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10 Years After Losing Her Husband: Lucy Kalanithi Reveals the Truth About Grief No One Talks About

Ten years after the loss of her husband, neurosurgeon and bestselling author Paul Kalanithi, Dr. Lucy Kalanithi reflects on how grief continues to evolve rather than disappear. In this deeply moving conversation with Jay, she shares what it means to find purpose alongside pain, why the goal isn't to fix suffering but to make meaning from it, and how staying present through life's hardest moments can transform the way we love, heal, and truly live. In this episode you'll learn: How to Live Through Grief How to Support Someone Grieving How to Talk About Death How to Stay Present Through Pain How to Comfort Without Trying to Fix How to Honor Loved Ones How to Raise Resilient Children No matter what season of life you're in, remember that joy and sorrow can exist side by side. Healing isn't about leaving pain behind, it's about learning to carry it with greater compassion, presence, and hope. With Love and Gratitude, Jay Shetty JAY’S DAILY WISDOM DELIVERED STRAIGHT TO YOUR INBOX Join 900,000+ readers discovering how small daily shifts create big life change with my free newsletter. Subscribe https://news.jayshetty.me/subscribe Check out our Apple subscription to unlock bonus content of On Purpose! https://lnk.to/JayShettyPodcast What We Discuss: 00:00 Intro 01:20 Life After Loss 03:22 A New Perspective on Death 07:15 Does Time Really Heal? 08:36 Does Everything Happen for a Reason? 11:12 Helping Someone at the End of Their Life 15:33 The Biggest Myth About Grief 17:56 Preparing for Death 23:08 Lessons From Facing Death 30:28 You Are Stronger Than You Think 35:33 Let Your Child Find Meaning On Their Own 40:02 Choosing Family Despite Uncertainty 43:48 A Different Way to Grieve 47:38 Keeping a Loved One Alive After They’re Gone 50:33 Can You Love Again? 53:23 What Real Partnership Means 57:19 Letting Go vs. Giving Up 01:02:39 Sitting With the Dying 01:05:58 Sharing Life-Changing News 01:08:41 How to Live Well Episode Resources: LinkedIn | https://www.linkedin.com/in/lucy-kalanithi-baab214 X | https://x.com/rocketgirlmd https://www.instagram.com/jayshetty https://www.facebook.com/jayshetty/ https://x.com/jayshetty https://www.linkedin.com/in/shettyjay/ https://www.youtube.com/@JayShettyPodcast http://jayshetty.me

Jay ShettyhostDr. Lucy Kalanithiguest
Jul 1, 20261h 11mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 1:20

    Intro

    1. JS

      10 years after losing her husband, Lucy joins me to explore what grief looks like after a decade

    2. LK

      He ultimately got the news that he had a chest X-ray that essentially looked like a cloudy sky. I mean, it was like dense with tumors. We both knew what it meant. I never thought I was gonna feel okay. It was like Paul died, and I was like, "It's all over."

    3. JS

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

    4. LK

      There's two big questions: What would be left undone, and how can I live most fully in the time I have left? [gentle music]

    5. JS

      Hey, everyone. Welcome back to On Purpose, the place you come to become happier, healthier, and more healed. Today's guest is Dr. Lucy Kalanithi. 10 years after losing her husband, bestselling author and neurosurgeon Paul Kalanithi, Lucy joins me to explore what grief looks like after a decade, how love evolves after loss, and what being so close to death can teach us about being fully alive. Lucy Kalanithi, welcome to On Purpose.

    6. LK

      Thanks for having me.

    7. JS

      Uh, I have waited for this conversation since I read the book, and-- When Breath Becomes Air, and I read it when I still lived in New York when I moved to the States, and

  2. 1:20 – 3:22

    Life After Loss

    1. JS

      it moved me so much because I hadn't really come across a book like that that felt like it was written at such a powerful moment and such a pivotal moment in someone's life.

    2. LK

      Hmm.

    3. JS

      And then to have your reflections within it as well, it's kind of left an imprint on me. And then my team and I were sitting down, and we're thinking about books that had, had an impact on us as a team and, and this came to mind immediately. And so I can't tell you how grateful I am for your time and energy for the trip over here. I know you've traveled here especially to be with us in LA, and just wanna start off by saying thank you.

    4. LK

      Thank you so much.

    5. JS

      Tell me, what does it feel like remembering Paul 10 years on?

    6. LK

      I used to think life was like a mountain that you climb, like I'll follow the path, and then I'll get where I'm going. And now, like having lost Paul, having taken our daughter from being a baby to now being a seventh-grader, I think of life much more as like a series of moments. In a way, it's like that my marriage and Paul's illness and even medical school, right? Those were all mixed together, medical school, residency, being married, losing him. That was like a chapter, and now I'm in such a different chapter. It's actually kind of amazing for the opportunity to, like dip back in, like to get sort of like talking about Paul in a way that's really embodied because you're also experiencing him, and we're talking about him in, like in a real way. And at the same time, he's like sprinkled through my life all over the place. Like, you know, I'll go through like a breakup and think like, "What would Paul say," you know, in this situation to me, to him? And also just like, "What would Paul think of Cady?" She's so different. She's such a, like singular, specific person, not a baby, you know? So I guess, like the things I can say about it are like 10 years on, you know, I never thought I was gonna feel okay. It was like Paul died, and I was like, "It's all over. Who am I? What happened?" Like, "It's me, and I'm here, and I have this baby, but I'm so lonely.

  3. 3:22 – 7:15

    A New Perspective on Death

    1. LK

      How is this ever gonna fill in?" And my mom said, like, "Things will fill in. It'll become okay," and I was like, "I literally don't believe you." But it's like things do, like things become okay. And then at the same time, like even after you lose someone, like they don't even remain static even though they're gone. Like you're not static. You continue to learn new things about them. You know, with Paul, I hear from Paul's readers about his book, and that's sort of like an ongoing relationship with him through other people. Anyway, I guess it's all just like a beautiful, terrible mix.

    2. JS

      Thank you for sharing that.

    3. LK

      Yeah.

    4. JS

      Is there, is there anything you understand differently about Paul?

    5. LK

      Yeah, I mean, like the thing that makes me feel like wanna burst into tears is actually a thing I don't yet understand, which is, you know, Paul, he was a doctor. He was a young neurosurgeon, really interested in meaning and mortality, like thought he would become a professor of philosophy or a writer and then sort of surprised himself by going into medicine, um, and was incredibly intoxicated by neurosurgery because the brain is just an organ in our body, like our liver, like our heart, but then it's also the seat of identity. And he was so interested in, okay, if you're un- undergoing like brain trauma, a stroke, you know, a tumor, how does that alter your identity and meaning? But also, how does, like neurosurgery alter your sense of identity? He was really interested in patients who were facing like upheavals in meaning and identity. Then he himself became sick, had to face this whole upheaval, had to face the end of his life, and I felt like as Paul was going through this serious illness and dying, I really felt immediately in it with him. I felt so like fused with him. We had to do so many things together to take care of him, to make sure the book got written, to cope, to like show up for each other in like every way. But I wonder whether like when and if something happens to me and I'm sick and dying, if I'll read Paul's book and see how much I didn't understand-

    6. JS

      Mm

    7. LK

      ... and see like new things in the words or like reflect on his experience and think like, "Oh, was he alone in that?" And so like that sort of breaks my heart. Like what did I miss?

    8. JS

      Mm.

    9. LK

      You know, in answer to your question of like how have I gotten to know Paul differently, yeah, I mean, when someone dies, like stories come rushing in, and then I think reading his book at different phases of my own life, I even get different things even though I knew him so well. Um, and then I think, you know, just the process. There's a flip side, which is like how to not flatten someone after they die. Like I think like when someone dies, they're sort of-- suddenly they become like so amazing and perfect-

    10. JS

      Mm

    11. LK

      ... and I can't believe we lost this person, and all those things are true. But at the same time, it's like He like, you know, left his socks on the floor, and it annoyed me [laughs]

    12. JS

      [laughs]

    13. LK

      Like, you know, just he was just a regular person, and he was funny, and he drank too much whiskey, and he, like, just he was, like, textured, you know? And so I often think about, like, all the things I do remember about him. How do I keep those, like, in memory and keep him, like, complicated instead of, like, mythic?

