder about just the

work that you're doing as well and as we kind of navigate this conversation I'm like I know that in my life when I lose someone I'm close to especially when they're around the same age there's something different than when I lose someone older because at least when someone's older or at an age that feels appropriate for loss there's that story that you can tell you yourself whereas I lost one of my monk friends he was still a monk when he passed away

relived in the monastery together but he passed away a few years back now and he died of a stage four colon cancer and he was like maybe two years older than me yeah and I remember watching him through the whole journey present with him talking to him on the phone seeing him when I could when I went back and visited him and I almost feel like I learned so much more from him about life than I've ever taught or known and I wanted to know like what

did being so close to death teach you about life and living yeah it's hard to separate actually like being so close to death and being so close to Paul because it was like so embodied you know and it's funny it's like you're talking about your friend dying and like what a surprise that is when someone young dies and it's like the way I've ended up like conceiving of it is sort of like

“turns out that's what was gonna happen like that helps me a lot actually I think like being so close”

to someone who's dying actually taught me something about dying which is that until you die your life you know like what happened for Paul was like he got he was a neurosurgeon got diagnosed with cancer worked for a year as a neurosurgeon like this is who I am this is what I care about then I got pregnant during that year on purpose then he had sort of serendipitously

and because he was a beautiful writer transition to writing first essays and then a memoir

and so he sort of like built a new vocation during the time that he was sick and it's like he was

ill and at the same time he was so like engaged and what he was doing like so just sort of like intellectually engaged in the world of ideas and in the world of relationships too like being a new dad and it was just really interesting to to see like one of the book reviews of Paul's book was by the doctor named Gavin Francis and he wrote like this book is unforgettable or this book is

something it is crackling with life and I just remember thinking like how amazing to be

crackling with life when you're dying and I think the same thing is true with aging the same thing is true with like disability or patienthood it's like there's this idea that like you know something about like a human identity is taken from you when you're aging but it's like some of my favorite people are little old ladies who are so giggly and hilarious and like not afraid of anything you know and like I used to think like little old lady and now I think like

gosh like spitfire who like knows everything and like you know nothing shocks are and so I think the thing it taught me also as a doctor you know like just how totally human like

everyone is you know and I think when you're at work as a doctor there's so much dehumanization

“it's like you're at work you're rushing around you're hungry you have to go to the bathroom”

you have to get to the OR and so it's like all of the families like sleeping on the sofa's outside the ICU are sort of the furniture like they're the furniture at work because you're doing your job but also it's like you're constantly toggling between like this is the worst day of this person's life and I have 36 minutes with them and then in an answer to your question for real about like what can dying teach us about being alive and living die it's like the one of the most human

things we do it's like it's too big for any model it's too big for a medical model it's too big

for like a lot of religious models it's not a medical event it's like a human thing

Frank Osticewski it's like a Buddhist teacher who founded Zen hospice and San Francisco so gorgeous he's so beautiful and like he talks about her dying is all about relationships so interesting it's like your relationship to yourself your relationship to people you love your relationship to like holiness whatever that would be he's like it explodes every kind of relationship and then I rely on who's this like really beautiful doctor here actually talks

about like having worked with a lot of people who are dying and then like you know what they have to teach to people who are living and he's like it's two big questions that he uncovers he says what would be left undone or unseed if I die now you know like how can I live most

“fully in the time I have left you know and I think there is sort of a like transcendence in just”

like death is not like something that happens like at the end of the road it's like it is here all the time it is something you can like tap into like finitude or transcendence like even like a traffic jam you're like uh road rage I'm going where I'm going I hate these people they're in my way like it's like no like you are the people you are the traffic and everyone in this traffic jam like was it tiny baby like will be on a deathbed has someone who loves them who will be like

bereft when they're gone like god willing right and so like suddenly zooming out to that you're like who cares about the traffic everything's beautiful so I don't know I think there's like a real like luminosity that can be found like when someone's dying and then at the same time like traffic jams yeah you know when someone's dying you also have to like make dinner and you know pick up the

