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Dr. Lucy Kalanithi is a primary care physician and Clinical Associate Professor of Medicine at Stanford University. She is the widow of Dr. Paul Kalanithi, who wrote the incredibly gorgeous memoir When Breath Becomes Air, which is now part of our literary canon. If you haven’t read it yet, do it! It’s such a monumental book about what it means to live and die with meaning.

I interviewed Lucy many years ago, which you’ll hear us talking about at the top of today’s conversation, and I was so excited for the chance to speak to her again today. Lucy has a beautiful way of looking at the world, and of capturing it.

Today we talk about why Lucy doesn’t believe there is intrinsic meaning in suffering—but what kind of meaning she has found. We talk about life changes and transformations, and giving yourself permission to be you. We talk about uncovering what we really want in medical care, and why advanced directives are so empowering. We talk about Paul’s legacy, and their young daughter, and the ways that we all may lean on each other, and connect more deeply with one another.

Lucy, as always, instills so much hope in me. And for that, I’m very grateful.

Paul Kalanithi’s book: When Breath Becomes Air

Lucy’s Website

My first conversation with Lucy

LUCY:

I just listened to our chat from eight years ago.

ELISE:

Isn’t that wild?

LUCY:

Yes,

ELISE:

I listened to it as well. Yeah,

LUCY:

And

ELISE:

I will link it for people who want to go back into the archives of a different show and listen to that conversation, but I was thinking about how wild it was. I remember being on the plane, this is back before, I don’t even know if you’d ever done a podcast, but I used to do everything in person, which is wild. I know. And you invited me to your house, which was so lovely, and I remember sitting with you in the living room and that morning I had, as I flew up to San Francisco, I was like, I made this trip exactly a year ago for the death of Peter, for Peter who died early, early that morning, and then that was wild. Were scheduled to speak and it was, I think you said it was the three year or five year anniversary of Paul’s diagnosis.

LUCY:

Yeah.

ELISE:

Weird. Yeah.

LUCY:

What did you do in San Francisco after? Did you go to one of your favorite places with him or anything?

ELISE:

No, he didn’t live in San Francisco. They lived in New York, and so they were in San Francisco staying at the Fairmont for his older brother’s wedding. And so I know San Francisco had Paul on it for me after that. So that was my first time back. But I did go into the city and saw friends and sort of started to rehabilitate my relationship with San Francisco. But yeah, that was, when did we record? Maybe in 2018?

LUCY:

It must have been May, 2018.

ELISE:

Yeah, may of 2018. Exactly. Obviously. So here we are, and it has been another minute, and this book just continues to be propulsive in the world and the culture.

LUCY:

Yeah, it’s been wild. It’s still around. I mean, that’s the thing that’s crazy is it’s kind of in the cannon. It’s wild. That would’ve been really meaningful to Paul. Obviously. He loved books so much and to have his book be out there and around is wild. And it’s cool because, so Katie’s 11 now, and she was less than a year when Paul died. She was eight months. And so she’s starting to develop a relationship to the idea of Paul at least, and now I can picture her reading it, which is really different and a big deal. She’s still young to read it, but as an example of the way it kind of keeps popping up in my life all the time is I was at work the other day and got a package at work and it was 20 letters in individual envelopes from college students in Texas, and their literature professor made them write to me after they read it as part of their class.

And one of them, I started opening them and one of them was like, I thought this was going to be a boring, annoying, pompous book. And then it turned out it was, I got to think about my values and I appreciate it, and it wasn’t stupid. And I was like, this is my favorite letter. And then I brought them home and I was like, look, Katie, here’s some letters about daddy’s book. Do you want to open them with me? And she’s like, no, I want to open them when I read it, so can you just put them aside for me and they’re going to be mine? And I was like, sure. I was like, oh, she can have her own relationship with readers, which I didn’t even think about. So just that part keeps evolving for us too. But yeah, I mean it’s really cool. It’s really cool and and I have talked before about how it’s so nice to have people talk to you about your person who died, and it’s nice to have a hook to do that because he’s still part of our lives. He’s our family forever. He’s her dad. Yeah,

ELISE:

No, I’m sure. I mean, how meaningful for her that he is such a prominent person in the culture with no signs of that ever abating. It is in the canon. It’s a classic. It is one of those genre defining memoirs and to know that he continues to be alive for readers who are just discovering him and you and her by extension, what an incredible gift to her

LUCY:

