Although Paul Kalanithi dreamed of becoming a writer, he first planned to spend 20 years as a neurosurgeon-scientist. Tragically, however, in 2013—during his last year of residency at Stanford—the nonsmoking 36-year-old was diagnosed with stage IV lung cancer. 

Soon after, he wrote a powerful New York Times op-ed piece, “How Long Have I Got Left?,” describing his diagnosis and struggle to make the best use of his remaining time. “Tell me three months,” he wrote, “I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases.”

In the months before his death in March 2015, Paul managed to do all three. He received treatment, continued to perform surgery as long as feasible, spent precious moments with his wife and family, became a father for the first time, and wrote a thought-provoking memoir about his life, illness and mortality, When Breath Becomes Air.

“He was working really hard,” recalls his widow, Lucy Kalanithi, a Stanford internist who met Paul while the two were in medical school at Yale. “He was suffering physically and of course emotionally. But he was very, very tough and thoughtful, and somehow coped and kept going.”

She describes her husband as “unbelievably smart, and, to top it off, the funniest person I’ve ever met, while at the same time, soft-spoken and subtle.” The couple often sat or lay side by side during his illness and Lucy’s maternity leave, with Lucy sometimes reading Paul’s words as he wrote. His manuscript afforded the couple a natural opportunity to communicate about what was happening and how Paul was feeling.

“It was exhausting, but we were having a really good time,” Lucy says. “It was very purposeful; we loved each other and we loved Cady [their daughter]. We knew that Paul’s time was limited and we were in pain . . .  but it was kind of an amazing time. It’s a weird word to use, but also very fun.”

Lucy notes that her husband was “uniquely positioned” to write this book, and that she, as a physician, was also uniquely positioned to help take care of him, along with their families and friends.

“And it still took everything I had,” she says. 

In the book’s foreword, Stanford physician and author Abraham Verghese aptly describes Paul’s writing as “stunning” and “unforgettable,” noting: “See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.”

Paul thought deeply before he wrote, and then his words flowed; his wife recalls that he wrote his op-ed piece during an airplane flight. “He wrote very quickly,” Lucy explains, “and didn’t spend a lot of time going back over it, partly because he didn’t have a lot of time and he knew it. Literally, he was racing to finish.” 

The beauty of his prose is hardly a coincidence, because Paul earned graduate degrees in English, history and philosophy before turning to medicine. Early in the book he declares, “I knew with certainty that I would never be a doctor.” Pages later, he eloquently traces his unforeseen career trajectory, explaining, “I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context.” 

Paul didn’t expect to face his own intersection so soon. Summing up his transformation from physician to patient, he writes: “Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle. I’d always imagined the doctor’s work as something like connecting two pieces of railroad track, allowing a smooth journey for the patient. I hadn’t expected the prospect of facing my own mortality to be so disorienting, so dislocating.”

The book was nearly complete when Paul died. “One of the last things he said to me was ‘Please get this finished,’ ” Lucy remembers. She explains that all the words in the book are his: His editor occasionally supplemented his manuscript with passages written elsewhere in essays, his book proposal and lengthy emails to friends. 

Lucy also penned a powerful epilogue describing Paul’s last days in a sad but elegant coda to the book. “I’m not at all a writer like Paul was,” she admits. “But writing that epilogue—I just loved it. It was the most meaningful thing I’ve ever written.”

As she works part time at Stanford (planning to return full time in March), Lucy finds the grief process to be “unexpected and unpredictable.” She rejoices in every milestone of their daughter Cady’s life. “Paul would have loved that her first word was ‘dog,’ ” she says. “There are all these little things that are just so bittersweet because he’s not here.”

When Breath Becomes Air closes with Paul’s heartbreakingly beautiful words to Cady, who brought him so much happiness during his dying days. “I’m so happy that he wrote it for her,” Lucy says. “That passage is my prized possession. I haven’t memorized it. I didn’t even try. I’ve just read it so many times.”

In the midst of her grief, Lucy remains excited about the book’s publication. “I’m keeping a promise that I made to Paul, which feels really important and makes me feel purposeful.” 

“I’m very happy about sharing him with the world,” she adds. “This book will be on people’s bookshelves. I can’t believe it. Paul really wanted to be a writer. We worked so hard to make it happen.”

Nonetheless, she can’t help but lament: “I’d give anything for you to be talking to Paul rather than me.”

Editor's note: This article has been updated to correct the date of Paul Kalanithi's death.

This article was originally published in the January 2016 issue of BookPage. Download the entire issue for the Kindle or Nook.

There were many surprises in store when you inherited your father’s desk and 1,800 pounds of his writing. Of the more than 400 novels he wrote, most were pulp porn. Were you aware of this as a child? What did you know about his writing career then?
Dad was a salesman who wrote at night and on weekends. He got a few stories in print, then, when I was 12, he published his first novel. My understanding was that he wrote only science fiction. He kept his porn activity very secret. This was mainly due to living in a very conservative area—the Bible Belt of Appalachia.

By the time I was 16, I realized he wrote some porn. But I believed it was supplemental income, a little bit here and there to make ends meet. It wasn’t until his death that I fully understood the scope of his output, and the primary focus on porn.