“prescription but I think it's like a constant toggle that's like zooming into me and transcendence you know”

just like hopefully what we can all do like every day yeah zooming into me yeah yeah yeah yeah for a few months now my team and I've been creating these zoomed out versions when you were describing that yeah of almost like city crosswalks uh parks yeah and and we just we placed these little thoughts on what everyone's going through what and and people are like moving around in the park or sometimes it's awesome you like a scribe like a story oh I play that game with my kid yeah

oh wow oh no way tell me about that we just lay that like a dinner and stuff we're out to dinner I don't know what we're talking about yeah yeah yeah we'll be like what are they talking about and then you'll be like oh this person just walked by like his dog's name sometimes it's just sort of like silly it's like his dog's name is peanut and just make it up but sometimes it's like oh like do you think he's just gone through a breakup like look at his face like oh like just we just sort

of make it up like as a way to pass the time but it is sort of like an empathy game absolutely yeah so we're doing exactly the same thing except creating it on social media and sharing the

an airport or whether it's a park or whether it's a crosswalk and we'll have lots of people walking around and we'll just put little stories on on top of them I love thinking that way

yeah because I always know that if I cut someone off in traffic I feel I have a good reason

sure if someone cuts me off in traffic yeah yeah so what are you trying to show or are you just trying to show like everyone has like a rich life as rich as yours yeah and we're not alone in our suffering yes so you may feel like you're suffering right now you're definitely not alone right that everyone you meet may simply be projecting their own suffering onto you and it isn't a reflection of who you are oh totally and everyone has a story

everyone has a thing yeah yeah and so just trying to help us I guess transcend but then I like your version of it's still bullshit traffic so I need to make one of those and I think we need to end it with that yeah yeah cool so cool I can't wait to see that yeah no as you're saying it was just it's it's helpful to hearing it from you as you're answering these questions I'm so honestly like it it's staring so much with me because when you sit down with someone who's

really done the work and really had to work through grief and really had to think through this loss on such a personal level your answers are beyond any

“logic in a beautiful way thanks and they they're counterintuitive almost and that's what's so”

helpful and refreshing yeah you know it's so weird though it's like partly it helps you and then partly it doesn't because like the next thing that comes is also really hard like so when does I think that about talking about Paul I'm like going through that experience like Paul's memoir came out a little under a year after he died and then I immediately went on a book tour like an unexpected book tour and was like processing in real time like what had happened

really just like aching through grief and describing it and now I'm describing like I went through this process and what came out of it which is like a wonderful thing but then like the things that are happening for me like I talked to somebody the other day actually who said this who said like oh I'm raising this like challenging teenager and it's the hardest thing I've ever done and then she was like well I told the friend that and the friend said wait a second like

12 years ago your wife had cancer and you had young children isn't that the hardest thing you've ever done and she was like oh it is it definitely is but right now this feels like the hardest thing

“like it's the new hardest thing you know but at the same time I think you end up realizing like”

okay I've done a hard thing before you know like Jane Fonda on a Julia Louis Drife it says podcast

she was like people always say that being old is hard and she's like no being young is hard

she's like being old is amazing like you've been through so many things you know you can do it and I was like that's awesome if we're able to pull from that well yeah of experience and tragedy and if we're able to look at it and go because I think I think humans don't give themselves enough credit for how much they've survived same yeah we don't give ourselves enough credit because we don't we don't look back at that moment and think we were strong we look back at it and

think we were we that's so interesting and that we just like I was a stupid teenager and then you're like know you had to learn yeah yeah yeah exactly yeah like owning that is what gives you what I think what you're sharing which is oh I can look back and think wow I got through the heart

“and and I can relate to that I mean I remember talking to my mom once and my mom is not someone who”

gives me motivation or advice or gives me wisdom she's loving and caring but not yeah a wise sage in her words and I remember I was going through my most difficult fight yet at a certain point in my life around nine years ago and I was talking to my mom and she was asked me how I was and what I ate for dinner which she it was usually upon the same thing and I just said to I was like yeah you know I'm just I'm doing all right I'm just stressed out doing a bit you know

and and I would say that in a passing way and you said you're good at dealing with stress and I was like like my mom doesn't just say it's so helpful yeah and I said what do you mean and she said well when you were in my room you went through a lot of stress and it was like oh my gosh you're no cry it gave me so gift so much it it's still what I turned to when I need strength oh my goodness it broke through the challenge I had at that time like it gave me all the

reasons to conviction I needed because my mum just reminded me that well that's so beautiful yeah

it was it was unbelievable it's amazing too because she's saying like that's such an embodied thing

because like oh my gosh I'm gonna cry because like she's telling you like you're the fact that you weren't in fitness right like she's telling you like your body already knows how to do this

like amazing form of trust she gave you in yourself I've been thinking a lot about this idea of

