Lucy Kalanithi: What Loss Can Teach Us About Living (The Perspective Shift That Changes Everything)

Ten years after losing her husband, Lucy joins me to explore what grief looks like after a decade. 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 going to feel okay. It was like Paul died and I was like, it's all over. What did being so close to death teach you about life and living? There's two big questions. What would be left undone? And how can I live most fully in the time I have left? Hey everyone, welcome back to On Purpose, the place you come to become happier, healthier and more healed. Today's guest is Dr. Lucy Kalanathy. Ten years after losing her husband, bestselling author, neurosurgeon Paul Kalanathy, 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 Kalanathy, welcome to On Purpose. Thanks for having me. I have waited for this conversation since I've read the book and when breath becomes air and I've read it when I still lived in New York when I moved to the States and 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. And then to have your reflections within it as well, it's kind of left an imprint on me. And my team and I were sitting down and we're thinking about books there and it had an impact on us as a team. 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 want to start off by saying thank you. Thank you so much. Tell me what does it feel like remembering Paul ten years on? 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 the situation to me to him. And also just like what would Paul think of Katie 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 going to feel okay 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. How is this ever going to 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 sort of like an ongoing relationship with him through other people anyway I guess it's all just like a beautiful terrible mix. Thank you for sharing. Is there is anything you understand differently about Paul. Yeah I mean like the thing that makes me feel like when a person to tears is actually a thing I don't yet understand which is you know Paul he was a doctor he was like young neurosurgeon really interested in meaning and mortality like I thought he would become a professor of philosophy or writer and then sort of surprised himself by going into medicine 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 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 are 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 and see like new things in the words were like reflect on his experience and think like how was he alone in that and so like that sort of breaks my heart like what did I miss. You know an 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. 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 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 annoyed me 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. 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 lost through someone else but loss of ourselves there may be certain things that we miss on that journey and we we don't recognize. And maybe we shouldn't until that time yeah exactly 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 sure we only see all the bad things yeah and then as you're saying on the flip side when someone goes we only see the good things and it's so fascinating how the mind does that I guess he would know as a neurosurgeon like you know why we why we do that yeah. Yeah yeah the question yeah and where that comes from like why is it that we kind of like what's the neuroscience of grief. Did you a sense of that grief of how we block people's good things and they're alive and block people's you know bad things and they're gone and. Rater 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. Yeah don't forget when you hear the age old phrase time heals all wounds how does that sit with you 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 grief is a wound that festers I was sort of like oh I don't agree with that because of 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 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 yeah 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 yeah yeah and some of them don't work right like yeah or you you have to decide which ones work for you like if someone sends you a card with something on it or someone says you know everything happens for a reason you believe that it's not helpful but you're right I think many of those like. Things in literature things like that hold up what do you feel about that one everything happens for a reason 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 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 so and then I think like. Suffering if you're a man search for meaning yeah of course yeah no no no. you read it. That's why I say. 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. 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 can see some 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 or whether just like the pure achievement of just persisting alone. I think there is like actual meaning in that. And so I think the idea 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. Like that's only yours and maybe it takes years. I appreciate that. The idea that there wasn't some predetermined reason or some reason that had to be the way it was at journey of discovery. Yeah. And I think some people think that. And that's also like a beautiful story or a beautiful, you know, 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 relationships at the time? Yeah. And what do you find useful now? Yeah. And helpful. This isn't about other people actually, but this was a really helpful thing for me is 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 health care 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. Like they're all yours. And he was like, I don't need to. And I was like, I don't need to either. 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? Do you think is really beautiful? 