Lucy Kalanithi’s Epilogue: Completing Paul’s Manuscript and Legacy

This article is an excerpt from the Shortform summary of "When Breath Becomes Air" by Dr. Paul Kalanithi. Shortform has the world's best summaries of books you should be reading.

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Lucy Kalanithi is an American physician. She was Paul Kalanithi’s wife, and completed and published his book, When Breath Becomes Air after his death.

In Dr. Paul Kalanithi’s touching memoir about life and death in the face of a cancer diagnosis, he details the harrowing journey of treatment, starting a family, his marriage, and learning to live life on different terms.

Paul met his wife, Lucy Kalanithi at Stanford. The couple later married and moved to California together. Throughout When Breath Becomes Air, Lucy Kalanithi is a central figure. Lucy is initially angry about Paul’s diagnosis, but both later admit it saved their marriage. Lucy, supports Paul through his treatment, and later completes his manuscript.

Lucy Kalanithi’s Epilogue: Paul’s Final Days

The final pages of When Breath Becomes Air are written by Paul Kalanithi’s wife, Lucy Kalanithi. She describes how Paul died on March 9, 2015, in the hospital with his loved ones by his side. Their daughter, Cady, was eight months old. 

Paul’s treatment stopped working a few months earlier, at Christmas. He became weaker but kept living as best as he could. They had friends over for dinner, played with Cady, and continued to enjoy each other’s love and companionship. Paul also worked on this book. During his last months, finishing the book was of the utmost importance to him. 

The transition to spring brought a resurgence of life in the natural world while Paul’s life continued to wane. In February, he was put on oxygen to help his breathing. More scans were done, showing the growing grip of the cancer in his lungs and the spreading of it to his brain. The new brain tumors brought a shortened life expectancy and would eventually lead to neurological deficits. 

The ensuing deterioration of his mind was particularly crushing for Paul, fearing the loss of meaning and independence. Thwarting these devastating effects became the main goal of whatever treatment he would receive.

Lucy Kalanithi remained strong for Paul, but on the inside, her heart was breaking. She didn’t know how much time they had left together, but she never thought it would only be a matter of days. 

For his final weekend, Paul’s family came to their house and spent time with him and Cady. Paul knew he wasn’t likely to finish his manuscript either due to time or his physical capacity. But he still put it aside that day, preferring to be present with his family. 

The family was hoping Sunday would bring more of the same. More time to relax and enjoy each other’s company, maybe go to church. But Paul spiked a fever and slept for most of the day. By Sunday night, Paul’s health took a dramatic turn. He couldn’t breathe and was taken to the ER. He knew, as they all did, he was unlikely to leave the hospital again.

The doctors suggested intubating him, and Paul and Lucy Kalanithi discussed and struggled over the decision. Intubation would keep him alive, but at what cost? Could his current ailments improve to a point where he could come off ventilation? Or would he continue to deteriorate, his brain and organs shutting down?

The other option was comfort care, an action that was certain to lead to rapid death. Paul’s main question regarded his quality of life even if he was able to recover from the respiratory issues. With the cancer in his brain, was there a good reason to lengthen his time if he would not be lucid enough for it to have meaning? He signed a “Do Not Resuscitate” and decided to sleep on it.

In the morning, his attention turned again to comfort care and the possibility of dying at home. But Lucy Kalanithi, a Stanford educated doctor, knew his condition was delicate and that he might not make it home. It was decided that she would bring home to him. The only thing he wanted was Cady. 

Paul lay with Cady in his arms while the doctors commiserated over what was left to do. But Paul knew what he wanted. He turned to Lucy and said, “I’m ready.”

Surrounded by his family, Paul became emotional as he communicated his love and gratitude. Before the supplemental oxygen was removed and morphine injected, Paul asked his family to ensure this book was published. He also told Lucy he loved her one final time. 

After another hour, Paul drifted into unconsciousness. Eventually, he inhaled and breathed out the last breath he would ever take. 

Lucy Kalanithi’s Epilogue: Life After Paul’s Death

Lucy Kalanithi says the years since Paul’s death have been hard. Some days, her grief is so severe, she is inconsolable. But she’s also found beauty in remembering their love. She’s had to contemplate life and death every moment, and in doing so, she’s found peace and appreciation for what they shared. She says she didn’t expect to feel the power of love intertwined with her grief, but she does. She continues to love Paul with the same depth as she had when he was alive.

Paul was buried in the Santa Cruz Mountains in Northern California. From this plot, the ocean and coastline are in view. Lucy goes there frequently, bringing along a bottle of wine and reveling in her memories, many of which are held within that same environment, from Paul and Lucy Kalanithi’s Stanford days to his end of life.

The earth above Paul continues to grow and morph as the laws of nature progress. Each season brings a regrowth and a reminder of the unending connection between life and death. 

The integrity Paul showed throughout his illness, and especially in those final months, was not limited to his life with cancer. He lived his entire life this way. He faced death daily and sought the answers to how to live despite it. Lucy believes that Paul’s illness was devastating, but his life was not a devastation. He wondered whether it was possible to hold life and death in his hands and still live a meaningful and graceful life. Lucy Kalanithi knows the only answer possible is yes. 

As Paul Kalanithi’s wife, Lucy Kalanithi fulfulled her promise and published Paul’s book after his death. The book was released in January, 2016. After publishing When Breath Becomes Air, Lucy continues to speak about Paul and his legacy.

Lucy Kalanithi’s Epilogue: Completing Paul’s Manuscript and Legacy

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Here's what you'll find in our full When Breath Becomes Air summary:

  • How Paul Kalanithi discovered he had cancer
  • How Paul coped with his cancer until his very end
  • How Paul's wife dealt with his death and found the strength to continue

Carrie Cabral

Carrie has been reading and writing for as long as she can remember, and has always been open to reading anything put in front of her. She wrote her first short story at the age of six, about a lost dog who meets animal friends on his journey home. Surprisingly, it was never picked up by any major publishers, but did spark her passion for books. Carrie worked in book publishing for several years before getting an MFA in Creative Writing. She especially loves literary fiction, historical fiction, and social, cultural, and historical nonfiction that gets into the weeds of daily life.

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