“the stories of your parents and the stories of your ancestors and when I think about the”

stories of my parents which I learned early on but not as much detail as I wished I just heard about how much they went through and I was thinking about this with Katie is where I'm going with her and it's almost like I didn't live that with them I didn't live in those homes they grew up in my dad grew up in the slums in India my mum grew up in a war torn country they both moved to England you know and they got married and when I think about them like wow that is

that's so difficult my parents did something really hard yes my mum was studying for exams when she had soldiers on her rooftop well yeah and my dad shared a bathroom with like 25 families yeah and yeah when I think about it I think god that is and and then when you think and you're like but I come from that sure like like I come from that and like what yeah and so I wonder when like for Katie who yeah as you were talking about earlier like doesn't necessarily know her a father

but how do you think about yeah creating that experience for her in in helping her make sense of it it's interesting that you're saying this thing about your parents because like the hardest thing is when your parents lay it out for you right like you do need to sort of absorb it yourself yeah you know like you're like okay but like it's so beautiful that you really absorb it so it's like I guess I hope Katie will do that you know from reading Paul's book or from like watching

“me and you know being me whatever she takes from that but I think I think so much about how to”

like give her sort of like spaciousness like support and spaciousness to like figure out what it all means to her you know because she's her own person her child it is very different from mine and this other way right like she has the hardship of losing a parent I didn't she's like decidedly not Paul she's decidedly not me she's very specific I think none of us honestly like comes to appreciate that her parents are like full human beings like it do I remember in my 20s

being like we just like it my dad is not a professional dad he's like a dude he's just a dude like that explains so much like that explains so much in a really like gorgeous way you know he's like someone who's just amazingly doing his best Katie has fewer like signposts to know who Paul was but she has this book to read and the book essentially says like it's important to try hard

“it's important to do your best and I love you like he's you know Paul wrote so much about”

striving and about struggling to find meaning and about you know like about facing death squarely

and then at the end he like stops and he's writing in the second person to her and like writes a message

to her and that's the last piece that he puts for her as a reason Katie I try to have her sort of taken like random information about Paul like just truly random like you love taking a hot shower I hate a hot shower I get into that like you and daddy like love a hot shower he loved to hot shower you take the hour power shower shower just like daddy so that's just like a random thing that you would know if you were like growing up like next to someone right so I try to ever those kinds of

things instead of just like your dad died and he was so wonderful and he left you it's like I try to give her like sort of specifics that are like neither here nor there but they're like they like

create a tapestry yes she likes sees his brothers who are like really funny and amazing and

sort of like just funny in the way that he was and then I don't know what her interaction will be with Paul's book like it's all over her house it's like you know all over but like with five copies and there are different bookshelves and they're around and I don't know when she's going to pick it up I don't know what she's going to take I don't know if he's going to feel really close if he's going to feel really far or if she's going to say like I'm not interested in this or if

she's going to be 30 and produce some movie out adaptation like I have no no idea but I hope that she'll find some way that helps her like you did understand like where she came from and that she was loved and yeah she came from this like that's really beautiful to hear you say that I came from that yeah so I have no idea yeah no of course you don't but I I appreciate how you incorporate the story the tapestry the the natural the real love of what an experiences and and they're not heavy also

the version that's digestible and in a whole yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah

connecting with like grief groups and just all kinds of stuff since Paul died I've actually asked people for advice like if anyone here in the audience is the kid you know who like lost grandparents or less than whoever and then you don't know them and you're piecing it together what advice you have and like the resounding advice has been like don't put away the pictures don't lock it up you know like let the kid sort of like have access ask questions like discover it

and just don't like put it away what was it like making that decision to have Katie at the time and then actually go through both coming to terms with Paul's mortality and then you know

wanting to create life together Paul and I had sort of always thought like that would be the moment

when we would think about having children like he was at the end of his residency I was an attending by then this is when things will like a extensively become easier and then right at that moment he's diagnosed with metastatic terminal cancer the prognosis is like months to a few years but we both looked at each other and thought like maybe we should do this still sort of like surprised ourselves and he was more certain than I was he really really wanted to and I

needed to sort of shore up like the practicality is it was sort of like is the family I'm bored with this like we refinance the mortgage like all of these things it's like can I be a solo parent like

