← Good Life Project
Good Life Project
When Life Meets Reality | Finding Grace When the Future Falls Apart | Lucy Kalanithi
00:50:31
Loading summary
Transcript110 lines
- [00:01]
Jonathan Fields
Simple question, brutally hard answer. When life upends everything you thought would be coming in your future, what still matters? I have been wanting to have this conversation for a long time. Ten years actually, and today I'm sitting down with Lucy Kalanithi, a physician and storyteller whose life and work they sit at the intersection of medicine, meaning and love. And Lucy is the widow of Paul Kalanithi, author of When Breath Becomes Air, a book that many of you know well. And it's a book that has really moved me profoundly, one I've read many times and often reread at the beginning of every year to kind of reorient me around who and what genuinely matters. Paul wrote the main part of the book, or most of it, as we'll learn, and Lucy wrote the epilogue, a piece that brings the story fully into the heart, including writing in vivid detail her husband's death scene, which she shared, is exactly how he'd have wanted it. Ten years later, she's still living these questions not as theory, but as life. Just deeply invested in how we devote our energies and deepen our relationships and our love and truly center what matters. And we talk about how our relationship with time changes when certainty just disappears, how values can guide decisions when plans fall apart and what hope really means when winning is no longer the frame, and how to build a life that actually fits who you are to not who you thought you would be or the life you thought you would have. This is a conversation about grief and love and medicine and parenting and choosing what matters most when the future feels fragile. So excited to share this conversation with you. I'm Jonathan Fields and this is Good Life Project. Good Life Project is sponsored by Audible. So if you've ever hit a moment where life feels a little too full and you're craving something that brings you back to yourself, Audible has become that small, steady anchor for me on early morning walks. I've listened to their well being collection and it's such an easy way to reconnect without adding anything heavy to the day. You can learn from voices that genuinely lift you up. Renee Brown on courage, Jay Shetty on mindset, Jamie Oliver helping you rethink how you nourish yourself, or even soundscapes from the sleeping world when you just need to rest. I've also been spending time with Raising Good Humans for gentle reminders about how we show up in our relationships. And there's so much more to explore. Audiobooks, original series, sleep tracks, wellness programs. It all helps you imagine more for your life. One listening moment at a time, so give it a try. Kickstart your Wellbeing with your first audiobook free when you sign up for a 30 day trial at audible.com goodlife or just click the link in the Show Notes. This message is brought to you by Apple Card so it's a great time to apply for an Apple Card you'll love earning unlimited daily cash on every purchase. That includes 3% daily cash when you buy the latest iPhone, Air Pods and Apple Watch at Apple through this special referral program. When you get a new Apple Card, you can earn bonus daily cash. To qualify, you must apply at Apple Co getdailycash Apple Card issued by Goldman Sachs Bank USA Salt Lake City Branch offer may not be available elsewhere. Terms and limitations apply. Good Life Project is sponsored by Pura, so we talk about shaping our days with intention a lot. One of the most overlooked influences is actually scent. Pura lets you choose clean premium fragrances and control them from an app. When they turn on, how strong they feel and when they fade into the background. Nothing overpowering, nothing accidental. I love that scent becomes a part of the rhythm of a day, energizing when you want to lift softer when you want to just slow things down or just completely off, when stillness feels better. And right now Pura is offering a free PURA plus diffuser when you subscribe to 2 cents for 12 months with a 30 day risk free trial. Visit pura.com or just click the link in the Show Notes. Your late husband Paul's story, and necessarily elements of your story together are shared in his memoir, When Breath Becomes Air that became this giant global phenomenon. Really, he writes the heart of it, you write the epilogue for it. Necessarily. This book has actually meant the world to me. It's helped me think and feel and question what I truly want sort of from and for my life. I often reread it in the beginning of every year, which actually just did shortly before this conversation.
- [04:24]
Lucy Kalanithi
Same, same.
- [04:25]
Jonathan Fields
And it never ceases to move me and make me see things that I didn't see before and explore things that I hadn't explored before for those who haven't been exposed to the book for context for some of the early part of our conversation, can you share a bit more about this kind of incredible love story and what happened then also in the years leading into the book, which was, I guess about a decade ago.
- [04:48]
Lucy Kalanithi
Yeah, thank you so much for saying that. That like really brings tears to my eyes and it means a lot to me that you've reread it as well. So yes. When Breath Becomes Air was written by my late husband, Paul Kalanithy, who was a neurosurgeon and writer. We first met when we were in medical school at Yale. And he initially had thought he would never be a doctor. He thought maybe he'd be an English professor or a philosopher. And then became really intoxicated by questions about meaning and mortality. Actually, even as a young person, was really in love with literature, got really interested in bioethics and thinking about the mind and the brain. And then that ultimately led him into medicine to try to sort of grapple with really meaningful, meaty, ethical and emotional questions with his patients. And he became a neurosurgeon. Ultimately, he just loved people who were going through a crisis and thinking about identity and meaning. And then when he himself was a chief resident in neurosurgery at Stanford, which was about 10 years after we had met and gotten married, I'm an internist, so I was moving along in that career as well. He sort of started to develop a set of ominous symptoms and started losing weight and becoming really fatigued and having back pain. And initially we thought it was because he was a hardworking surgeon and.
- [06:14]
Jonathan Fields
Right. And neuro is also, like, one of the most brutal ways he can spend your waking hours on the planet. So it's like suffering is. Even in the best of conditions, is a part of the experience.
- [06:24]
Lucy Kalanithi
Right, right. It's like you yourself don't have a body. You're like just a neurosurgeon. Yeah, yeah. So. But his sort of started to disintegrate, and he realized, ultimately, we realized, that he had stage four lung cancer, which was obviously totally upending and shocking. And so in order to cope and face what was happening to him, suddenly he was the patient on the other side of the table. He started reading voraciously again and then started writing, initially as a way to process what was happening and then sort of as a new vocation as he became unable to work as a surgeon. And he lived for 22 months after the diagnosis. He died 10 years ago. Died almost 11 years ago. We had a baby during that time also, who now is a sixth grader. And then he finished, almost finished the manuscript for When Breath Becomes Air and had just handed it over to the editor and publisher and then died. And so ultimately, I worked on sort of, like, tying it together and then putting this capstone epilogue on it, like you said, which was about reflecting on Paul and what happened since his death. And then also, also, like, really importantly, told the story of the day he died, which actually was like a very, very Paul day. And I think if he could have told that story, he would have. So that's why I did. And then as a grieving person, it was really wild and incredible to do a book tour for him. Just like, really helpful in grief and wonderful and meaningful to me as a physician to be talking about end of life and talking about healthcare and talking about being a person and threading that all together. My career has become like much more storytelling. And then now it's 10 years after Paul's book came out. So it's another interesting moment to dip back in and get to talk to you. And a number of different things in the course of my own evolution.