That we keep keeping. It’s also, it’s kind of weird because it’s also a frozen moment in time for our family. That family capsule of me, Paul and Katie, that was a short time. And then also, it’s funny you say he’s a prominent writer, but he was not a prominent writer when he was alive. He was writing, but we put writer on his ed stone. It says Paul Hy neurosurgeon and writer. And I remember being like, can I put writer? And was this book, I don’t even think it was out at all when we were writing that on his headstone, but I was like, well, he was a writer. If you write, you’re a writer. But now it seems kind of like writer eclipses, neurosurgeon. But that’s really interesting. It’s your identity and your legacy intertwined after you’re gone in a way that you never see

ELISE:

And how not necessarily defining, I’m curious to talk to you about this sort of the identity that you have and as a physician who’s also walked through this whole experience with him as both a caretaker and a partner, both as a loving wife, but also as a fellow physician who couldn’t deny what was happening, but then how that starts to shift and change as the person who finished brought this book across the finish line has represented it to the world. And one of my really good friends is, I don’t know if you’ve ever encountered her work in the world, her name is Nora McInerney, and she started high

LUCY:

Her

ELISE:

Just the best and one of the conversations that we have all the time, and she’s remarried and has a quite large extended family, but it’s like I’m sort of tired of being the sad wit that everyone brings their suffering to.

LUCY:

And

ELISE:

Yet also, I wouldn’t give this up for anything. So I’m curious how that feels for you as you have shaped your own legacy and when are you going to write a book? By the way, you’re such a beautiful

LUCY:

Writer. Thank you. Yeah, I’m not a writer. I’m a talker, so this is what I would rather be doing. Oh, that’s super interesting about what Nora says. It’s true. I don’t know if she still has it, but she had her show terrible Thanks for asking, which was all about excavating hard things. Everyone’s

ELISE:

Worst days.

LUCY:

She does it with such a lightness. I feel like she’s one of those people where she’s sort of this example of everything is everything all at once. It’s funny, it’s horrible. It’s real. She’s just really real. So I feel like that’s maybe where I have landed slash hoping to land. As we talked about before, I don’t think there’s necessarily a point to suffering except it connects you to fellow sufferers, which is literally everybody. And so I do having the ability to name things and see things that people are going through. And it’s interesting. I think one thing that I’m interested in is just the moments people have, and it’s not just illness, but it could be where everything changes in an instant. And I’ve had a lot of people actually come up to me and say, oh yeah, I had stage zero cancer or stage one cancer and I didn’t suffer at all. Your husband did, but it was a big deal for me. And I’m like, well, you kind of did suffer. My husband did because you had the lightning bowl where this thing happened to you, and then you are the same person you were five minutes before, but you’re also totally different person

Suddenly. And you have to figure out, what’s my narrative? What’s important to me? What does this mean? Things are never going to be the same. And so I don’t know. Something about that is really interesting. That can happen in all kinds of ways. Or even when you have a baby, I’m me, but I’m the new me and nothing’s ever going to be the same. And so just thinking about the only thing, I just was saying this to Katie yesterday, it’s like that phrase of the only constant is change. We were talking about that because we just moved house. And so it was like, well, which things are the same and which things are different anyway, I think I don’t feel like people just bring me their sad stuff. I feel more like people share themselves, which we don’t always get a chance to do. I don’t know.

ELISE:

Yeah,

LUCY:

It’s been nice.

ELISE:

Yeah, I think that it is sort of that idea of everything all at once. And I write about this, and I’m sure you relate to this as well, which is, God, I would do anything to have Peter back. That has been sort of the great before time after time in my life, and I’m not a sentimental person and my parents are, my dad’s a physician. I’m just not that person. And yet this was a dramatic transformation for me as well. I think about the gifts of his death, which are manifold. He completely changed in his death, the trajectory of my entire life and my understanding of the world.

LUCY:

Wow.

ELISE:

And I think about it as before times and after times, it just deepened me dramatically and gave me a whole new set of questions about meaning. And is this what there is? Paul’s book definitely is that right? It is a wrestling with meaning.

I want to talk about suffering and then I want to talk about meaning because obviously the two are entwined. And I was looking at something that you wrote where you said, well, this brings them all together, that this conception of Victor, Frankl’s conception of meaning that comes from three primary sources, work, love and suffering. And then you write, I don’t think that there’s intrinsic meaning and suffering, but one of its meanings for me is that it gives us the chance to love and be loved. And I think that’s such an important distinction, and I want to stay there with you for a minute between the intrinsic meaning of suffering, but thinking of it more as this catalyzing event. It doesn’t matter what it is, a diagnosis, a death loss of a relationship, loss of a job, whatever it is, there’s an identity fracture,

LUCY:

And

ELISE:

That puts us into a totally different place, I think. Is that sort of what you mean?