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 going to 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. And I was like, oh, so amazing. And it also wasn't like too flowery or too like perfect or whatever. It was just like, this is how it's for some fields. It's definitely how I feel. Also, it's still funny. Like 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 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 instant. So when people would come to visit and hang out, they'd say, like, come 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, if that's what you would do anyway, like, just because he's dying, like, doesn't mean he doesn't want to 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 a gentick and be, that's a word, be an agent and like, be a full person. I think we all lose our powers when we love someone and they lose someone. Totally. I think for a lot of people listening and watching, I think a lot of people become distant. Totally. Because 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 you can help and you really mean it. Yeah. And I've done that. But I think when you're the sick person, it's like you are quite overwhelmed. And so it is useful to just like 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. And then like, let's talk to the first thing. Just like, you know, that kind of stuff. Hey, like, do you need babysitting this week? Like, let me know. Yeah. Like, I'm dropping off food. Do you want me to ring 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. What do you think most people misinterpret about grief? One thing is like, oh, if I say something, I'm going to remind her or if I say what if I say something and 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? Is there anything you 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 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 of 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 sound so cozy or nice. And it's like they didn't have to say a special, perfect wise thing they just described, you know? So I think that's also really helpful. Describing what you're going through is sometimes better than trying to say the perfect thing. Or the right thing. Yeah. Absolutely. Yeah. To just be like, this is the worst day ever. Yeah. Yeah. This is hard. This is hard. Yeah. This is, this is really difficult. Yeah. It's so much more, I don't know, there's something about it that opens up the heart rather than closes it. Totally. Yeah. Yeah. Just it's almost acceptance. Yes. Yeah. Yeah. Yeah. Can I just come sit with you? This looks so hard. Yeah. Exactly. Yeah. Yeah. To admit that to ourselves. That's what we struggle to do. What was, 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 the last few years. I've lost spiritual mentors. I've lost friends. Yeah. And different scenarios. But I had a friend recently who is going through it in the States. His partner's a doctor, but he's not. Yeah. And his partner wasn't as supportive as he wanted them to be. 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 going to be fine. They're going to figure it out. 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? The way Paul got diagnosed was he'd been getting sicker and sicker. And then he ultimately got the news that he had a chest X rate that essentially looked like a cloudy sky. You know, we're going to the hospital tomorrow for 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 going to go and get expedited to work up. 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 being in time by Heidegger and Miraculous Janity by CS Lewis. And then a novel called Cancer Ward by Solson Nitsen. And it was the 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 we just need to turn to like the human experience of this. And for him, that was like, oh, I'm back to literature. 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, He was like looking at a patient's scan and then you're like, "Oh my gosh, it's you, it's you." And then we 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. It's such an amazing kind of love. And people have it, right? People have it for their children, people have it for their spell. 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 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. Surviving? Yeah, surviving. And I think that metaphor is so flimsy, you know? Interesting. 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 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 sides up the battle metaphor, which was really helpful. And then I think part of that was just we knew how sick he was. 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, 'cause then we could decide what to do. What I'm hearing you say is that it wasn't the doctor conversation or the medical conversation because that was almost accepting what was in front of you. Yeah. But it was the conversations that you both allowed each other to have beyond the knowledge that you both were aware of. Yeah, like luckily. And at the same time, like I mean, it sound easy and it like totally was so, so painful and like so confusing and just so like it took months, months for us to like even feel like we had our feet on the ground, you know? And then things are like, it's a constantly shifting landscape, you know? And he's going through his emotions. You're going through yours like to kind of imagine that they align every day. Yeah, totally. When I wonder about just the work that you're doing as well and as we kind of navigate this conversation, I'm like, I know that in my life when I lose someone I'm close to, especially when they're around the same age, there's something different than when I lose someone older. Because at least when someone's older or at an age that feels appropriate for loss, 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 stage four colon cancer. Yeah. And he was like maybe two years older than me. Yeah. And I remember watching him through the whole journey, present with him, talking to him on the phone, seeing him when I heard 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. And I wanted to know like, what did being so close to death teach you about life and living? Yeah, it's hard to separate actually, like being so close to death and being so close to Paul, because it was like so embodied. And it's funny, it's like you're talking about your friend dying and what a surprise that is when someone young dies. And it's like the way I've ended up 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. 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 that he was sick. And it's like he was so sick and so debilitated and still, like physically still and like won. 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 to like being a new dad. And it was just really interesting 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, like spitfire who like knows everything and like, 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. 