    14. JS

      Both of those answers to what you said, you almost feel like you don't understand, which maybe you never will until we're all in the same position and going through something similar and when we're facing not loss through someone else, but loss of ourself-

    15. LK

      Right. Right

    16. JS

      ... there may be certain things that we miss on that journey, and we, we don't recognize. And, and maybe we shouldn't until-

    17. LK

      Sure

    18. JS

      ... that time-

    19. LK

      Or couldn't.

    20. JS

      Yeah, or couldn't.

    21. LK

      Yeah.

    22. JS

      Yeah, exactly.

    23. LK

      Yeah.

    24. JS

      But then on the flip side, the idea that you're saying that it's almost like sometimes we don't celebrate people until they're gone.

    25. LK

      Sure. Yes.

    26. JS

      And we only see all the bad things.

    27. LK

      Yes. Isn't that interesting?

  4. 7:15 – 8:36

    Does Time Really Heal?

    1. JS

      Yeah.

    2. LK

      Yeah.

    3. JS

      And then as you were saying, on the flip side, when someone goes, we only see the good things-

    4. LK

      Right. Right

    5. JS

      ... and we don't... And it's so fascinating how the mind does that.

    6. LK

      Right.

    7. JS

      I guess he would know as a neurosurgeon, like he'd know why we, why we do that.

    8. LK

      Yeah. Yeah. Good question.

    9. JS

      And, and where, yeah, and where that comes from. Like, why is it that we kind of-

    10. LK

      Right? Like, what's the neuroscience of grief?

    11. JS

      The neuroscience of that grief of how we block people's good things when they're alive and block people's, you know, bad things when they're gone and-

    12. LK

      Right, or is it about remembering? Like, remember to notice when you have your person here, and then yeah, when they leave, remember to, yeah, don't forget.

    13. JS

      When you hear the age-old phrase time heals all wounds, how does that sit with you?

    14. LK

      I mean, it's sort of, like, simplistic, and it actually makes it sound like the wounds will then go away. And so I don't believe that part, but I do believe-- I do think time heals all wounds in a certain way. Prince Harry was writing about grief, and he said something like, um, "Grief is a wound that festers." I was sort of like, "Oh, I don't agree with that," because if something festers, it's, like, untended, right? And so I do think, like, there will always be a scar. There will always be something that looks different, feels different, something you're carrying, something you're literally carrying on your body. Like, that's also how grief feels. I think if you can sort of think to yourself, like, it's going to be okay

  5. 8:36 – 11:12

    Does Everything Happen for a Reason?

    1. LK

      in some way. You just don't know what okay means, and, like, sort of let the pain move through you, you will end up somewhere, you know, that's different and better than you thought.

    2. JS

      Yeah, it's, it's interesting how all these statements have stood the test of time, but they have so much nuance when you're actually living them.

    3. LK

      Yeah, yeah, and some of them don't work, right? Like-

    4. JS

      Yeah

    5. LK

      ... or you, you have to decide which ones work for you. Like, if someone sends you a card with something on it, or if someone says, you know, "Everything happens for a reason," and you don't believe that, it's not helpful. But you're right. I think many of those, like, things in literature, sayings like that hold up.

    6. JS

      What do you feel about that one? Everything happens for a reason.

    7. LK

      I don't subscribe to that necessarily, but I think more than I did before, I think when hard things happen, I do believe something beautiful will come out of it.

    8. JS

      Ah.

    9. LK

      Something. Even if the only thing that comes out of it is that you suffered, which connects you to every human being everywhere across time ever, and then potentially deepens your empathy for other people or deepens your ability to be a friend or, you know, whatever it might be.

    10. JS

      Mm.

    11. LK

      So, and then I think, like, suffering-- Have you read Man's Search for Meaning?

    12. JS

      Yeah, of course.

    13. LK

      Yeah, of course. [laughs]

    14. JS

      Of course.

    15. LK

      Yeah.

    16. JS

      Yeah. No, no, no. No, I know.

    17. LK

      It's so gorgeous. No, no, no.

    18. JS

      No, I love it. Yeah, yeah, yeah.

    19. LK

      I'm with-- You're saying-

    20. JS

      Yeah. Yeah

    21. LK

      ... yeah, I'm not surprised you read it.

    22. JS

      Yeah.

    23. LK

      That's why I say.

    24. JS

      Yeah.

    25. LK

      And, like, Viktor Frankl, who, you know, survived the Holocaust in a concentration camp and then went on to become a therapist afterward, he talks about witnessing all of these people and how they survived the unsurvivable. And he ends up talking about, like, how purpose or relationships, like, you wouldn't survive just because you had those, but you could only survive if you had something you were waiting for or someone who was waiting for you on the other side.

    26. JS

      Mm.

    27. LK

      And ultimately, he ends up talking about how suffering is actually a really meaningful part of our lives. He says, like, his construction is that meaning comes from three things, and he says he conceives of work and love and suffering, and I love that. He says work is, like, the things you do and create, you know, like the imprint you leave on the world maybe. Love is, like, all the types of love between people, and then gratitude also, and just, like, love writ large. And then suffering, he talks about how, like, suffering is not this sort of, like, side event that you wish would go away. It is here. It will be here. Whether something beautiful comes out of it, whether it connects you to other people,

  6. 11:12 – 15:33

    Helping Someone at the End of Their Life

    1. LK

      or whether just, like, the pure achievement of just persisting alone-

    2. JS

      Mm

    3. LK

      ... I think there is, like, actual meaning in that. And so I think the idea [chuckles] of, like, everything happens for a reason, it's like a reason will be found, but only you can find it. No one can tell you what it is, and no one can tell you that it's okay.

    4. JS

      Mm.

    5. LK

      Like, that's only yours, and maybe it takes years.

    6. JS

      I appreciate that, and the idea that there wasn't some predetermined reason or some reason that had to be the way. It was a, a journey of discovery.

    7. LK

      Yeah, and I think some people think that, and that's also, like, a beautiful story or a beautiful, you know-

    8. JS

      What for you was actually helpful, as you just talked about the need for relationships, the need for meaning, what was useful to hear from your-

    9. LK

      Yeah

    10. JS

      ... relationships at the time?

    11. LK

      Yeah.

    12. JS

      And what do you find useful now?

    13. LK

      Mm. Yeah.

    14. JS

      And helpful.

    15. LK

      This isn't about other people actually, but this was a really helpful thing for me is, um, so Paul got sick, and we were both doctors, and there was something in that that was immensely helpful. And obviously, like, the privilege and logistics and all of that kind of stuff that came out of, like, being a healthcare person and a doctor was very helpful. But the thing that was the most helpful was having spent years and years taking care of sick people and their families and thinking, like, terrible things can happen to wonderful people, whether it's, like, a car crash or sudden diagnosis of cancer. And so when he was diagnosed, like, at one point I was like, "Whatever you need to do to cope, go for it. Like, would you like to punch a wall? We have all these walls. [laughs] Like, they're all yours." And he was like, "I don't need to." And I was like, "I don't need to either."

    16. JS

      Mm.

    17. LK

      Like, what's that about? And I think it was kind of like, okay, turns out, like, it's our turn to, like, be the people who are doing this. So it was really helpful to sort of, like, have that perspective. And Paul, in his writing, wrote, you know, like people often ask, "Don't you ask why me?" And he said, "Well, why not me?" Which I think is really beautiful.

    18. JS

      Mm.