LUCY:

Yeah, I think so. Identity fracture is really interesting. Yeah. I mean, I love that thing. Viktor Frankl says, yeah, he believed that three big sources of meaning are work and love and suffering and work is the things we are doing and creating and love is love for fellow human beings, all the different kinds of love and also gratitude for being alive and then suffering. It’s so interesting, like well, suffering is just there. It’s going to be there for everybody. And it’s not some side event. It’s like, oh, wish I didn’t have to do that. It is going to happen and we can choose our response to suffering, and that’s where meaning is, or that’s an actual source of meaning in life. But also, Krista Tippett said this really interesting thing about suffering on her podcast, on being a while ago. I think she actually, it’s in the episode, it’s so incredible about depression.

She talks to Andrew Solomon about depression. She talks about how she herself, this is a little aside, she herself was deeply depressed, apparently maybe when she was in her thirties or something like that. And now she’s older, and she was like, I wouldn’t have been able to do this. Reminds me of the thing you said about Peter. I wouldn’t have been able to do my work, all of this deep relational work and thinking about life had I not been through that depression, that it really changed her. But she also says, if you had come to me when I was deeply depressed and been like, this is going to mean something. This is good. She’s like, it wouldn’t have computed at all. It wouldn’t have helped me. It wouldn’t have meant anything. It would’ve been kind of horrible. And so she’s like, it took me years to figure out how it related to me and who I was becoming. And I really like that too, because many beautiful things come out of hard things, but I kind of love that. She’s like, it’s only yours to figure out, and it actually might take a long time and it’s not going to be perfect. And I actually kind of loved that too.

ELISE:

If you’ve ever read The Science of Spirituality, she’s a professor at Columbia. I just had her on my show as well. Lisa Miller, she’s a PhD, and she introduced me to this concept, similar to what Krista said, where she was saying that psychiatrists, psychologists now understand that there are these periods of they’re actually developmental depressions. And that often, I don’t know when Krista was describing this event, but this, it happens often for people sort of in late stage adolescents into adulthood and then at midlife, and then for a lot of women going into elderhood, menopause, these stage gates and that they’re developmental. And she was like, they’re essentially almost like a spiritual awakening is the way that she would perceive them. And that most often that people look back and say, that flipped my conception of myself on its head and gave me a much deeper tool set for excavating meaning. But as you were just describing, when you’re in it, you’re like, I’m miserable and I just want ice cream or not, or I don’t know. I mean, they’re horrible. Horrible.

LUCY:

Totally. I don’t know if you’ve faced this too, but I also was like, oh, my husband died. I’ve done one of the hardest things. Now I know how to do everything. Now I can handle suffering. And then the next thing happens. You’re like, my kid needs this, or I’m in a breakup. And then you’re like, Nope, not prepared. I just have to start again.

ELISE:

I mean, my brother certainly felt this way, that somehow you feel like you’ve paid a karmic debt. So a few years before Peter died, my brother was one. There was this, I don’t know ultimately what his diagnosis was. He went to jail, but he grabbed a pair of gardening shears in Riverside Park and stabbed a bunch of people, including my brother. I know. Oh my goodness. Can story. I know. It was a wild event. Nobody died. My brother lost his spleen and part of his liver, which I guess rebuilt. And anyway, but after that happened, which was obviously a highly traumatic and surprising event, I just remember Ben and Peter being like, well, we’ve paid, we’ve done it. And then Peter died a few years later. But yeah, I think that there is that too. We think we have a certain requisite amount of suffering that’s ours. And then it’s pastures, but no rights.

LUCY:

So funny, just

ELISE:

Back on your knees all the time again and again, heartbreak, divorce, whatever it may

LUCY:

Be. Right, right.

ELISE:

Yeah. I know it’s not fair. And yet, if you can sort of change the way that you approach these things as some sort of that amazing poem about the box of darkness as this gift that something good will come. Right.

LUCY:

And I feel like this conversation is just going to be like me and you quoting cool women saying things, but there’s on Julia Louis Dragon’s podcast when Jean Fonda was on it on Wiser Than Me, she says, everyone thinks being old is so hard. And she’s like, I love being old. Being old is great. Being young is actually really hard. It is. I love being old, and she’s lucky. Her body is so strong, and that’s also a testament to her, but I’m sure that that’s also a really blessing to her in her older age. But I love that she says that there is one part, which is after you go through more and more hard things as you’re growing up, when the next thing happens, you are like, okay, I think I can probably do this, and that is different. I think that’s one good thing.

ELISE:

Yes. Yeah. I think you have a larger framework or context and you’ve survived things that you thought were unsurvivable. Right? I’m sure there were moments after Paul passed where you were like, I can’t do this, or This is too

LUCY:

Hard. Or if you see it. Yeah. It makes me think about how you also see that across communities of communities that have suffered who are like, this is how we do this as a people. That’s interesting to think about too. Resilience in people, resilience in communities.