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 an answer to your question for real about like what can dying teach us about being alive and living, dying is like the 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 Osticewski, it's like a Buddhist teacher who found its end 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 Biak, who's this like really beautiful doctor 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. He says, what would be left undone or unsaid 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 even like a traffic jam and you're just like, ah, road rage. I'm going where I'm going. I hate these people, they're in my way. Like it's like no, like you are the people. You are the traffic, 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? Everything's beautiful. So I don't know. I think there's like a real like luminosity that can be found like when someone's dying. And then at the same time, like traffic jams suck. And like 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. The team like zooming in, zooming out. And transcendence, you know, which is like hopefully what we can all do like every day. Yeah, yeah, yeah. It's zooming in, zooming out as you said. Yeah, like for a few months now, my team and I've been creating these zoomed out versions when you were describing that of almost like city crosswalks. Parks. And we just we place these little thoughts on what everyone's going through. What and people are like moving around in the park or sometimes it's possible. When you like a scribe, like a story. Correct. I played that game with my kid. Oh, on the way, tell me about that. We just laid out like a dinner and stuff. We're out to dinner. I don't know who we're talking about. Yeah, yeah. We'll be like, what are they talking about? And then you'll be like, oh, this person just walked by like his dog's name. Sometimes it's just sort of like silly. It's like his dog's name is peanut. and just make it up. But sometimes it's like. - Oh, like, do you think he's just gone through a breakup? Like, look at his face. - Yeah. - Oh, like, we just sort of make it up like as a way to pass the time. But it is sort of like an empathy game. - Absolutely, yeah, so we're doing exactly the same thing except creating it on social media and sharing the mysteries for people to zoom out a little bit. And so we'll take different scenes, whether it's an airport or whether it's a park or whether it's a crosswalk and we'll have lots of people walking around and we'll just put little stories on top of them. - I love thinking that way. - Yeah. - Because I always know that if I cut someone off in traffic, I feel like I have a good reason. - Sure. - If someone cuts me off in traffic. - Yeah, like the fundamental attribution error. - You're like, they're an asshole. - Yeah, yeah, yeah, exactly. - Yeah. So what are you trying to show? Are you just trying to show like everyone has like a rich life as rich as yours? - Yeah, and we're not alone in our suffering. - Yes. - So you may feel like you're suffering right now. You're definitely not alone. - Right. - That everyone you meet may simply be projecting their own suffering onto you and it isn't a reflection of who you are. - Oh, totally. - And everyone has a story. - Everyone has a thing. - Yeah. - Yeah. - And so just trying to help us, I guess, transcend. But then I like your version of, it's still bullshit. - Yeah. - So I need to make one of that one. - Yeah, of course. - I think we need to end it with that. I think you found the perfect ending. - Yeah, cool. It's so cool. Can we just see that? - No, as you're saying it was just, it's helpful hearing it from you. As you're answering these questions, I'm so honestly like 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. - Thanks. - And they counterintuitive almost. And that's what's so helpful and refreshing. - Yeah. - You know what's so weird? Those like partly it helps you and the partly it doesn't 'cause like the next thing that comes is also really hard. Like 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 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 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 the 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. Like it's the new hardest thing, you know? But at the same time I think you end up realizing like okay, I've done a hard thing before, you know? Like Jane Fonda on Julia Louis-Dreyfus's podcast. She was like, people always say that being old is hard and she's like no, being young is hard. She's like being old is amazing. Like you've been through so many things, you know you can do it. And I was like that's awesome. - If we're able to pull from that well of experience and tragedy and if we're able to look at it and go, because I think humans don't give themselves enough credit for how much they've survived. - Same. - Yeah. - We don't give ourselves enough credit because we don't look back at that moment and think we were strong, we look back at it and think we were weak. - That's so interesting. - And that we just love that. - Or like I was a stupid teenager and then you're like no, you had to learn that. - Yeah, yeah. - There's no other way to learn that. - Exactly. - Yeah. - And like owning that is what gives you what I think what you're sharing, which is oh I can look back and think, wow I got through the heart and I can relate to that. I mean I remember talking to my mom once and my mom is not someone who gives me motivation or advice or gives me wisdom. She's loving and caring, but not a wise sage in her words. And I remember I was going through my most difficult fight yet at a certain point in my life around nine years ago and I was talking to my mom and she was asking me how I was and what I ate for dinner, which it was usually a conversation. And I just said to her, I was like, yeah, you know I'm just, I'm doing all I'm just stressed out doing a bit, you know, and I would say that in a passing way. - Sure. - And she said, you're good at dealing with stress. And I was like, my mom doesn't just say. - But it was so helpful. - Yeah, and I said, what do you mean? And she said, well when you were in my womb you went through a lot of stress. - That's so beautiful. - And it was like, oh my gosh, you know Craig. It gave me so gift, so much. It's still what I turned to when I need strength. - Oh my goodness. - And it broke through the challenge I had at that time. Like it gave me all the reasons and conviction I needed because my mom just reminded me that. - Well, that's a beautiful. - Yeah, it was unbelievable. - It's amazing too, because she's saying like, that's such an embodied thing because like, oh my gosh, I'm going to cry. Because like, she's telling you like your, the fact that you were in a fetus, right? - Yeah. - She's telling you like, your body already knows how to do this, like your body did this before you like, could even, when you were pre-verbal. - Yeah. - Wow, what an amazing form of trust she gave you in yourself. - I've been thinking a lot about this idea of the stories of your parents and the stories of your ancestors. - Oh. - And when I think about the stories of my parents which I learned early on, but not as much detail as I wished. - Okay. - I just heard about how much they went through. And I was thinking about this with Katie, is it where I'm going with this? - Yeah. - And it's almost like, I didn't 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 mom grew up in a war torn country. They both moved to England, and