    19. LK

      And in terms of, like, what was helpful for us in terms of coping, I felt like the most important thing was just to feel witnessed. I actually didn't need anyone to try to fix it, to try to, like, say something that was gonna fix it or that it was okay. Like, one of the best condolence cards I got after Paul died was-- it just said, "This sucks really big." [laughs] And I was like, "Oh, so amazing." Like-

    20. JS

      Mm

    21. LK

      ... and it also wasn't, like, too flowery or too, like, perfect or whatever [laughs] . It was just like, this is how this person feels. This is definitely how I feel. Also, it's still funny. Like-

    22. JS

      Yeah

    23. LK

      ... even when you're dying, you're still you. You know? Like, you're still funny. Like, one thing that did-- that was really helpful for Paul, actually, when he was sick, you know, he's-- was a 36 and 37-year-old neurosurgeon, right? So he's used to being like, like, healthy, dominant, in charge, in control, and then, like, loses all of that in an instant. So when people would come to visit and hang out, they'd say, like, "Okay, I'm coming to visit. Like, what can I do that's helpful?" And I was like, "Just come and hang out and, like, be-- just, like, be you. Like, be funny. Like, ask Paul for career advice, you know [laughs] , if that's what you would do anyway. Like, just because he's dying, like, doesn't mean he doesn't wanna know what's going on with you. He's not, like, radioactive. He's not different." You know, I think illness can be so flattening. It's like people get sick, and it's like humor zips out of the room. Like, sexuality zips out of the room. And, like, you're just like, "I'm still me. Like, I'm still me, just the same, and I'm losing all of these abilities, but I also still have all these capacities." So I think just, like, making room for people's full self and people to be, like, agentic and be-- if that's a word, be an agent [laughs] -

    24. JS

      Mm

    25. LK

      ... and, like, be a full person.

    26. JS

      I think we all lose our powers when we love someone, and they lose someone.

    27. LK

      Totally.

    28. JS

      And I think for a lot of people listening and watching, I think a lot of people become distant.

    29. LK

      Totally, 'cause you don't really know what to do. Yeah. And I think, like, showing up is half the thing. And then also it's like, I do think there's something to, like, being specific. You know, like people often say, like, "Let me know if there's any way I can help," and you really mean it.

    30. JS

      Yeah.

  7. 15:33 – 17:56

    The Biggest Myth About Grief

    1. LK

      keep offering a little thing with no pressure. Like, I had some friends whose baby was in the hospital, and the husband was like, "The best thing anyone ever did for us was say, like, 'I'm at the mall next door getting a burger. Like, what do you want on yours? I'll drop it off in 20.'" And they were just like, "The works. Thanks." [laughs] And then, like, they didn't even have to talk to the person.

    2. JS

      Yeah.

    3. LK

      Like, just like, you know, that kind of stuff. "Hey, like, do you need babysitting this week? Like, let me know."

    4. JS

      Yeah.

    5. LK

      Like, "I'm dropping off food. Do you want me to ring the do- the doorbell or just let you know, just text you when it's there?" Just, like, something that has no pressure but also is, like, present and keep doing it.

    6. JS

      What do you think most people misinterpret about grief?

    7. LK

      One thing is like, "Oh, if I say something, I'm gonna remind her," or, "If I say-- what if I say something and then I make her sad?" And I think when you're a grieving person, you're thinking about it all the time. It's present for you all the time. And so I think if somebody says, like, "Hey, I heard what happened. I've been thinking about you," you know? "Hey, I heard what happened. Like, how are you doing today? Um, is there anything I can do?" It doesn't remind you. It just makes you feel seen and connected at a time when, like, it's really hard to feel connected. My mom said this amazing thing when we were growing up. She used to say, "When in doubt, describe." And it basically meant, like, even if you don't know what's happening to-- for you, or even if you don't know the perfect, perfect thing to say, like, you can just describe what's going on. So you can just say, like, "I heard that so-and-so died. It's really sad. I've been thinking about you so much. I wish I knew the perfect thing to say, and I don't, but I want you to know I love you." And, like, that-- doesn't that sound so cozy-

    8. JS

      Yeah

    9. LK

      ... and nice?

    10. JS

      Yeah, yeah.

    11. LK

      And it's like they didn't have to say a special, perfect, wise thing [laughs] . They just described. You know? So I think that's also really helpful.

    12. JS

      Describing what you're going through is sometimes better than trying to say the perfect thing-

    13. LK

      Isn't it? Isn't it?

    14. JS

      ... or the right thing.

    15. LK

      Yeah.

    16. JS

      Yeah, absolutely.

    17. LK

      Yeah.

    18. JS

      To just be like-

    19. LK

      Yeah

    20. JS

      ... this is the worst day ever-

    21. LK

      Yeah

    22. JS

      ... is-

    23. LK

      Yeah, this is hard

    24. JS

      ... yeah, for-

    25. LK

      This looks hard

    26. JS

      ... yeah, this is hard. Yeah. This is, this is really difficult.

    27. LK

      Yeah. Yeah.

    28. JS

      Is so much more-- I don't know. There's something about it that opens up the heart rather than closes it.

    29. LK

      Totally. Yeah.

    30. JS

      Yeah. Just to-- it's almost acceptance-

  8. 17:56 – 23:08

    Preparing for Death

    1. JS

      I've-- it's been really interesting as I was preparing for this interview. I've had friends who've-- I mean, I've lost friends to cancer over-

    2. LK

      Mm-hmm

    3. JS

      ... the last few years. I've lost-

    4. LK

      Sorry

    5. JS

      ... spiritual mentors. I've lost friends.

    6. LK

      Yeah.

    7. JS

      And different scenarios, but I had a friend recently who was going through it in the States. His partner's a doctor, but he's not.

    8. LK

      Yeah.

    9. JS

      And his partner Wasn't as supportive as he wanted them to be.

    10. LK

      Ah.

    11. JS

      Because to him, cancer felt like the big C word that was scary from the moment he heard it. But her take was, "You're gonna be fine."

    12. LK

      Ah.

    13. JS

      "They're gonna figure it out."

    14. LK

      Uh-huh. Uh-huh.

    15. JS

      And I was wondering what were the kinds of conversations you both had as both being doctors, and what was the most important conversation you think you had at that time?

    16. LK

      The way Paul got diagnosed was [laughs] um, he'd been getting sicker and sicker, and then he ultimately got the news that he had a chest X-ray that essentially looked like a cloudy sky. I mean, it was like dense with tumors. We both knew what it meant. You know, we're going to the hospital tomorrow for s- for a CT scan. It's going to show, you know, metastatic cancer. And it was so interesting because as we were packing for this hospital stay, he was gonna go and get expedited workup. I was packing, like, practical things like phone charger, insurance card, like fuzzy socks or whatever, and he packed books. It was so interesting. He packed, um, Being and Time by Heidegger and Mere Christianity by C.S. Lewis, and then a novel called Cancer Ward by Solzhen- Solzhenitsyn. And it was this sort of like immediate recognition of like, the doctor stuff is not going to help me. Like, I need to turn to words and literature and-- or just need to turn to, like, the human experience of this. And for him, that was like, "Oh, I'm back to literature."

    17. JS

      Mm.

    18. LK

      So that was really interesting. I think one of the most important conversations was right away, which was we ended up looking at the CT scan ourselves and sort of like wordlessly absorbing this diagnosis of like-- it was like looking at a patient's scan, and then you're like, "Oh my gosh, it's you." Like, "It's you." And then we, like, got into the hospital bed together, and then he said, "I want you to remarry," before we almost talked about anything, which was really beautiful. Like beautiful, and felt so sort of like shocking at the time. But then there's like all these layers to that. Like the biggest one is like, "I love you into a future where I will not be there." Like, that's amazing. That's such a, like an amazing kind of love. And people have it, right? People have it for their children. People have it for their spou- It's like, "I love you forever independent of my existence," right? But he also was saying with that sentence like it was so stark that it was kind of like, "Okay, I'm gonna go, I'm gonna go there immediately and then implicitly tell you, like, we can talk about anything." And that was really helpful. Like super, super helpful. And I think, like, the battle metaphor for cancer is so pervasive. Like it started with like Nixon's war on cancer, but then now it extends to like individual level. Like we'll beat it, we'll fight it, we're gonna win.