“that is what I'm going to be and then I also was honestly worried about his I was worried about”

like what you said like how to hold like birth and death and all of it at one time and I I asked him actually and was like you are you are second like as you're going through this process don't you feel like having a child will make dying more painful for you and he said he said wouldn't it be great if it did make it more painful which just like cracked the whole thing open and I think actually for anybody who has a child like nobody is doing it because it's going

to make their life easier there's like a million things we do that make our lives harder like

everything everything right like you know climb a mountain all the way to the top to come down again in the exact same day it's like you didn't do that because it was easy and so I just think wouldn't be great if it did has changed my life so much and cracked open like not necessarily the best one sometimes you cannot have joy without risking pain or inviting pain and for me it was like another layer of uncertainty it's like pregnancy itself is like so much uncertainty so much fear

then I actually as a new mom had to keep reminding myself like you know it's like you go in and you like make sure the baby's still breathing you know like has everything okay she gets a fever

“and it's such a panic and like I had to remember and be like I am 99% certain that this person is”

going to be fine I'm 99% certain that Paul will not be fine so like that is not like where I need to hold like my energy so that was kind of like helpful like when she was a baby it was like it's so easy to wish away time you know it's like oh I can't wait till she sleeps through the night or like what's she gonna be like when she's like 18 and there was none of that it was like this is like the moment that Paul will be here for is like Katie's infanthood and like Paul's

final years and so there was no like wishing away the moment it was all present and it turned out like that's actually really good for you it's the reason people like learn to meditate or you know or it's like I'm washing my hands in the sink like this is the feeling of the cool water it was like that it was like like a baby cries someone dies I'm here like in this moment you know and so yeah and I still can access that somewhat and then I also am like you know where the pencils

for seventh grade so like but anyway it was it was like beautiful and amazing and really good that we did it and just yeah it it worked out taught me a lot

were you always so evolved and or did this accelerate it in a way that because when I hear you

speak I'm just like oh this is like a lot of growth and a lot of in a short amount of time a lot taking on a lot of different things in a short amount of time and it's almost like

“do you feel like you are somewhat prepared for it from somewhere in your past?”

the heaviest lift for me actually I think in terms of like training my like brain and heart

every fiber of my being to figure out like intellectually and emotionally how to take care of sick

people and attend to like every every layer of what's happening in this room and then like make a 10,000 decisions about like how to make it all happen so that was really hard I also went through an episode of depression and residency it was incredibly painful I wasn't like hospitalized but I took two weeks off work and I felt like I just felt like I didn't exist I mean it was depression it's like depression like under Solomon says about depression like depression is not the

opposite of happiness it's the opposite of vitality it's like so interesting that was really hard and I think like making it through that I don't even think I could put into words what it like taught me but touching that like pain like left me with I don't know some sort of ability to approach darkness or something just to be like okay like I don't know I have no idea yeah then I just have like really good friends or talking all the time like I'm a processor

by talking honestly you know and then at the same time it's like I wonder this hard thing if all these ideas about like what helps me cope and then you go through a breakup and you're like

“heartbroken you hate everything and you have to start again or like you know you have to figure”

out how to explain it to a kid and then you know like that's impossible or they think you're stupid you know like I don't know it's all everything it's all everything it's the transcendence and both yeah you know this actually makes me think of this thing yeah transcendence and bullshit do you know this idea it came out of damn Gilbert that Harvard the social psychologist this idea of like the end of history illusion so like he talks about like when you're asking this question of like

like what got you to where you are today and then like he interviewed a bunch of people and he said like how much do you think you've changed in the past 10 years and everyone said so much like so much and they said how much do you think you're gonna change in the next 10 years and people said probably not a lot and he interviewed people every age and there's like a little of a little bit of a slow down like in midlife but essentially everyone changes all the time everyone changes the same

amount in the 10 years you walk around thinking it's the end of history illusion of like I'm me I've made it here I've got it sorted here we go you know and then in 10 years you'll be like a whole different you with like different sensibility or like different frameworks like isn't that crazy yeah so I don't know I find it really helpful I don't know why yeah allowing ourselves new

and different I mean it's interesting when you first said that question I was like oh I'd say

haven't changed much in the last 10 years might out be my initial take I feel like I knew who I was