ELISE:

Well, I think most of the resilience does come from that community. The ability to have rituals and processes and initiatory events for these moments where there’s a process and the way to be held as you’re going through these. I think that’s fracturing, which is really in our culture, in part because this is your work as a primary care physician and working within medicine. But we are so unwilling, and this is, again, I feel such a debt of gratitude to Paul for writing his memoir, but we are so phobic about death and we won’t look at it, and we want to insist that life is to the right and up and that these things are given. But it makes me so happy that this book is so enduring, or that I did a Substack newsletter last year at some point. I’d written a version of it shortly after Peter died about the most loving things you can do is preparing for your own death and to do it young, and hopefully it’s just a Google document that you continue to update over time. But that’s one of my most popular substack, which gives me hope. Oh, interesting.

Isn’t that

LUCY:

Interesting? Do you mean writing things out, or do you mean the passwords for practical? Do you mean writing a letter or something?

ELISE:

I mean, writing a letter would be a beautiful thing to do, and that’s something that I’m going to do now that you’ve mentioned it, but it’s the practical parts, the advanced directive, the life insurance. This is what I would like. These are my passwords. This is where my bank accounts are. These are the contacts for the people that you will need to unwind my life hoping that nobody uses it, but recognizing that is a service of love. That is

LUCY:

A massive gift. Some serious Lou thing, just as a practical matter, by the way, after doing that stuff for Paul, and I did have all the passwords and everything, apple, leave your apple ID password because Apple will not give it out. They’re so stingy about it. And that’s the one, the literal one that was so hard. And then it’s all that you could lose pictures. So anyway, for what that’s worth,

ELISE:

No, no, no. It’s an incredibly important, you don’t think about it. And yeah, we had nothing because Peter died in his sleep. So you’re trying to hack into your partner’s stuff, and that unwinding is really unnecessarily cruel. And yeah, there’s no, in a way, you’re like, thank you for protecting my privacy apple, and yet so much is lost. Right? You don’t have access to emails, to documents, to so many things that you

LUCY:

Need.

ELISE:

That said, that is promising that people are acknowledging that this is important, but we still have so far to go, right. Palliative care is still too small. And you talk a bit about that as a physician, the way that you think about that.

LUCY:

Yeah, sure. I think the main thing is what you said we’re death phobic. And I think it’s a weird moment in history because it’s aging and dying and disability are still stigmatized, othered, and that’s wild. And I think that hasn’t been true across history when things were much more intergenerational and you couldn’t really hide bodies in the same way and stuff like that. So it’s a cultural moment, a historical moment. But anyway, I do think the same cultural stigma that’s out in the world, the battle metaphor for cancer or this sort of wish about forever, longevity and hack biohacking, all of that is just so out there as possibility and technology and the same stigmas that are out in the world follow you into the hospital. And doctors should and are developing better leadership around this for patients and families to be able to actually name what’s happening, to be able to help people see the real truth and then untangle their own values about what they want in their medical care.

And sometimes it truly is just a matter of there’s no good choices. And so how are we going to choose the one that fits us the best when this is actually really sad. And one thing that’s interesting, the advanced directive thing is really real. There’s participating and representing someone if you do have some idea about what they would’ve wanted when they can’t speak for themselves, can be really meaningful and can help avoid medical trauma that can cause a lot of pain for families. And that’s real, and that’s also a responsibility of healthcare workers and hospitals to minimize that trauma. But one thing that can be really helpful for patients and families is the field of palliative care and asking for a palliative care team to be part of your care, because that’s a whole medical specialty that actually grew up around this unmet need of what is everybody doing about quality of life and what is everybody doing about thorny medical decisions? And you don’t have to have a terminal illness for that. You could just have a challenging illness, could have Parkinson’s, you could have heart failure, just something that could go on for a long time or be unpredictable, and they are so helpful, and hospice is a teeny part of that field. But palliative care is really big, and it’s helping people with quality of life around illness

ELISE:

Because there are all these, BJ Miller is a really dear friend, and he has, it’s called metal, M-E-T-T-L-E, and it’s a counseling service essentially around palliative care, but it’s again, not the same as hospice. It’s not necessarily what you need when you are in your last weeks or months. It is questions about sex and you’re taking and loss of, loss of body functions about life. Yeah. Yeah. They’re there to help with those conversations. I think that it seems so isolating and lonely, and you’re like, am I the only

LUCY:

Person

ELISE:

Who can I ask? Who can I talk to? Who knows? Whereas so many people know, but people are just siloed, right? Yeah, totally. Yeah. Yeah. It’s a shared experience even though it seems so solitary and singular and

LUCY:

Lonely. Yeah, totally.