    19. JS

      Surviving.

    20. LK

      Yeah, surviving. And I think that metaphor is so flimsy, you know?

    21. JS

      Interesting.

    22. LK

      Like it's sort of like there's winners and losers, and there's like one thing you're supposed to do here, and it's just like [laughs] survive at all costs. And I think there's like when you survey people with cancer, there's like so many things people hope for. It's like people hope for dignity. People hope for, like, functionality as long as possible. People hope that their loved ones will be okay. I don't know. There was sort of just like this panoply of hopes that I think, like we knew to like sidestep the battle metaphor, which was really helpful. And then I think part of that was just we knew how sick he was.

    23. JS

      Mm.

    24. LK

      We couldn't get away from it. We could not escape, like, understanding how sick he was, which was like the worst part, but in some ways the best part.

    25. JS

      Eh.

    26. LK

      'Cause then we could decide what to do.

    27. JS

      What I'm hearing you say is that it's-- it wasn't the, the doctor conversation or the medical conversation because that was almost accepting what was in front of you.

    28. LK

      Yeah.

    29. JS

      But it was the conversations that you both allowed each other to have-

    30. LK

      Yeah

  9. 23:08 – 30:28

    Lessons From Facing Death

    1. JS

      there's that story that you can tell yourself. Whereas I lost one of my monk friends. He was still a monk when he passed away. We lived in the monastery together, but he passed away a few years back now, and he died of, uh, stage four colon cancer.

    2. LK

      Yeah.

    3. JS

      And he was like maybe two years older than me.

    4. LK

      Yeah.

    5. JS

      And I remember watching him through the whole journey, present with him, talking to him on the phone, seeing him when I could when I went back and visited him. And I almost feel like I learned so much more from him about life than I've ever taught or known.

    6. LK

      Mm.

    7. JS

      And I wanted to know, like, what did being so close to death teach you about life and living?

    8. LK

      Yeah. It's hard to separate actually, like being so close to death and being so close to Paul [laughs] because it was like so embodied, you know? And it's funny, it's like you're talking about your friend dying-

    9. JS

      Mm

    10. LK

      ... and like what a surprise that is when someone young dies. And it's like the way I've ended up like conceiving of it is sort of like, turns out that's what was gonna happen. Like, that helps me a lot actually. I think like being so close to someone who's dying actually taught me something about dying, which is that until you die, you're alive. You know? Like what happened for Paul was like he got- He was a neurosurgeon, got diagnosed with cancer, worked for a year as a neurosurgeon, like, "This is who I am, this is what I care about." Then I got pregnant during that year on purpose. Then he had sort of serendipitously, and because he was a beautiful writer, transitioned to writing, first essays and then a memoir. And so he sort of, like, built a new vocation during the time-

    11. JS

      Mm-hmm

    12. LK

      ... that he was sick. And it's like he was so sick, and so, like, debilitated, and still, like physically still, and, like, wan, you know? He was ill, and at the same time he was so, like, engaged in what he was doing. Like, so just sort of, like, intellectually engaged in the world of ideas, and in the world of relationships too, like being a new dad. And it was just really interesting to, to see... Like, one of the book reviews of Paul's book was by this doctor named Gavin Francis, and he wrote, like, "This book is unforgettable," or, "This book is something. It is crackling with life." And I just remember thinking, like, oh, how amazing to be crackling with life when you're dying. And I think the same thing is true with aging, the same thing is true with, like, disability or patienthood. It's like there's this idea that, like, you know, something about, like, a human identity is taken from you when you're aging. But it's like some of my favorite people are little old ladies who are so giggly and hilarious and, like, not afraid of anything, you know? And, like, I used to think, like, little old lady, and now I think, like, gosh-

    13. JS

      [laughs]

    14. LK

      ... like, spitfire who, like, knows everything. And like, [laughs] you know, nothing shocks her. And so I think the thing it taught me also as a doctor, you know, like, just how totally human, like, everyone is, you know? And I think when you're at work as a doctor, there's so much dehumanization. It's like you're at work, you're rushing around, you're hungry, you have to go to the bathroom, you have to get to the OR. And so it's like all of the families, like, sleeping on the sofas outside the ICU are sort of the furniture. Like, they're the furniture at work because you're doing your job.

    15. JS

      Mm.

    16. LK

      But also, it's like you're constantly toggling between, like, this is the worst day of this person's life, and I have 36 minutes with them. And then in answer to your question for real about, like, what can dying teach us about being alive and living, dying [laughs] is, like, the m- one of the most human things we do. It's like it's too big for any model. It's too big for a medical model. It's too big for, like, a lot of religious models. It's not a medical event. It's, like, a human thing. Frank Ostaseski, he's like a Buddhist teacher who founded Zen Hospice in San Francisco, so gorgeous. He's so beautiful, and, like, he talks about how dying is all about relationships. So interesting. It's like your relationship to yourself, your relationship to people you love, your relationship to, like, holiness, whatever that would be. He's like it explodes every kind of relationship. And then Ira Byock, who's this, like, really beautiful doctor, um, here actually, talks about, like, having worked with a lot of people who are dying, and then, like, you know, what they have to teach to people who are living. And he's like it's two big questions that he uncovers, and he says, "What would be left undone or unsaid-"

    17. JS

      Hmm

    18. LK

      ... "if I died now?" You know, like, how can I live most fully in the time I have left, you know? And I think there is sort of a, like, transcendence, and just, like, death is not, like, something that happens, like, at the end of the road. It's like it is here all the time. It is something you can, like, tap into, like finitude or transcendence. Like, [laughs] even when, like, a traffic jam, and you're just like, "Ah, road rage. I'm going where I'm going. Ah, I hate these people. They're in my way." Like, it's like, no, like, you are the people. You are the traffic.

    19. JS

      Mm.

    20. LK

      Everyone in this traffic jam, like, was a tiny baby, like, will be on a deathbed, has someone who loves them who will be, like, bereft when they're gone. Like, God willing, right? And so, like, suddenly zooming out to that, you're like, "Who cares about the traffic?"

    21. JS

      Mm.

    22. LK

      Everything's beautiful. So I don't know. I think there's, like, a real, like, luminosity-

    23. JS

      Mm

    24. LK

      ... that can be found, like, when someone's dying, and then at the same time, like, traffic jams-

    25. JS

      Yeah

    26. LK

      ... suck. [laughs] And like-

    27. JS

      Yeah

    28. LK

      ... you know, when someone's dying, you also have to, like, make dinner and, you know, pick up the prescription. But I think it's, like, a constant toggle-

    29. JS

      Yes

    30. LK

      ... between, like-

  10. 30:28 – 35:33

    You Are Stronger Than You Think

    1. LK

      like, a rich life as rich as yours?

    2. JS

      Yeah, and we're not alone in our suffering.

    3. LK

      Yes.

    4. JS

      So you may feel like you're suffering right now. You're definitely not alone.

    5. LK

      Right.

    6. JS

      That everyone you meet May simply be projecting their own suffering onto you, and it isn't a reflection of who you are

    7. LK

      Oh, totally

    8. JS

      And everyone has a story

    9. LK

      Everyone has a thing

    10. JS

      Yeah

    11. LK

      Yeah

    12. JS

      And so just trying to help us, I guess, transcend, but then I like your version of it's still bullshit, transcend [laughs]

    13. LK

      [laughs] Yeah, yeah, yeah

    14. JS

      So I need to make one of that one.