- [08:26]
Jonathan Fields
It's such a beautiful story. And you started out by saying that Paul was a neurosurgeon, scientist, and also a writer, but he wasn't a writer just because he wrote this book in his final days. This was a thread that. I mean, it seems like earlier in life, that's actually the thread that he was following, like a deep, deep love and passion for literature and writing. And it's almost like the left turn into medicine was almost like. It sounds like, only because he couldn't get what he wanted, at least at that time, through not understanding the actual organ that is the source of so many of the questions that he had. Is that in any way on point?
- [09:05]
Lucy Kalanithi
Kind of. It's really interesting you say that. That like he was a writer first, because I agree. And then I also think he wouldn't have been the neuroscience work purely abstractly, like, it truly was related to people and patients, for sure. And so, like you just said, it was all really intertwined. I think he ultimately didn't see those things as separate. It was like science and philosophy and the humanities. So we're sort of all like circling around this questions of what does it mean to be human? What does it mean to build a meaningful life? Like, what does it mean to face up to suffering? Like all of those. He was super interested in that question. And so to totally. And literature. He thought literature was like, the way. Like the most honest way to look at what humans are up against.
- [09:53]
Jonathan Fields
You know, the book tells a lot of his story and some of yours, but you're also the one who was going through this. You were living every minute, every second of every day with him in the years leading up to. And then the two years, and I guess you said two months of illness before he lost his life. And then when that happens, as you described, he's almost Done with the book, he turns it in. But the book still needs an end cap, you know? So you write this epilogue, which is. This is not a typical epilogue. This is not a, quote, ordinary epilogue, because you effectively tell the story of how this book actually came to be. He was telling his story leading up to the final days. You tell a story of how this book actually emerged from those final days. And as you just described, you write the death scene because nobody else can but you. And I've often wondered, what's it like for you?
- [10:47]
Lucy Kalanithi
Yeah, I mean, writing the epilogue actually was a big surprise to me. I didn't. The Random House editor, Andy Ward, who's incredible, approached me and said, we'd love you to write an epilogue. And I was like, what? I'm not a writer. And then I was like, actually, it's really important to tell this story. And then it just kind of came pouring out of me. And I was like, oh, this is why writers write. It's like, you know, you write because you have something to say. And then it turned out, you know, like, just during grief. It's like, I'm a doctor. Paul was a doctor. We knew he had an incurable illness. We knew he was going to die at some point, way sooner than expected. On the day he died, I knew it was the day. And at the same time, when he died, I was, like, totally shocked in a way, because he just disappeared. Like, he was there, and then he disappeared. And it's like you're in your same life where he used to be, and then he disappeared. And so the thing that was really interesting to me was the time that I felt most like myself, during those, like, unspooling months, as you're kind of like, molting a relationship. The time I felt most like myself was working on the epilogue because he and I had been so intensely partners. Everything from talking about the emotions of it to I was over here managing all these medications so that he could focus and so that he could sit comfortably and so that he'd be able to write. And so the book as a project, still existing, and then me feeling like I was still doing it, in a way we were still doing it, was truly helpful.
- [12:27]
Jonathan Fields
Yeah.
- [12:27]
Lucy Kalanithi
Oh, can I tell you something interesting?
- [12:29]
Jonathan Fields
Yeah, yeah, go ahead.
- [12:30]
Lucy Kalanithi
So it's the 10th anniversary of the book, and so Random House approached me about, would I want to record the epilogue in my voice? Because initially we didn't. And I had said no 10 years ago because Paul had just died. And I was like, well, if Paul's not here to do his bit. I'm not going to do mine. I'll choose the voice actors. So I did, and then they asked me, okay, now do you want to put it in your voice? And so I said, sure. And it was so interesting. I went to a studio at Stanford to record it. This was about like a month ago. And I didn't practice it or even really reread it ahead of time because I was like, I know this so well. And then it totally shocked me how emotional it was like to narrate and read through that day again. And it really shocked me. And the director said, you know, if you need to take a break, you can. And I was like, I'm so used to thinking about this, I won't need to. And then I totally did. But the really interesting thing was, like, reading it 10 years later. I don't know, you know how, like, Taylor Swift re recorded a lot of her own songs to get her rights back. They're called Taylor's Version. But there's a sort of interesting phenomenon where an angry song will have, like, other layers of like, anger maturity or whatever. It's like, her voice is different, she's different. So that was kind of a strange experience to like, read that in sort of this telescoping way of like, I'm me now and I'm reading me then. And at the end of the very last page, the director had kept saying, like, picture that you're reading this to a small group. Like, you're not reading it to a big group. You're not reading it to, like, unnamed. No one. Like, picture a little group that you're communicating to. Which is weird because the whole epilogue, in a way, is like delivering bad news to the reader. So there's like that piece of it as well, sort of like a softness and a, like, intimacy. But on the last page, she said, get in your feelings, whatever they are, and make sure that you're reading it from you. So I finished it and the last line is, it says something like, you know, Paul wondered throughout his life whether he could face death with integrity. In the end, the answer was yes, I was his wife and a witness. And that's the last line. And so I read that and she was like, oh, that's not how I thought you were going to read it. She's like, I thought you would read it maybe like, more lightly, but you read it, like, really strong. And I was like, oh, that's so interesting. Like, I think that's me now, you know. So anyway, that was really interesting. I just wanted to share it with you. Yeah.
- [14:54]
Jonathan Fields
I mean, how wild to actually have that experience. And it's like, it's the same words, it's the same story.
- [15:00]
Lucy Kalanithi
Right.
- [15:01]
Jonathan Fields
But you're a decade further into your life. You're a decade further away from his death.
- [15:05]
Lucy Kalanithi
Right. So it's like Lucy's version.