ELISE:

Yeah. Just to double click on the advanced directive, I mean, my parents are obsessed with advanced directives, and my mom is continually updating hers with if for her, I think similar to Paul, cognitive decline is her biggest fear. And so she is like, if I become demented, I do not want to be fed. And I mean, she’s just incredibly specific, which that’s to be helpful. It’s hugely helpful. And again, I think that when we shy away from actually thinking about what we want and making our loved ones guess or make horrible decisions on our behalf to prolong our lives, even if we’re have no chance of recovery, et

LUCY:

Cetera,

ELISE:

You hear these stories, but how do you make that, it’d be such a gift to make that decision for yourself on behalf of someone else so that they’re not saddled with that responsibility. Right.

LUCY:

Totally. And at the same time, I think that’s so nice that she laid it out. That’s really cool. Then. Yeah, in the future, if you have to help make a decision for her, you can be like, well, the thing that was so important to her was lucidity or whatever.

ELISE:

Yeah. Well, I think that often we’re engineered, and I thought that they did a beautiful job of this. Have you seen the Pit, the Wiley show? Yeah.

LUCY:

Yeah, yeah, yeah.

ELISE:

But they did a beautiful job in that show of grappling in that one episode with this idea that we become just so convinced that we need to prolong life. And that’s what I think is also so amazing about Paul’s legacy is that his life was not long, and yet it was so deep. We get confused. We get it quite backwards. I think about all the bros who are biohacking and obsessed with the singularity and longevity, and this is how you want to spend your time. We don’t have that much of it. It’s a

LUCY:

Wild gamble. Right, right. What’s interesting, when you just said about that thing about pushing for life extension, there’s a narrative in medicine of do everything. If you bring your family member into the emergency room, they’re super sick, and you’re like, do everything. Do everything. And doctors are sort of scared when patients, patients or families say, do everything like, well, does that mean do CPR even if you’re definitely dying? Or does that mean you want to be on a ventilator? We’ve seen people suffer that way or have things happen that they don’t want. So how are we supposed to say, no, we don’t think you should do everything. But there’s this palliative care doctor named Steve Pantel at who did a Ted Med talk about this, and it’s so beautiful because he says, when a family and patient say, do everything, he’ll be like, do everything in service of what?

Do everything toward what. And as an example, there was this family who brought their really sick grandma in, and they’re like, please do everything for her. And it turned out that when they actually unpacked it more, it was do everything for her dignity. And what she really wanted, as they talked about it more, was they ended up bringing some beautiful clothes of hers, and she put on this beautiful makeup in the hospital, and it was do everything so she can feel like herself while she’s sick, and then we can have this beautiful time with her. And it was totally different from if you’re a doctor and you just made an assumption about what do everything meant. And I think maybe even asking the question helps the family just take a pause and be like, wait, what’s actually happening? And what does she really care about is so beautiful. So do everything for what?

ELISE:

Yeah. I love that. Just the continuation of a sentence and to help people in those moments of panic,

LUCY:

Fear. Yeah. Do everything to be you, stay connected or stay connected to what you care about. Yeah.

ELISE:

And I wonder how much of that, and I know that this is a big through line in when breath becomes air, but it’s the distillation of the values of your life. And I feel like so many of us don’t live those values because we’re searching for stability or whatever it is, all the other things of life, and then you’re trying to shoehorn it in the end, and I didn’t do the things that matter, and I don’t know how much panic is that at the end. I missed too much of life. You must have so many conversations with people about that. How do you think about that, a values driven life and bringing that to the fore?

LUCY:

Yeah, I mean, I do think those two things are related. I think if people feel like they’re dying, dying in a way that they can accept or dying, well, so to speak, I think it actually has to do with living well and realizing that you lived a life you’re proud of. There’s this Layla chatty poem where it ends and she says, my God, to have lived a life I would die for. So beautiful. And so I think those two things are two sides of the same coin. There is Ira Bak, the palliative care doc talks about, I think it’s the five conversations or the five questions that people, is it, I don’t know. He says, there’s a bunch of things that everyone kind of ends up saying at the end of their life. And it’s like, forgive me, I forgive you. I love you. There’s just some things that people say. And so I do think as you’re living your life, choosing your relationships, ending things, starting things like parenting, what are the things that make you proud right now? Those are the things that are going to make you proud later.