    15. LK

      Yeah, well, it's everything. Yeah [laughs]

    16. JS

      Yeah, so I need to... I think we need to end it with that. [laughs] I think, I think you found the perfect ending there

    17. LK

      Yeah. Yeah, yeah, yeah. Cool. Oh, it's so cool. I can't wait to see that, Jay.

    18. JS

      Yeah. No, as you're saying it, it was just... I mean, it's, it's helpful hearing it from you. I... As you're answering these questions, I'm so... Honestly, like, it, it's stirring so much within me because when you sit down with someone who's really done the work, and really had to work through grief, and really had to think through this loss on such a personal level, your answers are beyond any logic in a beautiful way

    19. LK

      Yeah. Thanks

    20. JS

      And they, they're counterintuitive almost, and that's what's so helpful and refreshing.

    21. LK

      Yeah

    22. JS

      And yeah.

    23. LK

      You know what's so weird though is, like, partly it helps you, and then partly it doesn't, 'cause, like, the next thing that comes is also really hard. Like-

    24. JS

      Mm

    25. LK

      ... sometimes I think that about talking about Paul, and, like, going through that experience. Like, Paul's memoir came out a little under a year after he died.

    26. JS

      Mm-hmm

    27. LK

      And then I immediately went on a book tour, like an unexpected book tour, and was, like, processing in real time, like, what had happened, really just, like, aching through grief and describing it. And now I'm describing, like, I went through this process and what came out of it, which is, like, a wonderful thing. But then, like, the things that are happening for me... Like, I talked to somebody the other day actually who said this, who said, like, "Oh, I'm raising this, like, challenging teenager, and it's the hardest thing I've ever done." And then she was like, "Well, I told a friend that," and the friend said, "Wait a second. Like, 12 years ago, your wife had cancer, and you had young children. Isn't that the hardest thing you've ever done?" And she was like, "Oh, it is. It definitely is." But right now, this feels like the hardest thing.

    28. JS

      Yeah

    29. LK

      Like, it's the new hardest thing.

    30. JS

      Yeah

  11. 35:33 – 40:02

    Let Your Child Find Meaning On Their Own

    1. JS

      live that with them. I didn't live in those homes they grew up in. My dad grew up in the slums in India. My m- my mom grew up in a war-torn country. They both moved to England, you know, and they got married. And when I think about that, I'm like, "Wow, that is... That's so difficult." Like, my parents did something really hard.

    2. LK

      Yes.

    3. JS

      My mom was studying for her exams when she had soldiers on her rooftop.

    4. LK

      Wow. Yeah.

    5. JS

      And my dad shared a bathroom with, like, 25 families.

    6. LK

      Yeah. Yeah.

    7. JS

      And when I think about that, I think, "God, that is insane." And, and then when you think, and you're like, "But I come from that."

    8. LK

      Sure.

    9. JS

      Like, like I come from that.

    10. LK

      Amazing. Yeah.

    11. JS

      And, like, what-

    12. LK

      Yeah

    13. JS

      ... and so I wonder when, like, for Katie, who-

    14. LK

      Yeah

    15. JS

      ... as we were talking about earlier, like, doesn't necessarily know her, her father, but how do you think about-

    16. LK

      Yeah

    17. JS

      ... creating that experience for her in, in helping her make sense of it?

    18. LK

      It's interesting that you're saying this thing about your parents because, like, the hardest thing is when your parents lay it out for you, right? [laughs] Like, you do need to sort of absorb it yourself.

    19. JS

      Yeah. Yeah, yeah, yeah.

    20. LK

      You know? Like, you-

    21. JS

      Yeah, they can't be like, "I did this and that." [laughs]

    22. LK

      Yeah, yeah. And then you're like, "Okay." But, like-

    23. JS

      Good point

    24. LK

      ... it's so beautiful that you really absorbed it. So it's like, I guess I hope Cady will do that, you know, from reading Paul's book or from, like, watching me and, you know, being me, um, whatever she takes from that. But I think, I think so much about how to, like, give her sort of like spaciousness, like support and spaciousness to like figure out what it all means to her, you know? Because she's her own person. Her childhood is very different from mine in this other way, right? Like, she has the hardship of losing a parent. I didn't. She's like decidedly not Paul. She's decidedly not me. She's very specific. I think none of us honestly, like, comes to appreciate that our parents [chuckles] are like full human beings. Like it do-- I remember in my 20s being like, "Wait a second, my dad is not a professional dad?"

    25. JS

      [laughs]

    26. LK

      "He's like a dude? He's just a dude?" Like, that explains so much. Like, that explains so much in a really, like, gorgeous way, you know? He's like someone who's just amazingly doing his best. Cady has fewer, like, signposts to know who Paul was, but she has this book to read, and the book essentially says, like, "It's important to try hard, it's important to do your best, and I love you." Like he's-- You know, Paul wrote so much about striving and about struggling to find meaning and about, you know, like, about f- facing death squarely. And then at the end, he, like, stops, and he's writing in the second person to her-

    27. JS

      Mm-hmm

    28. LK

      ... and like writes a message to her, and that's the last piece that he puts for her. As I'm raising Cady, I try to have her sort of take in, like, random information about Paul, like just truly random. Like, "You love taking a hot shower. I hate a hot shower. I get in and out. Like you and Daddy"-

    29. JS

      Mm

    30. LK

      ... "like love a hot shower. He loved a hot shower. You take the hour power shar- shower just like Daddy." So that's just like a random thing that you would know if you were, like, growing up as-- like next to someone, right?

  12. 40:02 – 43:48

    Choosing Family Despite Uncertainty

    1. LK

      Yeah, yeah, yeah

    2. JS

      ... without holding it.

    3. LK

      Inhalable.

    4. JS

      Yeah, yeah. That's even though it's not a word, but-

    5. LK

      Yeah, I actually asked, like, because I've done a lot of like speaking and, you know, doing this book tour and connecting with like grief groups and just all kinds of stuff since Paul died, I've actually asked people for advice. Like, "If anyone here in this audience is the kid, you know, who like lost a grandparent or lost whomever, and then you don't know them and you're piecing it together, what advice do you have?" And like the r- resounding advice has been like, "Don't put away the pictures. Don't lock it up."

    6. JS

      Mm-hmm.

    7. LK

      You know? Like let the kid sort of like have access, ask questions, like discover it, and just don't like put it away.

    8. JS

      What was it like making that decision to have Cady at the time, and then actually go through both coming to terms with Paul's mortality and then, you know, wanting to create a life together?

    9. LK

      Paul and I had sort of always thought like that would be the moment when we would think about having children. Like he was at the end of his residency. I was an attending by then. This is when things will like o- ostensibly become easier. And then right at that moment, he's diagnosed with metastatic terminal cancer. The prognosis is like months to a few years. But we both looked at each other and thought like, "Maybe we should do this still." Sort of like surprised ourselves. And he was more certain than I was. He really, really wanted to, and I needed to sort of shore up like the practicalities.

    10. JS

      Yeah.

    11. LK

      It was sort of like, "Is the family on board with this?" Like, we refinanced the mortgage. Like all of these things, it's like, "Can I be a solo parent? Like that is what I'm gonna be." And then I also was honestly worried about his-- I was worried about like what you said, like how to hold like birth and death and all of it at one time. And I, I asked him actually and was like, "You are s- you are sick, and like as you're going through this process, don't you feel like having a child will make dying more painful for you?" And he said, he said, "Wouldn't it be great if it did make it more painful?" Which just like cracked the whole thing open. And I think actually for anybody who has a child, like nobody is doing it because it's gonna make their life easier. There's like a million things we do-

    12. JS

      Hmm

    13. LK

      ... that make our lives harder. Like everything, everything, right? Like, you know, climb a mountain all the way to the top to come down again in the exact same day. It's like you didn't do that because it was easy. And so I just think, wouldn't it be great if it did, has changed my life so much and cracked open like not necessarily the best one. Sometimes you cannot have joy without risking pain or inviting pain. And for me, it was like another layer of uncertainty. It's like pregnancy itself is like so much uncertainty, so much fear. And I actually as a new mom had to keep reminding myself like- You know, it's like you go in and you, like, make sure the baby's still breathing. And you're like, "Is everything okay?" She gets a fever, and it's such a panic. And, like, I had to remember and be like, "I am 99% certain that this person is gonna be fine."