- [15:08]
Jonathan Fields
And it's like you're then also a witness to how you've shifted in those 10 years as you're reading this. And it's like, wait, wait. How interesting is this? The way that I'm feeling while I'm doing this?
- [15:19]
Lucy Kalanithi
Yeah, yeah.
- [15:20]
Jonathan Fields
So that epilogue, when I first got the book, which is pretty much when it came out, 2016, I read the main part of the book. I was traveling. Then I got on a plane and I started reading the epilogue. I got like three pages in and had to close it because I'm sitting on a packed plane, shoulder to shoulder in a middle seat and I start weeping and I'm like, this can happen on a cross country bike because they're going to think something really bad is happening here. So I close it up, I come home, and it absolutely wrecks me in the best of ways. And thinking about and reflecting on it and having shared, I've reread both a number of times now. The core of the book put me so deeply into my head. It was a deeply personal and powerful story. But also there's a lot of thinking, there's a lot of exploring the big question, the big issues, meaning, value, vocation, calling, and we'll talk about some of that. The epilogue took me from my head and dropped me into my heart. And I realized this would not have been the same complete experience without that, because it did something so deeply beautiful and powerful that brought the whole thing home. And that's why I think I keep returning to it and why it's so powerful for so many people, because it integrates these two parts that we often don't spend time together with.
- [16:45]
Lucy Kalanithi
Yeah, yeah, thanks for saying that.
- [16:47]
Jonathan Fields
Yeah. So before any of this happened, what did you believe sort of deep down about how life was kind of supposed to unfold and look and work?
- [16:58]
Lucy Kalanithi
You know, I think I sort of had a set of implicit assumptions that were like, somewhat unquestioned, which was sort of like. And Paul had these two, as he describes. But I think I sort of used to think of like, life as a path. Like I'm on the path and it's like. Or sort of. It's like a. It's like an upward slope and it's like I'm gonna keep working hard and I'm gonna like climb the mountain. And then I think just the real like obviously when something totally upends your life or in any way, but certainly like Paul's illness and death exploded everything. And so I think the way I think of it now, it's like I'm much more aware of like unpredictability and finitude and. And I think of life now as sort of a series of moments. You know, like now I'm in this like middle school moment with my child or like when breath becomes there has been a moment or. And it's like other moments around the corner and I don't know who I will be or what the moments will be. And at the same time I've come to really trust my instincts, you know, like, it's like you can only make the best decision you can at any given point with the information you have. It's like you're sort of just like hopping to the next lily path that lights up. So I feel like that's become sort of like I have a trusted place that I'm standing. But then it's like I don't think you can necessarily rely on knowing where you're going. A hard part about that is, you know, part of the mountaintop like path thing was entering medicine as like a young academic physician and thinking like my career is going to look a certain way and you go on to the professoriate. And my interest was healthcare value and thinking about policy and delivery. That has really shifted in a way that I've had to accept some pieces of not being as hard driving as I planned to. But at the same time I feel like another thing I learned is you kind of can't have it all. You sort of think you can, but it's like something will always suffer if you're trying to have everything. Or like the flip side, it's not even a negative thing. It's like, it's just that you must, you have to choose what you value the most about who you want to be and what you want to have. So like, for me as a parent, that's my number one. And so just like ending up with career flexibility was more important than I thought. And so I just think there's a number of things where, you know, you have to parse out, like what trade offs you're willing to make because I do think you can't have it all, but you can have a whole bunch of great moments or you can choose and like build something and then go on to the next thing.
- [19:39]
Jonathan Fields
If you look at social media, you absolutely can have it all, all the.
- [19:42]
Lucy Kalanithi
Time.
- [19:44]
Jonathan Fields
The fantasy world that's being sold to all of us. But yeah, I think that's a reality that so often you face when you're in a moment where you or someone very dear to you faces mortality. And also when there's a micro season where you kind of know something is reasonably inevitable. Right? Yeah, but you don't know 100%. But there's a fair level of certainty, but you have no idea if and when or what the shape it's going to take is. And that's like everything goes into the hopper of re examination again.
- [20:16]
Lucy Kalanithi
Yeah.
- [20:17]
Jonathan Fields
And we'll be right back after a word from our sponsors. Good Life Project is sponsored by adt. So there are those small moments that suddenly don't feel small at all. You're halfway to bed and wonder if the door is locked. You're already down the road and can't remember if the stove is off. Your body tightens because your space just matter. Home is where we're supposed to exhale. That's why ADT exists for moments when every second counts and peace of mind isn't optional. ADT pros can install a customized home security system the right way so you feel secure from the very start. It's backed by 247 monitoring, the most company operated monitoring centers in the industry, and technology that verifies alarms so help can be sent faster compared to unverified alarms. There's also the ADT app, which lets you check in on your home from virtually anywhere. A quick glance can settle your nervous system and let you return to the moment you're in. ADT helps make sure your home is a haven, not another thing to worry about. When every second counts count on ADT, visit ADT.com or call 1-800-ADT ASAP or just click the link in the show notes. Good Life Project is sponsored by Shipstation, so when your work starts to grow, shipping can quietly become the thing that pulls you away from what matters most. Orders increase, systems multiply, and suddenly logistics are running the day. And Shipstation brings everything together in one place. Order management, inventory returns, analytics. Instead of juggling a handful of disconnected tools, you connect to over 200 sales channels and manage it all from a single dashboard. It also compares rates across USPS, UPS and FedEx, including any discounts you already have, so every shipment gets the best option automatically. Here at Good Life Project, we're developing more tangible real world offerings. And having a shipping system that runs smoothly behind the scenes will be so important. So we'll be looking at ShipStation to create the kind of reliable, thoughtful experience we want people to feel from the moment something leaves our hands. More than 1 million businesses trust Shipstation. Try Shipstation free for 60 days with full access to all features. No credit card needed. Go to shipstation.com and use the code goodlife for 60 days for free. 60 days gives you plenty of time to see exactly how much time and money you're saving on every shipment. That's shipstation.com code goodlife shipstation.com code good.
- [22:36]
Shankar Vedantam
Life I'm Shankar Vedantam, here to tell you about a great mystery. That mystery is you. As the host of a podcast called Hidden Brain, I explore big questions about what it means to be human. Questions like, where do our emotions come from? Why do so many of us feel overwhelmed by modern life? How can we better understand the people around us? Discovery your hidden brain. Find us wherever you get your podcasts.