ELISE:

So Ira Bok, I grew up with Ira, his daughters. Yes. And Satya is a very dear friend. Well, they’re both friends, Lela and Satya, but we were just talking about him because we were talking about the Pit, and he actually worked on that episode or consulted on that episode. He seems so cool. And the four things. So these are the four things before Goodbye. And this is what Noah Wiley instructs them to say to their father, please forgive me. I forgive you. Thank you. I love you.

LUCY:

Amazing.

ELISE:

I know. So I love that. That’s fun. Full circle moment. But anyway, that’s the four things. And for many provide sort of a summation, closure moment of your life,

LUCY:

Right?

Yeah. And I think a lot of people, it’s so hard. You’re not like, oh, I’m mapping out my life and I have control, but I just feel like if you make decisions that are the most true to yourself through your life, I think that there’s a lot of people who look back and they’re like, oh, man, what I really wanted was this, and I didn’t do it of X. It’s giving yourself permission to be you and choose in a way that makes sense to you at each moment. Stand up for what you believe in. I think that matters to people a lot at the end of life. From what I’ve seen.

ELISE:

It seems too that I’m just thinking about our instinct to compartmentalize. And I’ve been reading the books of Avi Loeb who is coming on the podcast, and I don’t know if you’ve heard, do you know of him? He’s this fascinating guy, and in a weird way, he reminds me of Paul because he grew up on a farm in his mother, I think had a PhD in comparative literature, and he grew up wanting to be a philosopher specifically and just deeply immersed in the humanities. And then through a number of moments of fate or synchronicity, he ended up studying plasma. He sort of had a way within sort of his

LUCY:

With plasma

ELISE:

Within his tenure as part of the IDF. He is an incredible scientist, and so he was working on plasma. He ended up at Princeton, and then an astrophysicist was like, I actually sort of like your mind, and maybe you want to come and study here in sort of a post-grad way. And now he is an astrophysicist and he runs at Harvard. He runs the Galileo project, and if you’ve encountered him, it’s because

LUCY:

So interesting.

ELISE:

He wrote this book, extraterrestrial and Interstellar. And when these few objects like Atlas three or Uma Mua, these interstellar objects, he’s the one who’s like, there is a chance that this is an alien technology or artifact of a civilization similar to the way that we are putting all of this stuff into our solar system that has found its way, and people just go nuts. The public obviously loves it, but other scientists get so upset. And his point and why he’s just in his own way, a total sensation now is he’s ultimately a philosopher. He is involved in the deepest meanings of our cosmos.

LUCY:

It sounds like he’s comfortable with unknowing.

ELISE:

Yes. And I think about Paul and sort of his love of books and being a comedy writer and his deep love for the humanities, and then this turn into neuroscience, but there aren’t enough people who feel comfortable non compartment

LUCY:

Decompartmentalize

ELISE:

Are.

LUCY:

Yes. And

ELISE:

So I think it’s, you see these people, these flashes into culture of people who are like, I’m not going to write this as a neuroscientist. I’m going to write this as a deeply feeling human that’s engaged with the deepest questions of life.

LUCY:

I love

ELISE:

That. And we need more of that. And I think you’ve written about this as a physician transitioning from talking to your patients about the data-driven decision or the scientific explanation for what’s happening, and then shifting into English or questions of meaning

LUCY:

Or shifting into being, I see you have tears in your eyes. Yes. And then you sit there. Yeah. Yeah. I remember when I went to medical school, I was like, oh my gosh, this is using every part of me at the same time. It’s your head and your heart and your intellectual mind and facts and story. I remember just being like, I cannot believe I’ve never felt like this before, where it was everything all at once.

ELISE:

Yeah. And do you feel when you think about the medical industrial complex and where we are, and it feels like there’s this urgent need to actually bridge or bring these two things back together, we went too far right into sort

LUCY:

Of Yeah, it’s really gnarly. There’s so many. It’s injurious to human beings who are in the system. Like Walter Cronkite said, the American healthcare system is neither healthy nor caring, nor a system. It is weird. It is like medical industrial complex where I think human beings all across it are having a hard time. It’s a business and it’s fractured, and yeah, it’s all science and choices and efficiency. And I think there’s a lot of healthcare workers who are super burned out or super morally injured. And I always tell students, if you end up feeling like this isn’t for you, I mean for some people it’s just genuinely not for them. But there’s a lot of healthcare workers who are like, am I the only one? Why am I not doing well in this system? And you’re like, well, if you’re not doing well in this system, it’s the system. It’s not, you keep going. But at the same time, there’s so much beauty, but all of the structures and profiteering is just bananas. It’s bananas. I feel like, honestly, I’m literally apologizing on a daily basis, embarrassed.