    14. JS

      Yeah.

    15. LK

      Katie. I'm 99% certain that Paul will not be fine.

    16. JS

      Yeah.

    17. LK

      So, like, that is now, like, where I need to hold, like, my energy. So that was kind of, like, helpful. Like, when she was a baby, it was like, it's so easy to wish away time. You know, it's like, "Oh, I can't wait till she sleeps through the night," or like, "What's she gonna be like when she's, like, 18?" And there was none of that. It was like, this is, like, the moment-

    18. JS

      Mm

    19. LK

      ... that Paul will be here for, is, like, Katie's infanthood and, like, Paul's final years. And so there was no, like, wishing away the moment. It was all present, and it turns out, like, that's actually really good for

  13. 43:48 – 47:38

    A Different Way to Grieve

    1. LK

      you.

    2. JS

      Mm.

    3. LK

      It's, like, the reason people, like, learn to meditate or, you know, or it's like I'm washing my hands in the sink. Like, this is the feeling of the cool water. It was like that. It was like, like, a baby cries, someone dies. I'm here, like, [laughs] in this moment, you know? And so, yeah, and I still can access that somewhat, and then I also am like, you know, "Where are the pencils for seventh grade?" So, like [laughs]

    4. JS

      [laughs]

    5. LK

      But anyway, it was, it was, like, beautiful and amazing, and really good that we did it, and just, yeah. It, it worked out. Taught me a lot.

    6. JS

      Were you always so evolved and, or did this accelerate it in a way that... Because when I hear you speak, I'm just like, "God, this is, like, a lot of growth, a lot of, in a short amount of time-"

    7. LK

      Yeah

    8. JS

      ... a lot of taking on a lot of different things in a short amount of time, and it's almost like, do you feel like you were somewhat prepared for it from somewhere in your past?

    9. LK

      The heaviest lift for me, actually, I think in terms of, like, training my, like, brain and heart to hold a million things actually was in medical school. I was like, "I cannot believe I'm using, like, every fiber of my being to figure out, like, intellectually and emotionally how to take care of sick people and attend to, like, every, every layer of what's happening in this room, and then, like, make a t-10,000 decisions about, like, how to make it all happen." So that was really hard. I also went through an episode of depression in residency that was incredibly painful. I wasn't, like, hospitalized, but I took two weeks off work, and I felt like... I just felt like I didn't exist. I mean, it was depression. It's like depression, like Andrew Solomon says about depression, like, depression is not the opposite of happiness. It's the opposite of vitality.

    10. JS

      Mm. Mm.

    11. LK

      Which is, like, so interesting. That was really hard, and I think, like, making it through that, I don't even think I could put into words what it, like, taught me, but touching that, like, pain, like, left me with, I don't know, some sort of ability to approach darkness or something. [laughs] Just to be like, okay, like, I don't know. I have no idea. Yeah, and then I just have, like, really good friends, and we're talking all the time. Like, I'm a processor by talking, obviously.

    12. JS

      Mm.

    13. LK

      You know, and then at the same time, it's like I went through this hard thing of all these ideas about, like, what helps me cope, and then you go through a breakup, and you're, like, heartbroken and you hate everything and you have to start again.

    14. JS

      Mm-hmm. Mm.

    15. LK

      Or like, you know, you have to figure out how to explain it to a kid, and then, you know, like, that's impossible, or they think you're stupid. You know?

    16. JS

      Mm-hmm.

    17. LK

      Like, I don't know. It's all everything. [laughs]

    18. JS

      [laughs]

    19. LK

      It's all everything.

    20. JS

      It's the as- transcendence and bullshit.

    21. LK

      Yeah.

    22. JS

      Yeah, yeah.

    23. LK

      You know, this actually makes me think of this thing. Yeah, transcendence and bullshit.

    24. JS

      Yeah.

    25. LK

      Do you know this idea? It came out of Dan Gilbert-

    26. JS

      Yeah

    27. LK

      ... at Harvard, the social psychologist.

    28. JS

      Yeah, sure, sure.

    29. LK

      This idea of, like, the end of history illusion. So, like, he talks about... Like, when you're asking this question of, like, like, what got you to where you are today, and then, like, he interviewed a bunch of people and he said, like, "How much do you think you've changed in the past 10 years?" And everyone said, "So much." [laughs] Like, so much. And he said, "How much do you think you're gonna change in the next 10 years?" And people said, "Probably not a lot."

    30. JS

      [laughs]

  14. 47:38 – 50:33

    Keeping a Loved One Alive After They’re Gone

    1. JS

      that would be my initial take. I feel like I knew who I was. I'm pretty much the same person. But I think that's not fully true. I think-

    2. LK

      Sure

    3. JS

      ... there's a, there's also an end of history illusion from 10 years ago. [laughs]

    4. LK

      Yeah, yeah. That's interesting.

    5. JS

      In, in the sense of, like-

    6. LK

      Yeah

    7. JS

      ... I made up my mind who I was 10 years ago in my head.

    8. LK

      Yeah, stopped then.

    9. JS

      And I stopped then-

    10. LK

      Yeah, yeah

    11. JS

      ... and it's like, well, that's not obviously true.

    12. LK

      Yeah, yeah.

    13. JS

      That's fascinating. That's-

    14. LK

      It's interesting

    15. JS

      ... that's really cool to play with.

    16. LK

      Yeah, yeah.

    17. JS

      It's refreshing to allow yourself to say, "I have changed. My ability, my values have changed," or, "What I care about has changed," and...

    18. LK

      And then when a big, hard, hard thing happens, you're like, "Oh, it's gonna make the me." [laughs]

    19. JS

      Yeah, yeah.

    20. LK

      Yeah.

    21. JS

      Yeah, yeah.

    22. LK

      Yeah.

    23. JS

      Yeah. I like Dan's work, so I'll have to check that out.

    24. LK

      Yeah, he's really cool.

    25. JS

      Yeah. I wanted to ask you, actually, going back to something you said earlier, what about Kate- Katie reminds you most about Paul?

    26. LK

      Her eyes and her hands. Her stubbornness is, like, infuriating. She very much knows her own mind, which is infuriating.

    27. JS

      [laughs] I, I love him. Yeah, that's-

    28. LK

      It's like an en- entire parenting toolboxes are unavailable to me because she's not a pleaser. Um, and then she's, like, an incredible physical comedian, which Paul was also. Those are the things I think-

    29. JS

      Mm

    30. LK

      ... I would say. She's introverted. Like Paul, I process by, like, speaking, like, relating. Sometimes I don't even know what I think until I've said it, and Paul was much more, like, inward. I think that's, like, uh, sort of like why he's, like, When Breath Becomes Air spun out of his illness because he was, like, churning and processing and reading and writing. And she's introverted like that.

  15. 50:33 – 53:23

    Can You Love Again?

    1. JS

      [chuckles]

    2. LK

      But it's interesting because I actually think like for her, losing Paul was a big thing, and not having like a dad there is a big thing. But not having a sibling is actually also a big thing.

    3. JS

      Wow.

    4. LK

      Or having like our family look different from like most of the families at school. The permission slip is different. Like, she's not self-conscious about it, but I think she like knows it-

    5. JS

      Mm

    6. LK

      ... and it's a thing.

    7. JS

      Mm-hmm.