“I'm pretty much the same person but I think that's not fully true at the moment there's also an”

end of history illusion from 10 years yeah yeah that's interesting the sense of like I made up my mind where I was 10 years ago my head and I stopped there and it's like well that's not obviously true yeah that's fascinating that's actually cool to play with yeah it's refreshing to allow yourself to say I have changed my ability my values have changed or what I care about has changed and then when a big thark hard thing happens you're like oh it's gonna make the me yeah yeah yeah

yeah I like dance works I left it to me yeah yeah I wanted to ask you how you're going back to something you said earlier what about Kate Katie reminds you most about Paul her eyes in her hands her stubbornness like infuriating she very much knows her own mind which is infuriating yeah it's like an entire parenting toolbox that are unavailable to me because she's

a lot of fleas are and then she's like an incredible physical comedian which Paul was also

“those are the things I think I would say she's introverted like Paul I processed by like speaking”

like relating sometimes I don't even know what I think until I've said it and Paul was much more like inward I think that's like that's sort of like why he's like when breath becomes air spun out of his illness because he was like turning and processing and reading and writing and she's introverted like that but then she'll give you like you know like a little gleam you know of some things she's thinking yeah yeah yeah as she ever asked you anything about Paul like from her

own curiosity totally and she's actually so interesting you ask that because I was gonna say of course and then but it's not necessarily of course she's just sort of in the mix gleaning but recently she started too she said like could you make me a album of videos of daddy and I was like sure and it's like I so badly want to be like what's she watching when she's watching them you know because she's like having I've had time but like there's a bunch of videos there's like

some interviews and there's some goofy sketch comedy stuff and there's some like thanksgiving someone shot a video of whatever and so like she can look at that and then she asks for like stories I'll tell her a story of like oh here's a story about daddy like in a chest tournament when

just like oh but then there's a lesson in that and she like recently like of her own

volition like put a small photo of the two of them next to her bed you know and I was like oh so interesting like she's like claiming him yeah you know it's Elsa's interesting though it's like she doesn't have a sibling like it's me and her and she really wants a sibling she wants a little sister specifically she really wants me to keep dating so she can have a sit like like we can't engineer that whole thing like if you post it but it's interesting because I actually think like

for her losing Paul was a big thing and not having like a dad there is a big thing but not having sibling is actually also a big thing or having like our family look different from like most of the families at school the permissions lip is different like she's not self conscious about it but I think she like knows it and it's a thing so it's actually kind of interesting because it's not

“the only thing you know it's like she's piecing together like you know all of it”

the structure of everything as every kid is doing right about that I mean you mentioned earlier that Paul obviously wanted you to remarry obviously get his encouraging to date like what was that process like for you because you can say it when he's there and so I can understand that that's how you love me in that forever way yeah but what does that actually look like for the individual who has to go on and try to love again how did you even begin to open your heart

and mind to that possibility yeah and when did it feel possible I wasn't like trying to open my heart so I was just like it was just pure intuition I was just sort of like what I'll know when I know you know from my wedding ring I was like I guess I'll take it off sometime it's not today and then like six months after Paul died I went swimming and like took the ring off and then came out of the leak and was like oh I think I'm not gonna put it back on and then like

right now I have like my engagement ring of Paul's wedding ring on this hand just interesting

“but maybe I'll take them off like if I were like dating someone really seriously I think”

we take off Paul's ring you know so I was in this like support group called Hot Young Widow's club because the Paul died it was Normack and Ernie made it was incredible and there was actually a lot of conversation in the group it was a it was on Facebook at the time there's a lot of conversation about like what did your person say about dating again like did you have this conversation or not because I think a lot of people who'd have that conversation felt really

freed by it some people thought like what would they want me to do or like is it a transgression or is it a disloyalty and I don't think so at all like I think like not at all but I think like

I'll also always love Paul it's really interesting and I think like the analogy for me I mean

it's just like love is infinite like there's totally enough love to go around and I think for me it's not a perfect analogy but it feels a little bit like if someone's child had died and then they had another child you would never think like oh the this child replaced the other child or do they have enough space to like love the new child you'd be like no they're just different like it's a little different when it's your partner right but I'm like Paul the way I

think of it now is like Paul's my family like his family's my family like his family forever and I absolutely like can fall in love have fallen in love like it's just like there's enough love to go around you know it's been like pretty easy in a way and I think the grief part was actually the harder part it's like I needed to like heal to be like ready and be like emotionally available for like anything like I was just like parenting my kid and surviving and then I became