ELISE:

We are in such a strange, obviously incredible, and I don’t say that necessarily in the most positive way, but this moment where considering what’s happening at HHS and what’s happened to science and what’s happened to the CDC and the NIH and grants and research across, it’s just an abomination, and it is devastating. And so it is so hard to sort of join in this chorus of we all deserve better, and this is broken. And women need to be studied with the same level of intensity as men have been studied for however long, and all of these things which are fair and true without also feeling like you’re participating in the destruction of a sacred institution that we’re also dependent on. Anyway, it’s a really such a tricky situation to be, this needs remodeling and also watching it be completely dismantled. When you look into the future in that context, do you feel optimistic? Do you feel like we’ll be able to actually maybe with this instruction build something entirely new?

LUCY:

Yeah, I mean, I was just thinking about, as you were saying, that was all the ways that the gaps are getting filled in that are outside of the system, whether it’s abortion care networks or startups are coming in to take care of perimenopause and menopause, and that’s outside of the traditional healthcare system, or it’s just all the ways that communities support each other’s health mutual aid, or the way that food programs actually have way more to do with health than a very specialized type of medical care. I think health is defined so broadly and people, people and people take care of each other. So I think, yes, I think it’s really hard to watch this destruction, and there are many, many smart and living people working on filling all the gaps. I think both of those are true at the same time.

ELISE:

Yeah. Well, I think about that too. It’s almost like the healthcare system in its own way as proxy, as a symbi, as an organism. It’s on a macro and micro level. It will maintain homeostasis, right? It’s going to fill in the gaps. It’s going to modulate between, I don’t know. So I similarly feel

LUCY:

Optimistic.

ELISE:

We are incredibly gifted problem solving creatures, and that those higher impulses will able to, that we will figure out how to shore up our children’s vaccination. We will solve these problems

LUCY:

As they’re, yeah, I mean, I hope so. It’s hard. It’s hard. There’s the politics and the profiteering, and it’s incredibly racist and sexist, and I don’t know. I don’t know. It’s all of it at once, but it’s not good, but

ELISE:

Yeah. Right. I’m curious, as you’ve taken Paul’s work out into the world and your own experience, what can persist in being the most resonant for people? What do they want to talk to you about?

LUCY:

Yeah, it’s interesting. I mean, tons of people, I hear from all kinds of people from high school students, which is really interesting to older people, people all around the world, and the main things people are talking about, meaning mortality, suffering, and then kind of broadly what you were just talking about, which is how to live a values driven life. And that’s what young people talk. Young people are reading it, which is so interesting. It came out in 2016. The people who are high school students who are reading it were kids when it first came out. That’s really interesting to see. And those guys are talking much less about mortality, but more, although somewhat talking about finitude, oh, I’m realizing this is my one life, that kind of idea. And then thinking about, well, how do I tease out among all the things that are coming at me all the time, who I am and what’s important to me in my daily life? So that’s really interesting to hear about.

ELISE:

Yeah. When do you think that the idea of death becomes more understandable to young people? I feel like young people don’t get it necessarily. Right. You’re not as attached. You definitely don’t think it’s going to happen to you. You don’t want to think about it happening to your parents, but there’s something about it that that doesn’t have the wall up that it does for you and me. Right.

LUCY:

When

ELISE:

Do you think that that settles into our psyches?

LUCY:

Good question.

ELISE:

Is it like twenties?

LUCY:

I’m sure. Yeah.

ELISE:

Yeah.

LUCY:

I don’t know. I mean, maybe when it happens and you see it, but also little kids are even really smart about it. I don’t know. I remember there was this thing Katie said, Katie had found this little bell from our wedding. We had these little golden bells. Paul was Indian, and there were a number of Indian influences in our wedding, of course. And everyone who came got this little bell, and they rang it when we were coming out of the church, and she found one and she’s, what is this? And I was like, oh, that’s from my wedding with daddy, and she’s with I at the wedding. And I was like, no, you weren’t even in my tummy yet. You weren’t there. And she’s like, oh, that’s when I was dead. I was like, whoa. That’s when I wasn’t there yet. And then now daddy, and then she and Paul crossed over, and then now daddy’s not here and he’s dead.

And I was like, whoa. That’s smarter than anything I would’ve said about that. Just this idea of non-existence and then her sort of accepting that non-existence just as a fact of timing. And so I don’t know, kids are smart. I feel like also kids kind of learn that through animals. There’s a dead bee on the sidewalk and our pet died. And then it’s like, I mean, depending on how things go in your family, some children are exposed to way more, but then your grandma died, and then it’s just sort of starts to creep in as an accumulation, hopefully in the natural order. But I don’t know. I feel like kids start out smart.