- [23:07]
Jonathan Fields
Value is a word that you just used. And that was a word that actually Paul brought up in the book a number of times. It sounds like his oncologist kept bringing it back up to him saying, focus on your values. Talk to me more about this notion of value, because I think we've all done values exercises in our work and our jobs and stuff like this. But in your mind, what is that and why does it matter so much?
- [23:31]
Lucy Kalanithi
Ooh, great question. I mean, I think the real upshot is living in a way that's true to you. So figuring out your core values is a part of that, figuring out what you value in your life. But I think the main thing is building a life that fits who you are. And then for the oncologist, what she's building around that is building healthcare. Building healthcare For Paul, that fits around, like, how to help him achieve those things.
- [23:56]
Jonathan Fields
And also figuring out with whatever time I have, how do I use it? Well, right?
- [24:01]
Lucy Kalanithi
Yeah. And it's not to say, like, you know, thinking about this thing of you can't have it all. It's not to say, like, definitely put aside your career. Like, there's that thing about, like, no one on their deathbed wishes they worked more. But I actually don't, like, I sort of don't agree with that either. It's like if you're building something intensely meaningful, like, then maybe your work really is what takes you to your highest value. Of course. And maybe it's your family and maybe it's whatever. But I Think that's on each of us to figure out.
- [24:31]
Jonathan Fields
Yeah. There are these common tropes which do say, okay, we should all value this in a particular way. This should be the single most important thing. And maybe for many people, that actually works, but if it doesn't work for you, and then you're trying to hold yourself up to this standard of what I should care most about, I feel like that just layers shame into the equation along with everything else.
- [24:52]
Lucy Kalanithi
Sure, yeah. Like, am I doing it right? And it's like, well, you're you, so you'll know. Yeah. Like, if you really listen to it.
- [24:59]
Jonathan Fields
Yeah, 100%. Part of this conversation is also it's the notion of time in moments like these. How does your sense of time change when you have a high level of expectation that, you know, like, our time is going to be way shorter than we ever imagined it would be, but we don't know what that means.
- [25:18]
Lucy Kalanithi
Right.
- [25:19]
Jonathan Fields
You know, so how do you sort of, like, look at time differently now?
- [25:23]
Lucy Kalanithi
Yeah, time is weird. First of all, like, speaking for Paul and, you know, this reflects in his writing too, but for Paul, like, as a surgeon, he sort of thought of time as, like, 15 minute increments, maximal efficiency. How much can I do in a day? Like, you know, what am I doing in the next one year, five years, like, career arc, then later I'll be a writer. Like, it was all sort of, like, planned and assumed and, like, maximally efficient. And then he got this upending diagnosis where suddenly, like, his survival prognosis is, like, A, unpredictable and B, likely an order of magnitude shorter than he thought it would be. And especially then, and later, when he was dying and time was really short, he ended up saying this interesting thing where he said, like, I used to think of time as linear, and now time feels more like a space, which is to say, like, time sort of doesn't exist, or like, only this moment exists. And there was a really interesting version of that for me as a very young mom or like, a very new mom, when we had our daughter and Paul was super sick and he died when she was 8 months old. And I, like, distinctly remember thinking, this time is really intense. Like, there's all the diapers and the sleepless nights and, like, this is like, I kind of want this, like, infanthood grind to be over, but the closer this is to being over, the closer we are to Paul not being here, that sort of disappeared. It was just like, I'm in the moment of, like, baby Katie, Paul and me. And it did turn out to Just be a moment. And so the hyper intensity, hyper saturation of that was really, really noticeable. And then I think for me, time now, time sort of overlaps with selves in a way or becoming. I think. I think less about time and more about identity. I was actually just listening to this thing yesterday that I refound as I was talking through this with a friend. But have you ever seen Dan Gilbert's TED Talk?
- [27:36]
Jonathan Fields
Yeah, the original one from. It's like 20 years ago or something like that.
- [27:40]
Lucy Kalanithi
Yeah. It's basically about how. Because this is really interesting about time, too. Basically what he says is like, we all have this illusion that the self we are now is like our fully formed self. Like, everything led me to this moment, and now I'm me and I'll go forward as me. And so when people are asked, how much do you think you're going to change and evolve in the next decade? People are like, well, not a lot, because now I'm me. And then if you ask them how much they've changed over the past decade, they say they've changed so much in the last 10 years. And then it turns out if you ask people at any age, they all say the same thing, which is to say everyone thinks they're not going to change anymore, and then everyone does. And I think that's really interesting, actually, because that sort of like, I don't know, like collapses time and speeds it up all at once and just. I don't know, that's the way in which I think time and selfhood are the same thing. For me, we're sort of constantly evolving through time, but also through selves.
- [28:35]
Jonathan Fields
I mean, on the one hand, it's terrifying. On the other hand, it's really freeing.
- [28:38]
Lucy Kalanithi
Totally, totally.
- [28:40]
Jonathan Fields
It's like both at the same time.
- [28:42]
Lucy Kalanithi
I'm buying this house I'll retire in, and you're like, no, you won't enjoy it now.
- [28:48]
Jonathan Fields
Yeah, but it is. I mean, when both of you move through a moment like that also, it's just when all of a sudden time is compressed and you just have no idea. I mean, everyone always references the famous Steve Jobs commencement talk at Stanford about how his illness was the thing that made him really reexamine time and focus in on so much of what was just really reexamined meaning and a sense of who he was and why he was here. So I think it's all folded into the same thing. But we often don't think about any of these questions unless and until we hit a moment or a diagnosis or really close to somebody who's gets bad news and we're like, oh, oh, right. I'm a longtime New Yorker. I was in New York during 9 11. I knew people who went to work that day and didn't come home that night, who were my age, who are young, who are in the early stage, super ambitious, building huge careers.
- [29:43]
Lucy Kalanithi
That's a real reckoning.
- [29:44]
Jonathan Fields
Yeah, right. You're just like, okay, I don't ever leave the house planning not to come home that night. But here's somebody who I know that is exactly what happened then. And when it's that close to you or when it's you and you have some window, like some time to reflect on it, I wonder why sometimes we really never do this thinking until something like that happens. And then when you read the story of Paul, it seems like he was an extreme outlier because it seems like he was just living these questions all the time voluntarily.