“ready let me know if you want to set me up yeah they have to have one daughter younger than the”

woman yes getting on to the other side got it it's a good try to put it out on the show right now exactly I'm hearing from you that it's that intuitive tell it's not yeah it's not something that you consciously pursue or prepare like it's probably similar for a bunch of people right like after someone gets divorced and is like going through the like devastation and like identity and like what was what and what was my role and I don't know it's just like it's all in a peeve

all right that's like also so like terribly hard and so I don't know then it's like yeah when are you ready yeah absolutely yeah when are you ready and I think that's the question that everyone keeps quizzing in their mind but like you said you can only know internally it's not like a tactical practical thing you can kind of put into a number of months or years and yeah it doesn't it doesn't work that way right how do you define love today I mean I said you talk about it actually

on a clip where you were like the person who loves you well never use your wounds against you

and then you talked about how your wife like hold no judgment for you and I was like of course of course because you're you like and I don't mean you're Jay Shetty I mean like your your

like partnership doesn't mean you could like endlessly hurt the person either but like I don't know that's part of it I think I think there is like an unconditionality to love for sure and at the same time I think like that is more true for like children than adults like you don't love adults unconditionally right you like have boundaries that like adults like importance can't actually cross but like as long as you can like work a relationship within that

like real like partnership and spaciousness and like non judgment yeah it's a hard question it's

a really hard question say I'm always changing my mind I think there's so many nuances and facets

“to it that it's so it's such a hard question I think that's why we all struggle with it so much”

in finding and looking for it that's the answer to right it's like I would also be like fun and growth yeah but it's like the same time you're like it's sort of like that thing where it's like you know when you're not like it's intuitive yeah I mean ultimately it's teamwork and teamwork requires all those things you just said yeah teamwork should be fun and it should have growth and it should have mutuality and it should have reciprocation totally it should have connection and

communicate and so teamwork just feels very simplistic but but it gives you a good visual yeah and

at the same time like I do think it's like you know this but like obviously it's never going to be

perfect either like there's something actually really romantic and like choosing and like choosing like on a daily basis you know like that's very romantic of like sometimes one person's up one person's down sometimes it's like you know difficult you know but similarly like that's your team yeah exactly exactly and it's shared yeah it's a shared experience of the shared life it's a

“co-created life yeah it's a co-creation I think is so important and co-holding and co-co-everything”

while also like you're still like two beings like correct you're you correct absolutely yeah yeah it's complicated I mean it's like it's a concert as you're saying miss it's like

similarly to the like end of illusion yeah end of history illusion it's like it's never done

and that's it like it's like it's like it's like it's like constantly like work yeah yeah yeah absolutely I wanted to talk to you a bit about this idea of and I know you've spoken about this it's idea of like reimagining how we die uh because yeah it's kind of goes back to what you were saying earlier about the survivor or the beating cancer yeah a pro yeah my monk friend who who passed away like he he was very positive and he almost just didn't let anyone in to what he was feeling

and going through and that was his version of how he dealt with it yeah and as far as I know

“from him I believe he was happy with that yeah and then of course at the end of his life he needed”

support and help and everything and he and he got that I wonder what your take is on having obviously done this it's been a doctor has seen patients been at grief groups like when you think about this idea of people battling between letting go and giving up and like what the difference is and what you do when you get a diagnosis and how you weigh up whether I should fight till the end or whether I'm giving up or actually I might just let him go like can you help

make sense of that to some degree totally I mean no I mean I hear you about your friend and it really is like to each his own like people really have different ways of coping um it is a weird time to die in America in history um because like that sort of like battle idea like death is very medicalized and like varies sort of like western medicalized right now here and I think there's like a lot of reasons for that but the battle metaphor is one of them and another one is like we have

all of this technology available that is like you know built for emergencies but is getting offered to people who are like 90 you know with like failing organs um I think there's so much taboo around talking about death and dying and meanwhile also so much hunger to like crack it open and think about it I think like suffering and dying or really hidden like from view yes the way that they haven't been across history for people's it's like really interesting to be like oh what's

happening over there like how are we supposed to talk about it so I think there's sort of this like cultural force to like intervene to like you know anyone who's been through like a series illness with someone has seen how much sort of like momentum there is toward like aggressive medical care I think of it when you were saying like how do you choose whether to like you know am I giving up am I beating it I guess in my mind I sort of think of it as like a thing is happening like a thing

is happening it's like now there is Parkinson's here or now this person has metastatic cancer

healthcare that's going to make that the best possible like extended life as long as possible

some functionality like as long as possible help people do the things that they want to do