ELISE:

They do. I was just thinking about Tatiana, and I don’t know how old her daughter is. Her daughter is still a baby, right? Or a toddler. And that was so moving in the New Yorker when she wrote about this idea that her daughter will really only know her through memory or through other people’s stories. And how, for Katie, how does that grief materialize for her? Or do you feel like she gets a lot of sustenance from the people around you who knew Paul who can fortify her memory of him, but has that shown up for her or not yet?

LUCY:

Yeah, it’s interesting. We just moved house and I had all of our art laid around in our living room, and we were figuring out where to hang up what? And I was like, do you want to come and look at our family art and see which things you would want for your bedroom? So she chose a painting that my aunt did and this funny clock that we used to have in our kitchen and a couple other things. And then she chose this little picture of her and Paul and for next to her bed. And it was really interesting to me. I was like, whoa, I don’t know what this means exactly. And I didn’t ask her, just sort of let it be, but I was like, oh, that’s so interesting. She’s starting to claim him as hers. And I think for a while he was just kind of around.

He was everywhere in nowhere at the same time, and she doesn’t have a memory of him, so that’s kind of hard. A lot of other people do remember him. So I’m really curious to see. It’s just interesting though, because kids kind of accept what is at the same time, sometimes I’m like, she’s just as upset that she doesn’t have a sibling as that. She doesn’t have a dad. These are just my facts and where’s my baby sister? Come on. So I think some of it figures and it doesn’t, or it just is what it is, or I don’t know. Some days it’s fine, and a lot of days it doesn’t even figure. And so I think just the fact our family just looks different from other families period is a thing, which is fine, but it’s a thing for her. And so I’m curious how she develops in terms of her actual relationship with him.

ELISE:

She

LUCY:

Knows a ton of facts about him. We have a lot of pictures of him. His brothers are huge in her life, and his parents and those cousins. And so that’s all just is what it is. And then a lot of, I’ve been approached frequently about making a movie of when breath becomes there, and it’s never resonated for me or been something that I want to do for a variety of reasons. But I have this idea of I wonder if 25-year-old Katie will decide that she wants to be an executive producer and work on that, or a filmmaker. I mean, I don’t know what she’s going to end up being, whether that would be a big part of her life or a little part, but I was like maybe representing Paul as I sort of had this fleeting daydream about it. Maybe she’ll do that. That’ll be a project for her. I have no idea how it’ll unwind in her life.

ELISE:

Yeah. Well, it’s amazing when you think about the gift of his book and the way that she at someday will come to know him on the page, it’s very moving.

LUCY:

Right? Right. And it’s in the book. He’s basically saying, I mean, he was writing it knowing that she would read it, hoping that she would read it, and so he’s showing her who he is or a slice of who he is. He’s like,

ELISE:

You

LUCY:

Got to work hard

ELISE:

And

LUCY:

You’re loved.

ELISE:

I know we’re at overtime, but one more question, which is, do you feel his presence? Do you feel his presence in your life?

LUCY:

Totally, totally, totally. I mean, I’m not sure in a mystical way per se, although I often do hear bossanova in weird moments, someone will be playing sax on the street, and then I’m just like, wait, what? I was just thinking about you. But yeah, he’s just in my thoughts frequently sort of in and out. If I think about, oh, what advice would he give me? Or he always used to be like, you’re doing a great job, and I’ll hear that. And so it’s more like, and I’ve fallen in love again, certainly. And at the same time, I’m like, he’s my family. He’s my family. I think if someone had a child who died, then they have other children or another child. You’re not like, oh, these kids, we police the other kid. It’s like that. That was my husband, who’s my family, and then if I fall in love again, there’s someone new and there’s also him forever.

ELISE:

Oh,

LUCY:

I love you. Thank you for having me. I’ve really been looking forward to this so much.

ELISE:

Same. I’m so happy to see you

LUCY:

Again. Yeah.

ELISE:

I will link my first conversation with Lucy, which is more about the substance of their relationship and how they met and all of those fun things along with the decision about whether to have Katie at all, because they had Katie when he had his diagnosis and they knew that he did not have long to live, and I didn’t want to do a complete retread of that conversation here because it exists, and it’s interesting to listen to it almost as an artifact, a different time. But that book, I mean, it’s wild to think that that could be your legacy, right? To write essentially a book that’s similar to Man’s Search for Meaning. I know we mentioned Viktor Frankl, but it is one of those books that is in the cannon. Thanks for listening. If you got something out of today’s episode, I would so appreciate your help spreading the word. Please rate and review the episode, follow pulling the thread on your preferred podcast platform, and share this episode with a friend who would also enjoy it. That’s how we grow this thing. It’s so helpful. Thank you.