- [30:13]
Lucy Kalanithi
But don't you think we are sort of doing it all the time and maybe we should just recognize it? Because if you're parenting, like, you know, I think parents think about that a lot. Like, I just said this little thing, but maybe I just said a big thing, like, I need to think about what I'm saying to my kid or like I'm choosing between two jobs. I really have to think about, like, what do these jobs mean? So I actually, you know, don't you think we kind of are like, we should give ourselves credit for it at best?
- [30:38]
Jonathan Fields
Like, you know, or maybe what I'm trying to get at is maybe we do. Maybe you're right. We are thinking about it all the time, but we're not thinking about it. We are always assuming that we're going to have a significant future. So it's like, ah, if I make the right choice now or if I make the wrong choice, I can fix it. A couple years down the road I'll correct course. And for many people you will, and you'll have that. But seriously, I'm a writer also, and I just turned 60 last year and I'm sitting down to write the next book and then re listening to I want to call it Yora and Paul's Book because I really do see it as like this complete experience. And one of the questions in my head is, what is the book that's important for me to write now? Part of it is if I assume that I've got decades left, I'm going to make one choice.
- [31:33]
Lucy Kalanithi
Ooh, so interesting.
- [31:34]
Jonathan Fields
If I assume that I have months left or a couple of Years left, I'm going to make a very different choice.
- [31:41]
Lucy Kalanithi
Oh, sure, that's really interesting.
- [31:43]
Jonathan Fields
And that was surprising to me. I was like, huh, huh.
- [31:46]
Lucy Kalanithi
Like if this were the last book, right?
- [31:50]
Jonathan Fields
It's like the classic last lecture type of thing. So the assumptions that you make about how much time you have ahead of you, for me at least, it really changes the decisions I make about how I'm going to allocate very big chunks of my energy today and then tomorrow and like next month. And I wonder how different would your life be if you looked back over a decade, if you were making decisions based on the assumption that I don't have a lot of time, but then you end up actually having that time. And then versus if you just assumed, oh, I got plenty of time, then a decade down the road, you're like, huh? How do I feel about the way that I've lived this last decade?
- [32:31]
Lucy Kalanithi
That's really interesting. That's really interesting. And I also think there's another piece of that which is it's like so much of our identities, our present identities are tied up in this, in the idea of our future selves, what you plan to create. Like, whether it's like you're going through school, working really hard because you're going to be this thing, or you're raising a kid or whatever. And so I think, like, yeah, that's so interesting. It's like, what assumptions are you making about who you actually are, even right now, based on what you think you'll do?
- [33:02]
Jonathan Fields
The stuff that spins in my head all the time.
- [33:04]
Lucy Kalanithi
Would you choose for the book the Longview or the other one?
- [33:09]
Jonathan Fields
Literally. I was sitting at a Cafe at 7:30 in the morning this morning looking at two possibilities. And one is actually one that terrifies me, but it would be really fun to pour myself into. It's fiction, which I've never written before.
- [33:22]
Lucy Kalanithi
Oh, cool.
- [33:23]
Jonathan Fields
The other is much more of. It's a little more like, memoiry, which I've also never done before, but I've spent 20 years writing nonfiction, so that's just much more comfortable. It's a knowable domain for me. I know how to do that.
- [33:34]
Lucy Kalanithi
Interesting.
- [33:35]
Jonathan Fields
And probably what I feel would be really important to say is in that book, but the call to fiction is much stronger for me right now. So I'm doing this dance, I'm trying to figure out, what do I do here? And then the big question drops. While I'm thinking about this, I'm like, is there a way to put all of the underlying ideas, insights, Concepts, things I might want to share into the context of a novel.
- [34:03]
Lucy Kalanithi
In fiction. Yeah. My sister says all fiction is thinly veiled memoir, which makes sense, right? Yeah, that's very interesting. My mom actually has a good way to make decisions. Like if you're trying to figure out how to trust your intuition, you actually just do a coin flip and you're like, heads is fiction. Heads is my fiction book. And then you flip it and then if you get heads, just like feel your body for just a second. What did your body do? Were you like, oh, shoot, the memoir thing was where like. Or are you like, yes, fiction. You know what I mean? Do this tiny coin flip and then listen to yourself.
- [34:36]
Jonathan Fields
Yeah, I like that. I'm going to have to try that.
- [34:39]
Lucy Kalanithi
Let me know.
- [34:41]
Jonathan Fields
So for you, as you sort of moved through your career over the last decade or so and you're thinking about, okay, so how do I actually want to allocate my energy? Has there been a meaningful shift in how you thought you would be building your career before and after and how you've actually ended up making choices and building it?
- [34:59]
Lucy Kalanithi
Yeah. So I'm an academic physician. I'm on faculty at Stanford in the school of Medicine. And the really practical change, actually as a clinician, as I moved from primary care, which is my love, to urgent care. So that's like a super practical nuts and bolts decision because for the most part I'm a solo parent and so that gives me time with my kid and flexibility and headspace. But then the real change is that 10 years ago or a little before that, I was in a healthcare delivery systems fellowship at Stanford, really thinking about how to ensure healthcare value, which is like the quality over cost equation in healthcare around healthcare delivery. Like, how do we change health systems and implement new delivery models that will be higher value for patients. And then going through the, like taking care of Paul when he was sick, doing a book tour for Paul, thinking a ton about end of life care and palliative care and caregivers, family caregivers. The thing that's kind of intertwined for me is the places in medicine where the business case for improving something, the way we do something, intersects with the moral case or like the human humane case. And so that is so many of those same places. The way we do end of life care in America, the way we recognize and value caregiving, the way it should be valued, the way we take care of healthcare workers and their moral distress and ability to do their job in a loving, you know, protected way that's been really interesting. And I've also become so much more of a storyteller, I think. I used to think there's my doctor self and I'm sciencey and I'm smart and I'll translate things for people. And now I do feel like I'm more of my full self in every context, sort of just by practicing that as a speaker and thinker in these same domains where I had this academic expertise. But now I'm bringing a personal story and I'm, like, sharing it in professional context also. And I think maybe that's a characteristic of good leaders generally, actually, is to step into yourself in leadership contexts. And so it's sort of a broader lesson to me. And then I think, you know, as you go along in medicine, certainly, and you sort of have some more gravitas, you can also become more personal. So now I, like, hug my patients or I tell them, I don't know the answer. Let's look it up together. And I think when you're a younger physician, you sort of think you're supposed to have a facade of, I know everything, and, you know, trust me, because I look young, but I'm smart. And so I think just sort of growing into all of that has been meaningful. So now I'm fully formed and I'm me. I'll go forward as this self forever and 100% guaranteed.