“that are important to them but there is some like building of like you can sort of choose healthcare”

within that to kind of like design your healthcare or like make your choices around what's important to you but that requires like sort of facing up to like what is happening what is possible and then like having the team who's taking care of you like also level with you about that with their knowledge and experience I mean there's like two things like for all like if you're practical to about it but if people are like I am facing an illness my family member hasn't

illness I want to be able to like figure this out like how on earth am I supposed to do that one like thing people can do is ask for a palliative care team to be part of their care people get really scared around the word palliative so like palliative care hospice is a teeny part of it so hospice is like palliative care for people who are actually dying soon like you literally have to be certified like very likely more likely than not that you would die

within six months that's hospice then there's palliative care which is huge you could be like a 22 year old with Hodgkin's lymphoma who's going to be cured in two years and it's like really struggling and suffering and they'll take care of you too or you could be someone with heart failure where it goes up and down and up and down for years and you could have palliative care take care of you and basically it's it's a concurrent care model alongside whatever

other care you're getting alongside the oncologist alongside the neurologist or whomever is taking care of you it's actually a medical specialty that only was recognized in the U.S. 20 years ago it grew up just like a little bit before that but they combine like chaplaincy nurses social workers like doctors or other clinicians and then they take care of your family too so like when you walk in the door they're like who else is taking care of you who else is with you hey

does this person need some it's so incredible it's like if you could just dissolve the health care

system which Walter Cronkite said is neither healthy nor caring nor system you would just like start with palliative care and then just like build everything else around that there's a lot of like miss misunderstandings about what palliative care is but if anybody's struggling and isn't sure where to turn for that they're so incredible and you could just ask you would just be like can I have a palliative care specialist be part of what we're doing yeah absolutely thank you for sharing

that so it feels like there's all these hidden things that exist already that we miss out and even even like the what was it the hot widows hot young widows hot young widows hot young yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah kiddies that can't cast them yeah yeah yeah yeah yeah yeah and and just there's all these things out there yeah like people like them yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah

to help people at different stages and you almost don't know and and hopefully people who are

“in the position know but if they don't it's yeah I really appreciate you sharing yeah I think”

this is such an important conversation that I feel like you're such a big part of like how do we help people take back their dignity when they're dying like what does what does that actually mean what does that look like I think the the broad strokes answer is like don't forget that they're a person don't forget that they're still them think about what you would want in that situation you know I think like like we were saying it's like illness and dying can be sort

of so flattening of like your humanity your complexity it's so sort of like undignified right you're like you become sort of like infantilized you know or if you're in a hospital or if you're somewhere if you're in a health care facility you're literally naked you know you're not wearing your own clothes so just as much as like people can protect your privacy ask you what's important to you make things beautiful essentially you know like their flowers here there's music here

like people are touching you like people are looking you and I like I don't know I could say a

million other examples I also think like respecting what someone like cares about you know when

people are dying and they're trying to make a difficult decision like Paul did I wrote about this in the end of Paul's book but he was very very sick and ultimately got rushed to the ICU because he was suffering so much and couldn't breathe well and then had to make this decision about whether to be intubated like whether to be on a breathing machine a lot of people were a sick

“end up sort of with a north star of what's really important to them I want to be with my family”

I want to be free of pain I want to make it to my child's graduation for Paul his was I want to be mentally lucid like I want to be mentally lucid to like be with my family and keep writing as long as I can write you literally was like writing up until like two to three days before he died and so that decision about whether to be intubated became really clear you know where he's like there's a chance

for him it was like the way to like maintain his dignity was like or align with his values was like

okay if this is the end of mental lucidity then this is the end and like will listen to you you know like great like will make that happen yeah which was when that was actually happening it was like incredibly confusing incredibly painful and incredibly so hard but also like so there was a