    8. LK

      So it's actually kind of interesting 'cause it's not the only thing, you know? It's like she's piecing together like, you know, all of it-

    9. JS

      Yeah

    10. LK

      ... like the structure of everything-

    11. JS

      Yeah

    12. LK

      ... as every kid is doing, right?

    13. JS

      Yeah. About that, I mean, you mentioned earlier that Paul obviously wanted you to remarry. Obviously-

    14. LK

      Yeah

    15. JS

      ... Cady's encouraging you to date.

    16. LK

      [chuckles] Yeah.

    17. JS

      Like what was that process like for you? Because you can say it when he's there and say, "Okay, I understand that that's how you love me-"

    18. LK

      Yeah

    19. JS

      "... in that forever way."

    20. LK

      Yeah.

    21. JS

      But what does that actually look like for the individual who has to go on and try to love again? How did you even begin-

    22. LK

      Right

    23. JS

      ... to open your heart and mind to that possibility?

    24. LK

      Yeah.

    25. JS

      And when did it feel possible?

    26. LK

      I wasn't like trying to open my heart or something. I was just like it was just pure intuition. I was just sort of like, "Well, I'll know when I know."

    27. JS

      Yeah.

    28. LK

      You know, for my wedding ring, I was like, "I guess I'll take it off sometime. It's not today." And then like six months after Paul died, I went swimming and like took the ring off and then came out of the lake and was like, "Oh, I think I'm not gonna put it back on."

    29. JS

      Mm.

    30. LK

      And then like right now I have like my engagement ring and Paul's wedding ring on this hand-

  16. 53:23 – 57:19

    What Real Partnership Means

    1. LK

      can fall in love, have fallen in love. Like it's just like there's enough love-

    2. JS

      Mm

    3. LK

      ... to go [chuckles] around.

    4. JS

      Yeah, yeah.

    5. LK

      You know? It's been like pretty easy in a way. And I think the grief part was actually the harder part. It's like I needed to like heal to be like ready and be like emotionally available for like anything. Like I was just like parenting my kid and surviving, and then I became ready.

    6. JS

      Yeah.

    7. LK

      Let me know if you wanna set me up. [both laughing]

    8. JS

      Yeah, yeah.

    9. LK

      They have to have one daughter younger than 11. [both laughing]

    10. JS

      Yes. Cady wants a little sister. Got it. That's a good criteria. We're gonna put it out on the show right now.

    11. LK

      [chuckles] Yeah, exactly.

    12. JS

      I'm hearing from you that it's that, it's that intuitive tell. It's, it's not-

    13. LK

      Totally

    14. JS

      ... yeah, it's not something that you consciously pursue or prepare for.

    15. LK

      Which like is probably similar for a bunch of people, right? Like after someone gets divorced and is like going through the like devastation and like identity and like what was what and what was my role, and I don't know, it's just like it's all an upheaval, right? That's like also so like terribly hard. And so I don't know, then it's like, yeah, when are you ready?

    16. JS

      Yeah, absolutely. Yeah. When are you ready? And I think that's the question that everyone keeps quizzing in their mind. But like you said, you can only know internally. It's not-

    17. LK

      Yeah

    18. JS

      ... like a tactical-

    19. LK

      Right

    20. JS

      ... practical thing-

    21. LK

      Right

    22. JS

      ... that you can kind of put into-

    23. LK

      Right

    24. JS

      ... a number of months or years and, yeah, it doesn't, it doesn't work that way.

    25. LK

      Right.

    26. JS

      How do you define love today?

    27. LK

      I mean, I saw you talk about it actually on a clip where you were like, "The person who loves you will never use your wounds to-

    28. JS

      Mm-hmm

    29. LK

      ... against you."

    30. JS

      Mm-hmm.

  17. 57:19 – 1:02:39

    Letting Go vs. Giving Up

    1. JS

      this idea of, and I know you've spoken about this, this idea of, like, reimagining how we die. Uh, because-

    2. LK

      Yeah

    3. JS

      ... it kind of goes back to what you were saying earlier about the survivor or the beating cancer-

    4. LK

      Yeah

    5. JS

      ... approach.

    6. LK

      Yeah.

    7. JS

      My monk friend who, who passed away, like, he, he was very positive, and he almost just didn't let anyone in to what he was feeling and going through.

    8. LK

      So interesting.

    9. JS

      And that was his version of how he dealt with it.

    10. LK

      Yeah.

    11. JS

      And as far as I know from him, I believe he was happy with that.

    12. LK

      Yeah.

    13. JS

      And then, of course, at the end of his life, he needed support and help and everything, and-

    14. LK

      Yeah

    15. JS

      ... and he, and he got that. I wonder what your take is on having obviously done this, as been a doctor, has seen patients, been at grief groups. Like, when you think about this idea of people battling between letting go and giving up and, like, what the difference is and what you do when you get a diagnosis and how you weigh up whether I should fight till the end or whether I'm giving up or actually am I just-

    16. LK

      Right

    17. JS

      ... letting go. Like, can you help make sense of that to some degree?

    18. LK

      Totally. I mean [chuckles] no is the answer. [laughs]

    19. JS

      Yeah. Yeah. [laughs]

    20. LK

      Um, I mean, I t- I hear you about your friend, and it really is, like, to each his own. Like, people really have different ways of coping. Um, it is a weird time to die in America in history, um, because, like, that sort of, like, battle idea. Like, death is very medicalized and, like, very sort of, like, Western medicalized right now here, and I think there's, like, a lot of reasons for that, but the battle metaphor is one of them. And another one is, like, we have all of this technology available that is, like, you know, built for emergencies, but is getting offered to people who are, like, 90, you know, with, like, failing organs. Um, I think there's so much taboo around talking about death and dying and meanwhile also so much hunger to, like, crack it open and think about it. I think, like, suffering and dying are really hidden, like, from view-

    21. JS

      Yes. Yes

    22. LK

      ... the way that they haven't been across history for people.

    23. JS

      Yes.

    24. LK

      So it's, like, really interesting to be like, "Oh, what's happening over there?" Like, how are we supposed to talk about it? So I think there's sort of this, like, cultural force to, like, intervene, to, like... You know, anyone who's been through, like, a serious illness with someone has seen how much sort of, like, momentum there is toward, like, aggressive medical care. I think of it-- When you were saying, like, how do you choose whether to, like... You know, am I giving up? Am I beating it? I guess in my mind, I sort of think of it as, like, a thing is happening. Like, a thing is happening. It's like now there is Parkinson's here, or now this person has metastatic cancer, and, like, it's going to play out the way it's gonna play out. And so, like, how do you, like, provide healthcare that's gonna make that the best possible? Like, extend life as long as possible, extend functionality, like, as long as possible, help people do the things that they wanna do that are important to them. But there is some, like, building of, like, you can sort of choose healthcare within that to kind of, like, design your healthcare or, like, make your choices around what's important to you. But that requires, like, sort of facing up to, like, what is happening-

    25. JS

      Yeah. Yeah

    26. LK

      ... what is possible, and then, like, having the team who's taking care of you, like, also level with you about that with their knowledge and experience. I mean, there's, like, two things, like, for-- I'll, like, give you a practical tip about it. But if people are like, "I am facing an illness. My family member has an illness. I want to be able to, like-

    27. JS

      Yeah

    28. LK

      ... figure this out."

    29. JS

      Yeah.

    30. LK

      "But, like, how on earth am I supposed to do that?" One, like, thing people can do is ask for a palliative care team to be part of their care.

  18. 1:02:39 – 1:05:58

    Sitting With the Dying

    1. JS

      things that exist already that, that we miss out and even, even like the, um, what was it? The Hot Widows.

    2. LK

      Hot Young Widows. [laughs]

    3. JS

      Hot Young Widows. Totally, yeah.

    4. LK

      Yeah.