- [37:50]
Jonathan Fields
A decade from now, if we ask you, you'll be absolutely the same. No change whatsoever. Right. It is really interesting, right, because you had this experience, and really, it shifted a lot of the way that you see things, but also the way you want to devote a lot of your energy. And then the storyteller part of you taps in and says, okay, yes, there's a ton of data here. We can look at all of the business cases, we can look at all the studies, we can look at all the research. But let me tell you a story.
- [38:16]
Lucy Kalanithi
Totally.
- [38:17]
Jonathan Fields
And, like, nothing. It's been my experience you can share all the data in the world, but it's the story that really incites change.
- [38:23]
Lucy Kalanithi
Right. Even if you're, like, stuck to numbers, you have to tell a story. You're correct. Yeah, I totally agree.
- [38:30]
Jonathan Fields
Yeah. And we'll be right back after a word from our sponsors.
- [38:36]
Stephanie Fields
Hi, this is Stephanie, Jonathan's wife. So, over the last 10 years, I've been dealing with everything from changes in my hair, skin, sleep, and even brain fog related to changing hormones. A lot of my friends have, too, and it's so hard to get clear answers. That's why Alloy Health matters. They connect you with a menopause expert doctor who looks at the full picture, creates a personalized treatment plan and offers ongoing support with care delivered right to your door. Nearly 95% of women feel better in just two weeks. If something feels off, you don't have to navigate it alone. Try Alloy health. Go to myalloymy a l l o y.com and use the code goodlife today or just click the link in the show notes.
- [39:19]
Jonathan Fields
Good Life Project is sponsored by Olli. So the start of a new year has a way of whispering that you should do more, be more, fix more. And honestly, that can get exhausting really quickly. Sometimes what actually helps is choosing support that feels doable and kind. And that's what stands out to me about Ollie. They're not chasing perfection. They focus on science backed supplements that meet you where you are and fit into real life, especially for women who already have enough on their plates. One place I've been paying more attention lately is gut health. It's one of those quiet foundations that affects really how you feel all day. Ollie's probiotic mango gummies make taking care of yourself just feel more doable. They support your gut, digestive health and immune system. Three little wins in just two gummies. That kind of simplicity matters. Small, consistent support without turning wellness into another full time job. If you want an easier way to support your gut and overall well being this year, give Ollie a try. Head to o l l y.com now or just click the link in the show notes. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
- [40:29]
Capital One Bank Representative
A password manager should be the first security purchase you make for your team. Why? Because compromised passwords are the number one way bad actors attack companies, and small businesses are their favorite targets. But unlike a lot of security challenges, passwords actually have a pretty simple solution. 1Password lets you manage all your business's credentials so you can feel confident that your data stays secure as your company grows. Find out more@1Password.com special offer and start securing every login.
- [41:03]
Jonathan Fields
What do you think patients and families most need from clinicians now? In moments when the news isn't good, how would you approach things? Or how would you sort of say like this is what I would love to see change in these moments. Or these are some of like the key, the key insights or key qualities of this type of interaction that maybe isn't happening all that much but would really make a difference.
- [41:26]
Lucy Kalanithi
Yeah, I mean it's like, some of the words that come to mind are like, witnessing selfhood support. You know, Walter Cronkite said, the American healthcare system is neither healthy nor caring nor a system. And I think people in the healthcare system suffer, including clinicians, because of, like, cultural taboos that follow you into the hospital walls or of like, time constraints or because of obviously money stuff. And I think medical schools are changing so much in terms of training students to literally, in the humanities actually, but also training people how to do those conversations. Like you're talking about delivering bad news or coming back to hard questions, or helping somebody discern what's important to them. And like, there's all kinds of decisions in healthcare where it's not just end of life care, it's like, do you want to have dialysis in a dialysis center or at home? Do you want to have knee surgery or not? So many decisions really do have to be made in a personal context. So I think asking what do you really care about and how do we help you get to that? I think so many of those conversations, like delivering bad news conversation, it's not just one conversation, it's multiple. And it's like multiple people across a family. So like making space for everybody and time. And then I think, like, as a practical pearl for people who are going through a hard medical issue, the field of palliative care is so incredible. So, like, for anyone who has not just a terminal illness, but like a curable illness, that's really hard to do, you know, like lymphoma and really intense chemo or Parkinson's or heart failure or just anything that is tough to manage in terms of like thorny medical care decisions or symptoms or existential distress. Literally. Ask for a palliative care team to be part of your care and they, like, work alongside the other specialists and they are part of a medical field that's like board certified and fellowship trained and everything to focus on quality of life alongside the rest of your medical care. And it includes social workers and chaplains and nurses and clinicians. And that's just. It's so weird because, like, that grew up out of an unmet need. And it's like if you could strip down the healthcare system, you would start with that and then build a bunch of medical specialties around it. But those guys sort of popped up in the middle of the healthcare system to say, like, what are we actually doing here? And so they sort of act as a. They can be sort of like a human quarterback. So that's something I would encourage people to check out is palliative care. And then hospice itself is a little subset of that for people who are really, really sick and dying. But palliative care could be for anybody who has something chronic or something thorny.
- [44:23]
Jonathan Fields
I think a lot of people, if they even have heard the phrase, or if they know what palliative care is or think they know it is, it's kind of very often automatically equated with hospice. This is what happens when there's no other. You're basically on your way out rather than instant. I light this reframe that says, no, this is actually. It can be related to that. But these are people who basically focus on quality of life throughout whatever the treatment experience is, which is super powerful.
- [44:48]
Lucy Kalanithi
Yeah, thanks for clarifying that.
- [44:50]
Jonathan Fields
Where does hope come into the conversation?