“grounding thing which was like what's important to Paul when I hear that I think about how”

usually when we're losing someone we're worrying about how it affects us and yeah they're the one who's going through lost two it's shared it is two ways but it's almost like I think us all of us naturally would want the person to stay so slowly but there's a independence and decision that that person also needs clarity on and like you said it may be yes I want to do this but his one was so specific to his policy and mission in the world totally and at the same

time like medically like families can go through real trauma like literal PTSD from like participating in medical care or having like their loved one get care that wasn't in line with their values or that they ultimately thought like oh that did cause them unnecessary suffering so it's like

there's always a trade off you know like it's like it can hurt everybody do you believe anything

needs to change and they standard protocol of how doctors deliver terminal news um totally when I was in medical school which was 20 years ago they were just starting to teach like hey make sure you attend the emotion in the room so like if someone is crying pause allows some space it'll feel like a long time to you doesn't feel like long time to them and then you can even say I see the tears in your eyes and just leave it where you can say this looks like it's feeling

really sad you know when we were learning those skills it was really interesting because they were teaching it to us like they were skills because they actually are and then you have a little nomadic about like attend to the emotion in the room but it's real like it's you it becomes part of

“you I think you know there was a study of doctors that said half of doctors said they had”

like given a prognosis that was rosier than what their actual medical opinion was just so interesting it's like even in the hospital it's like you sort of make this assumption of like what hope means to people like hope means longer life so I'm gonna say that I'm gonna keep them on outer bounds of what could be possible but I think what many people respond to like what I've ended up learning is a really good way to share with patients or even frame it to yourself is thinking

A about like prognostication for example as a range so like instead of saying like you have six months to live because like that's the median and the studies you say like it's likely a few months to a few years which is like broader but more accurate really and that's like enough information for someone to decide like do they want to have a baby they're like doing the filmists or not you know and then similarly another way that we've been trained to tell people that we're training

our students to tell people is a model where you say you share the best case the worst case and the most likely case and actually people can have a lot people get a lot of information from that where they can decide like how much risk do I want to take to aim for the best to prepare for the worst and then they're kind of like well I'm still allowing space for the best and in the meantime I'll make sure my family knows what I want when I'm gone yeah so like

I think like doctors are being taught to allow just like space space space space and more like accuracy yeah yeah that's really helpful to you it's helpful to you how humans process

yeah it's also like not just one conversation like of course the first time you hear the news

like you then you know you're anything else right then you have to hear it again you know you heard from different people but yes it needs to change and it is changing thank goodness I think right now in the world we're talking a lot about aging well yeah what's your sense of what it means to die well I think that living well is the same I think like the

“way to not be afraid of dying is to feel that you've had a meaningful life that's what I think”

I think that's what ended up being true for Paul and I'll just tell you like something beautiful that like Paul felt that I hope I feel too because I also think this sort of encompasses like a good concept is like similarly if you're lucky enough to like have the tools to like build a life that you felt is meaningful I think Paul ended up feeling like not just I'm cheesy but I love this you ended up feeling I'm not dying feeling that I'm losing everything I'm dying feeling

that I have everything which I think is so cool you know so I don't know how that happened to me

because you could argue he could have felt he didn't have everything like he hadn't had

“Katie and you know like hadn't had that experience and which seems like the natural thing we all”

feel at that time was like haven't done this yet or haven't seen this or want to make it to this

and so to really say they will always be true yeah don't be true for everyone but he was able to say

“he had everything he felt yeah or not like enough enough yeah I struggled with it later too”

and then a friend was like what if it was enough and I was like what if it was enough

I said thank you so much thanks for having me so grateful truly I'm so glad to meet you

“so grateful for your openness so grateful to learn about Katie and Paul and and yourself and”

thank you I'm truly in awe of your resilience and courage that's like wild here you see it's true I really mean it it's yeah would it treat I mean truly yeah no it's not it's not it my heart yeah truly I really mean that yeah thank you yeah such a joy if you love this episode you love my conversation with Malala use of zai on how she transformed extreme adversity into global purpose I was hanging out with some friends and what was like supposed to be a fun

night just took a sharp turn and immediately I froze this isn't i Heart Pat cast guaranteed human