    5. JS

      Like, that's like-

    6. LK

      Yeah, yeah

    7. JS

      ... even the camp you were talking about earlier when-

    8. LK

      Yeah, yeah

    9. JS

      ... before we started recording, like-

    10. LK

      Yeah, Katie's at Camp Kesem. Yeah.

    11. JS

      Yeah.

    12. LK

      Yeah, yeah.

    13. JS

      And, and just there's all these things out there that-

    14. LK

      Yeah, like people have thought of it

    15. JS

      ... humans are doing so many beautiful-

    16. LK

      Yeah

    17. JS

      ... yeah, so many beautiful things to-

    18. LK

      Yeah

    19. JS

      ... to help people at different stages, and you almost don't know and, and hopefully people who are in the position know. But if they don't, it's... Yeah, I really appreciate you sharing that.

    20. LK

      Yeah.

    21. JS

      I think this is such an important conversation that I feel like you're such a big part of. Like, how do we help people take back their dignity when they're dying? Like, what does, what does that actually mean? What does that look like?

    22. LK

      I think the, the broad strokes answer is, like, don't forget that they're a person. Don't forget that they're still them. Think about what you would want in that situation. You know, I think, like, like we were saying, it's like illness and dying can be sort of so flattening of, like, your humanity, your complexity. It's so sort of, like, undignified, right? You're like-- You become sort of, like, infantilized, you know? Or if you're in a hospital or if you're somewhere, it's-- if you're in a healthcare facility, you're literally naked. You know, you're not even wearing your own clothes. So just as much as, like, people can protect your privacy, ask you what's important to you, make things beautiful, like sensually. You know? Like, there are flowers here. There's music here.

    23. JS

      Mm.

    24. LK

      Like, people are touching you. Like, people are looking you in the eye. Like, I don't know, I could say a million other examples.

    25. JS

      Mm.

    26. LK

      I also think, like, respecting what someone, like, cares about.

    27. JS

      Yeah.

    28. LK

      Like, you know, when people are dying and they're trying to make a difficult decision like Paul did. I wrote about this in the end of Paul's book.

    29. JS

      Mm-hmm.

    30. LK

      But he was very, very sick and ultimately got rushed to the ICU 'cause he was suffering so much and couldn't breathe well, and then had to make this decision about whether to be intubated, like whether to be on a breathing machine. A lot of people who are sick end up sort of with a North Star of what's really important to them. "I want to be with my family. I want to be free of pain. I want to make it to my child's graduation." For Paul, his was, "I want to be mentally lucid." Like, "I want to be mentally lucid to, like, be with my family and keep writing as long as I can write." He literally was, like, writing up until, like, two to three days before he died. And so that decision about whether to be intubated became really clear.

  19. 1:05:58 – 1:08:41

    Sharing Life-Changing News

    1. JS

      obviously.

    2. LK

      Sure, totally.

    3. JS

      But there's a independence and decision that that person also needs clarity on. And like you said, it may be, "Yes, I want to do this," but his one was so specific to his-

    4. LK

      Totally

    5. JS

      ... purpose and mission in the world.

    6. LK

      Totally. And at the same time, like, medically, like, families can go through real trauma, like literal PTSD from, like, participating in medical care or having, like, their loved one get care that wasn't in line with their values or that they ultimately thought, like, "Oh, that did cause them unnecessary suffering." So it's like there's always a trade-off, you know? Like-

    7. JS

      Yeah

    8. LK

      ... it's like it can hurt everybody.

    9. JS

      Do you believe anything needs to change in the standard protocol of how doctors deliver terminal news?

    10. LK

      Um, totally. When I was in medical school, which was 20 years ago, they were just starting to teach like, "Hey, make sure you attend to the emotion in the room." So, like, if someone is crying, pause, allow some space. It'll feel like a long time to you. Doesn't feel like a long time to them. And then you can even say, "I see the tears in your eyes," and just leave it. Or you can say, "This looks like it's feeling really sad." You know what I mean? Like, we were learning those skills. It was really interesting because they were teaching it to us like they were skills because they actually are. And then you have a little mnemonic about, like, attend to the emotion in the room, but it's real. Like, it's you-- it becomes part of you.

    11. JS

      Yeah.

    12. LK

      Um, I think, you know, there was a study of doctors that said half of doctors said they had, like, given a prognosis that was rosier than what their actual medical opinion was, which is so interesting. It's like even in the hospital, it's like you sort of make this assumption of, like, what hope means to people. Like, hope means longer life. So I'm gonna say that. I'm gonna keep them on the outer bounds of what could be possible. But I think what many people respond to, like what I've ended up learning, is a really good way to share with patients or even frame it to yourself- Is thinking, A, about like prognostication, for example, as a range. So like instead of saying like, "You have six months to live," because like that's the median in the studies, you say like, "It's likely a few months to a few years," which is like broader, but more accurate really. And that's like enough information for someone to decide, like, do they wanna have a baby [laughs]

    13. JS

      Yeah, yeah, yeah

    14. LK

      ... like during this illness or not, you know? And then similarly, another way that we've been trained to tell people or we're training our students to tell people is a model where you say you share the best case, the worst case, and the most likely case. And actually people can have a lot... People get a lot of information from that where they can decide, like, how much risk do I wanna take to aim for the best, to prepare for the worst? And then they're kind of like, "Well, I'm still allowing space

  20. 1:08:41 – 1:11:39

    How to Live Well

    1. LK

      for the best."

    2. JS

      Mm-hmm.

    3. LK

      "And in the meantime-"

    4. JS

      Yeah

    5. LK

      ..."I'll make sure my family knows what I want when I'm gone."

    6. JS

      Yes.

    7. LK

      So like, I think like doctors are being taught to allow just like space, space, space, space, and more like accuracy.

    8. JS

      Yeah. Yeah, yeah. Yeah, that's really helpful to hear. It's helpful to hear how humans process-

    9. LK

      Yeah

    10. JS

      ... really difficult information.

    11. LK

      It's also like not just one conversation. Like-

    12. JS

      Of course

    13. LK

      ... the first time you hear the news, like, then you don't wanna hear anything else, right? [laughs] Then you have to hear it again. You know, you hear it from different people. But yes, it needs to change, and it is changing, thank goodness.

    14. JS

      I think right now in the world we're talking a lot about aging well.

    15. LK

      Yeah.

    16. JS

      What's your sense of what it means to die well?

    17. LK

      I think that living well is the same. I think like the way to not be afraid of dying is to feel that you've had a meaningful life. That's what I think. I think that's what ended up being true for Paul. And I'll just tell you like something beautiful that like Paul felt that I hope I feel too, 'cause I also think this sort of encompasses like a good death [laughs] is like similarly, if you're lucky enough to like have the tools to like build a life that you felt is meaningful, I think Paul ended up feeling, like not to sound cheesy, but I love this, he ended up feeling, "I'm not dying feeling that I'm losing everything. I'm dying feeling that I have everything," which I think is so cool, you know?

    18. JS

      Wow.

    19. LK

      So I don't know. Hasn't happened to me yet, so it'll be a surprise.

    20. JS

      That's a really powerful answer, and quite a unfathomable mindset because you could argue he, he could have felt he didn't have everything. Like, he hadn't had Cady yet and, you know, like hadn't had that experience and which seems like the natural thing we all feel at that time where it's like, "I haven't done this yet," or, "I haven't seen this," or, "Wanna make it to this," and sort of really say-

    21. LK

      But that will always be true.

    22. JS

      Yeah.

    23. LK

      That'll be true for everyone.

    24. JS

      But he was able to say he had everything. He felt that.

    25. LK

      Mm-hmm, yeah. Or enou- like enough.

    26. JS

      Enough.

    27. LK

      Yeah.

    28. JS

      Yeah, enough. Yeah.

    29. LK

      I struggled with it later too, and then a friend was like, "What if it was enough?" And I was like, "What if it was enough?"

    30. JS

      Lucy, thank you so much.

Episode duration: 1:11:40

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