- [44:53]
Lucy Kalanithi
Yeah, hope, man. I mean, I think of hope as, like, so much of the time when you talk about hope, especially in cancer, right, where there's this battle metaphor of, like, we're going to fight, we're going to win, we're going to beat it, which can be really flimsy and confining, actually, when people are actually going through it, it can feel constricting or intimidating to have to win the battle, because if you have to win, then you could also be a loser. And so I often think about hope like, okay, you're not only hoping to win. When they ask people, even as they're dying, what are all the things you're hoping for? It turns out there's a whole group of things that people hope for. So it's like, obviously people hope to live a long time and feel good, but also hope to feel spiritually at peace or mend relationships or make things smooth for their family, you know. So I think of hope as, like, really multifaceted because oftentimes there are many things you can hope for and many things you can achieve. So the question is, like, if you're hoping for something or if you want to, you know, like, do everything. You know, families, like, often come in and say, do everything. Do everything for my loved one. And the question, like, remains, like, do everything in service of what thing. Like, is it dignity? Is it time? Is it being pain free? Is it being lucid? Is it going home, any. Whatever it might be? So, yeah, hope is rough because. And sometimes you just have to hope for the best and prepare for the worst. You know, we talk a lot about prognosis in medicine and how to prognosticate and how to help people, you know, have a realistic sense, but also hold on to hope. And like. One of the frameworks I like the best is thinking about what's the best case that we're hoping for, what's the worst case that could happen, and then what's the most likely case. And oftentimes those are three different points, but they give you just a bit of a sense. If you can emotionally scope all of those and logistically scope those, that's hard work, but it helps you to do that. So I think that can be helpful.
- [47:01]
Jonathan Fields
Yeah. It's so interesting the way you laid that out as somebody who's been an entrepreneur for most of my adult life as just an exercise. Oftentimes when you're thinking about as a founder a new idea, you create pro forma's financial projections and you have a worst case scenario, best case scenario, and then the middle scenario. So it's kind of the same thing you're talking about.
- [47:19]
Lucy Kalanithi
Totally prognosis.
- [47:22]
Jonathan Fields
Yeah. But instead we're talking about life instead of a business. You've mentioned a number of times that you and Paul eventually decided to have a child when he was in his final months of life. A lot of people would probably hear that and like an eyebrow would get raised. Take me into this experience and decision.
- [47:40]
Lucy Kalanithi
Sure, yeah. I mean, I feel like I would raise an eyebrow if I heard about someone doing that and hadn't come up against it. It's like one of those things you just never know. And I actually wondered when Breath Becomes Air came out, I was like, I wonder if people will judge us for having a kid. There were a couple things in the book, or like, Paul writes about how our marriage had been on the rocks for a while. And I was like, I wonder if that'll come back. And it's like, it turns out that all of those things, like the hardest, trickiest, or when Paul writes about religion, like moving between atheism, agnosticism, Christianity, all of the thorniest bits are actually the parts that people come up to me and relate to. So anyway, that's an interesting experience. But yeah, so we had always wanted to have kids and thought that was actually around the time when we would think about it, which was toward the end of Paul's residency when I was also done training. And then things would sort of like, ostensibly get easier. And that was right when he got sick. And we actually talked about it within a day or two of him being diagnosed, looked at each other and said, like, is this something we should think about? And there's a practical piece there which is you have to like, think about fertility. Preservation immediately before you start your treatment. But we both had the instinct to still try, and Paul was more certain than I was. And I was, like, really embedded in the practical piece and also thinking about, I think I'm going to be a solo parent at some point going forward, so what will that mean for me? I read Andrew Solomon's book, actually, Far from the Tree, which was incredibly helpful. Like, thinking about parenthood and identity and, like, all the ways that your kid could be different or different from you in unexpected ways and how parents come to terms with that and find it meaningful ultimately. Because, like, having a kid also introduces a ton of uncertainty and work and just grappling with that, the real solidifying moment of that choice, actually, Paul writes about it in the book, was a conversation we had where I was thinking about his experience and said, don't you think that if we have a child, then saying goodbye to a child will make dying even more painful for you? And he said, wouldn't it be great if it did make it more painful? Which was so, like, really surprised me and then just sort of crystallized everything. And I was just like, oh, of course nobody is having a kid because they think it's going to make things easy. And there's a million things we do in our lives that make things great and hard at the same time. So many meaningful things we do, you know, become a healthcare worker, have a child, climb a mountain to the top and then come back down the very same day. Like, we do all these things because they're beautiful and hard. Just Paul, like, indicating that that actually was all okay with him and actually was great with him. Suddenly the answer was yes.
- [50:38]
Jonathan Fields
When your daughter's born and she's with the both of you for, I guess, another eight months before Paul passes, then you're also. It sounds like there was just this kind of crazy whirlwind because at the same time you lose your husband, he's turned. In this book, you're being tasked within or invited to then say, like, well, bring the book home for us. And then not too long after, it's out there in the world, and at the same time, you've just lost somebody. There's grief, there's mourning. That's a part of that. And I guess I'm curious how grieving, mourning his loss while also being there for this beautiful baby, change the quality of the experience and not that you ever have anything else to compare it to. Right?
- [51:25]
Lucy Kalanithi
Yeah. You mean change the quality of parenting or change, like, just what grief was like of grieving? Yeah, I mean, I think working on Paul's book and doing the book tour was, like, absolutely net positive. I mean, partly as a way to be out, like, physically out in the world and talking to people. And like I said, it's like, I'm a talker. Like, that's how I process, and that's what I want to be doing and, like, be with people. And then also, like, there's a piece to grief where when somebody dies in a. A year has gone by, let's say, that can truly feel like a millennium and a millisecond at the same time. And oftentimes people don't really enter into it, like, oh, it's been a year. She must be doing great. And it turns out that's so short, and you're still living with the loss all the time. And Paul's book gave me sort of a hook for people to talk to me about Paul at a time when I was still wanting to. And. And, you know, I mean, I'm still. Still wanting to. But it's like, it can be so hard for us to figure out how to relate to someone who's grieving and say, like, what if I remind her? What if she starts crying? What if my thing that I say is not perfect? And it turns out, like, just saying anything is almost always the right move. And you certainly aren't going to remind someone of their suffering. They, like, they know. And so it just turned out to be really nice for me. And then raising Katie, like, through that, like, she's just getting a sense of, like. I mean, she's actually sort of always had it around her. She's always had pictures. She's always had Paul's brothers, those cousins, the grandparents. Paul's, like, presence and family is, like, all over the place in our lives. And at the same time, he's sort of everywhere and nowhere. And his book is there, like, waiting for her when she wants it. But it'll just be interesting to see her, like, grow into forming her own relationship with Paul. Yeah. And I'm, like, letting her, like, take the lead for the most part on that. Just, like, whatever she needs, I'll give her. It's interesting because, like, as a parent, one of the great lessons you learn is, like, your kid is not you. Surprise. And, like, her experience, you're like, oh, shoot. But, like, her experience is not my experience, you know, So I don't know what it's like to lose your dad when you're little. But at the same time, she sort of accepts it and I think she'd love to have a sibling maybe as much as she'd love to have a dad. It's like she's the one determining what it all means to her.