As the oldest child of four, you ended up taking care of your siblings while your mother defaulted to taking care of your father’s needs. Do your younger siblings view your father very differently from you?
I’m the oldest by a few years, and took care of them extensively. Dad was always in the house, so it wasn’t a case of a physically absent father. But he worked nonstop.

As a kid, I occupied both a parental role and a big brother role. Later, after we’d all left home, this influenced our relationships as adults. They gave me more authority than I wanted or deserved. Sometimes they wanted approval from me that they didn’t get from Dad. They could also be angry with me because it was safer than getting mad at Dad.

These days, we are all still trying to work through this—not Dad’s death so much, but who we are now. All I really want to be is the “big brother.” But that may not be possible, since I still have more responsibility—for my mother and for Dad’s literary estate.

Apparently your mother typed up your father’s manuscripts for him. Do you think she ever made any editorial changes while typing them?
Yes. She corrected any surface errors and deciphered his handwritten edits. Mom was a good typist, much better than Dad. He taught himself to type with three fingers and made many errors.

Due to the sheer volume and the pace that he worked, Mom worked on some books in a more collaborative role. They worked together very fast: Dad wrote a first draft in longhand, then began typing. He’d get 30 or so pages and pass it on to Mom for the final draft. As a result, she made some changes—for clarity, structure and details. Sometimes she did the final typing while he was still finishing the book!

Your father earned a decent living from writing pornography (at least enough to pay for orthodontia), and as you say in the book, “died in harness,” as a professional writer—he kept writing until his end. You yourself have found success both in literary fiction and as a screenwriter. What traits as a writer (if any) did you inherit from him?
It’s difficult to know what was inherited and what was modeled in terms of behavior. I certainly inherited his love of reading, which is crucial for a writer. I have his curiosity and energy. Perhaps most important, I learned the value of discipline—treating the act of writing like a job. Like Dad, I write every day. Unlike him, I revise very heavily. He was much more prolific.

His father, my grandfather, was a failed writer. So maybe there is some genetic component. I didn’t want to be a writer because it meant admitting I was like my father. But at a certain point in my early 20s, I really had no choice. I wrote all the time.

You were a passionate reader as a child, and Louise Fitzhugh’s Harriet the Spy was a particular favorite. I’ve known many women writers to claim Harriet as a role model, but not male writers. What did you learn from Harriet?
Harriet’s gender didn’t matter as much as her circumstances and behavior. Her parents were busy and she was on her own most of the time. Harriet was a loner who walked around recording her observations in a notebook. She dressed like I did—jeans, long sleeves and sneakers. She often carried a flashlight and tools, as I did. Harriet had a strength and confidence that I admired. What I learned from the book was the value of recording thoughts on paper. I resolved always to carry paper and pen. I still do.

You speak of your deep affection for the land you grew up in—the wooded hills of Appalachia. Why do you think lonely, imaginative children attach so strongly to the natural world?
I can’t speak for other children, but in my case it was simple—the natural world was stunningly gorgeous and very safe. I never felt afraid or alone in the woods.

I believe that spending so much time alone in the woods sharpened my perceptions. You have to rely more on sound and smell, and careful observation, to not get lost or scared. Essentially, I learned to see in the woods—to see things as they are, not what I’d like them to be. The natural world doesn’t lie. There’s no hidden agenda or clever marketing. Nature is brutal and relentless and beautiful. Perhaps that’s why I don’t waste time on small talk.

My question is this: Why don’t more people form attachments to the natural world?

It’s hard to process the death of a difficult parent. You write of loving your father, but not liking him. Can you speak to the difference?
Babies are born with an impulse to love. They love whoever is around, especially their caretakers. It’s a natural drive that benefits humanity. Then kids grow and become adults. Some realize they don’t actually like their father or their mother or their siblings. But they still love them. Love doesn’t have an off-switch.

My father could be very funny and extremely charismatic. He was extremely likeable for short periods, but people had to interact with Dad on his terms or not at all. I loved him the way any boy loves his father. But Dad made himself very hard to like. He preferred not to be close with most people other than my mother. I believe it made him feel safe.

As with many people, he was easier to love at a distance than to like close up.

It was emotionally wrenching for you to organize and catalog your father’s literary output, so much so that your siblings suggested that you burn his papers instead. In the end, are you glad you completed the task?
Yes. I learned a lot about myself in the process of writing the book. I was also able to understand my father better. When I finished, I felt relieved. It was exhausting in every way—physically, mentally and emotionally. Two years went by, and my memory of that time is vague. I worked 12 hours a day. I read tens of thousands of pages of his work. I eventually cut 200 pages from the final manuscript. I’m not fully certain what is in the book and what is not. I don’t even know what it’s about. Dad, I guess.

Writing this book had short-term effects, some of which weren’t good. I’m very interested in learning the long-term effects a few years from now. What benefits will arise from having devoted myself to this book? At this point, I believe I’m a better person for having done so.

RELATED CONTENT:  Read our review of My Father, the Pornographer.

This article was originally published in the February 2016 issue of BookPage. Download the entire issue for the Kindle or Nook.