- [53:54]
Jonathan Fields
I think it was. I can't remember if it's the final words. And pretty close to the final words of the book is a short personal message from Paul, actually, to her. She's only a couple months old at that point. And years later, in an episode of your podcast Gravity, which ran, I think it was 2021, 2020, you had her read those words out loud to you. What was that like?
- [54:19]
Lucy Kalanithi
Yeah, I just. I need to go back and listen to that. Yeah, I had her read aloud the words that are, like, written in the second person to her by Paul at the end is the close of the book, and it's like, her little cute voice reading it. And I was like, hey, I'm recording this podcast for people to hear. Like, do you want some M and Ms? We can have M and Ms. After you record this. Are you willing to do it? I was like, people are going to hear your voice. And she's like, okay. But the gravity of it obviously didn't hit her. She was roughly five or six. But it's lovely that it's in her voice. I mean, that's the most intimate thing that Paul left to Katie. It's like that paragraph as a parent talking to a kid. It's really meaningful, and I really love it. And it's interesting because you said that thing about how, like, the part that Paul wrote for, you know, the book Paul wrote is, like, cerebral and a lot about, like, ideas, intellectual ideas and philosophical concepts and, you know, literary illusion and all that stuff. And then you said, like, you drop into your feelings more in the epilogue. But I actually think, like, that last part of the book is where, like, Paul drops into his feelings, you know, two, and then takes the reader. There's, like, a tonality.
- [55:38]
Jonathan Fields
Yeah, it's a very different shift. Yeah, it was beautiful, actually, hearing her share his works.
- [55:42]
Lucy Kalanithi
Thanks.
- [55:44]
Jonathan Fields
You kind of got a sense, too, that she was just kind of having fun reading it, but at some point she's gonna read it again and it's gonna land differently.
- [55:51]
Lucy Kalanithi
Yeah. And she says he uses the word ledger. And, like, in the middle of it, she's reading it says, like, give a ledger of what you've been and done and meant to the world. And she's like, what's a ledger? And then I'm like, it's a list. And then she keeps reading it's like so goofy, right?
- [56:06]
Jonathan Fields
It's like, let's look it up first.
- [56:07]
Lucy Kalanithi
Yeah, yeah, yeah.
- [56:08]
Jonathan Fields
No, it's really beautiful. It feels a good place for us to come full circle in our conversations. I always wrap the same way in this container of Good Life Project. If I offer up the phrase to live a good life, what comes up.
- [56:21]
Lucy Kalanithi
To live a good life? I guess for me it's like, stick to who you are and look out for other people.
- [56:30]
Jonathan Fields
Thank you.
- [56:31]
Lucy Kalanithi
Thanks a million.
- [56:34]
Jonathan Fields
Hey, before you go, be sure to tune into next week's episode for a powerful conversation with Brad Stulberg about what excellence really is and is not and how pursuing it can help you feel more alive and not burned out. And don't forget to follow Good Life Project in your favorite listening app. This episode of Good Life Project was produced by executive Executive producers Lindsay Fox and me, Jonathan Fields. Editing help by Alejandro Ramirez and Troy Young. Christopher Carter crafted our theme music. And of course, if you haven't already done so, please go ahead and follow Good Life Project in your favorite listening app or on YouTube too. If you found this conversation interesting or valuable and inspiring, chances are you did because you're still listening here. Do me a personal favor. A seven second favor. Share it with with just one person. I mean, if you want to share it with more, that's awesome too. But just one person? Even then, invite them to talk with you about what you've both discovered to reconnect and explore ideas that really matter. Because that's how we all come alive together. Until next time, I'm Jonathan Fields signing off for Good Life Project.
- [57:55]
Capital One Bank Representative
With no fees or minimums on checking accounts. It's no wonder the Capital One bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how most Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends it's pretty much all he talks about in a good way. What's in your wallet? Terms apply. See capitalone.com bank capital1na member FDIC.
- [58:25]
Sleep Number Representative
Why choose a sleep number Smart bed Can.
- [58:27]
Lucy Kalanithi
I make my site softer?
- [58:29]
Capital One Bank Representative
Can I make my site firmer? Can we sleep cooler?
- [58:33]
Sleep Number Representative
Sleep number does that cools up to eight times faster and lets you choose your ideal comfort on either side. Other side your sleep number setting Enjoy personalized comfort for better sleep night after night. And now during our President's Day sale, take 50 off our limited edition bed shop now for a limited time only at a sleep number store or sleepnumber.com.
- [58:55]
Paige Desorbo
Hey, it's Paige Desorbo from Giggly Squad. Obviously I love Amazon prime, and there's so many different reasons why I am obsessed with it. Not only can you see something on Instagram or TikTok or hear about it on a podcast and think, wow, I need to order that. And then you can order it on prime immediately, but it also just makes your life better because sometimes you forget someone's birthday or a Christmas gift or a Flag Day gift. I don't know any type of gift. And you can literally get it so fast with Prime. Prime just makes your life easier. And it always comes in clutch. Not only is it fast, it's also free delivery. Fast free delivery. It's on Prime.
- [59:36]
MeUndies Representative
Flowers die in three days. Matching underwear from Meundies. That's a gift that lasts. Meundies creates matching prints for couples and friends. Same adorable designs and different cuts for each of you. All made from their signature ultramodal fabric that feels impossibly soft. With 30 million pairs sold and 90,000 five star reviews, MeUndies matching prints are the perfect gift. Valentine's Day is February 14th, so don't wait. Get exclusive deals up to 50% off at Meundies.com acast code acast. That's Meundies.com acast Code acast.