they got married. And when I think about them, like, wow, that is, that's so difficult. And my parents did something really hard. - Yes. - My mom was studying for exams when she had soldiers on her roof top. - Wow. - Yeah. - My dad shared a bathroom with like 25 families. - Yeah. - Yeah. - And when I think about it, I think, God, that is, and then when you think, and you're like, but I come from that. - Sure. - Like, amazing. - Amazing. - Yeah. - And like, what? - Yeah. - And so I wonder when, like, for Katie who, - Yeah. - As we were talking about earlier, like, doesn't necessarily know her father, but how do you think about creating that experience for her in helping her make sense of it? - 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? Like, you do need to sort of absorb it yourself. - Yeah. - Yeah. - You know, like, you did this. - Yeah. - And you're like, okay, but like, it's so beautiful that you really absorb it. So it's like, I guess I hope Katie will do that, you know, from reading Paul's book, or from, like, watching me, and, you know, being me, 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 are, like, full human beings. Like, I remember in my 20s being like, we just second. My dad is not a professional dad. 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. Katie 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 facing death squarely. And then at the end, he, like, stops. And he's writing in the second person to her and, like, writes a message to her. And that's the last piece that he puts for her. As I'm raising Katie, I try to have her sort of taken, 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, like, love a hot shower. He loved a hot shower. You take the hour of power shower, just like Daddy. So that's just like a random thing that you would know if you were like growing up, like next to someone, right? So I try to give her those kinds of things instead of just, like, your dad died and he was so wonderful and he loved you. It's like, I try to give her like, sort of specifics that are like neither here nor there, but they're like, they like create a tapestry. - Yes, yes. - She like sees his brothers who are like really funny and amazing and sort of like, just funny in the way that he was. And then I don't know what her interaction will be with Paul's book. Like, it's all over her house. It's like, we know all over, but like, we've five copies and they're in different bookshelves and they're around. And I don't know when she's going to pick it up. I don't know what she's going to take. I don't know if he's going to feel really close. If he's going to feel really far, or if she's going to say like, I'm not interested in this, or if she's going to be 30 and produce a movie out of adaptation, like, I have no, no idea. But I hope that she'll find some way that helps her. Like, you did understand like where she came from and that she was loved and yeah, she came from this. Like, that's really beautiful to hear. say that. I came from that. So I have no idea. Yeah. No, of course you don't, but I appreciate how you incorporate the story, the tapestry, the natural, the real of what an experience is and and they're not heavy also. The version that's digestible and inhable. Yeah. Yeah. Without holding it. Yeah. Yeah. 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 less whomever and then you don't know them and you're piecing it together, what advice you have and like the resounding advice has been like, don't put away the pictures. Don't lock it up. You know, like let the kid sort of like have access, ask questions, like discover it and just don't like put it away. What was it like making that decision to have Katie at the time and then actually go through both coming to terms with Paul's mortality and then, you know, wanting to create life together? 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 in attending by then. This is when things will like 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. It was sort of like, is the family on board with this like we refinance the mortgage like all of these things. It's like, can I be a solo parent like that is what I'm going to 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 in it. I asked him actually and was like, you are, 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 going to make their life easier. There's like a million things we do 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. Then 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 going to be fine. I'm 99% certain that Paul will not be fine. So like, that is now like where I need to hold like my energy. So that was kind of like helpful. When she was a baby, it was like, it's so easy to wish away time. You know, it's like, I can't wait till she sleeps through the night or like, what's she going to be like when she's like 18? And there was none of that. It was like, this is like the moment 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 you. 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 in this moment. You know, and so yeah, and I still can access that somewhat. And then I also am like, you know, we're the pencils for seventh grade. So like, 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. 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, 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 are somewhat prepared for it from somewhere in your past? 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 10,000 decisions about like how to make it all happen. So that was really hard. I also went through an episode of depression and residency. It 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 Sullivan says about depression. Like depression is not the opposite of happiness. It's the opposite of vitality. It's 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 just feel like, okay, like I don't know. I have no idea. Yeah. And then I just have like really good friends or talking all the time like I'm a processor by talking obviously. 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. 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, like, I don't know. It's all everything. It's all everything. It's the transcendence and bullshit. Yeah. You know, this actually makes me think of this thing. Yeah, transcendence and bullshit. Do you know this idea? It came out of Dan Gilbert at Harvard, the social psychologist, 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 you think you've changed in the past 10 years. And everyone said so much like so much. And they said how much do you think you're going to change in the next 10 years? And so people said probably not a lot. And he interviewed people at every age. And there's like a little bit of a slowdown like in midlife. But essentially everyone changes all the time. Everyone changes the same amount in the 10 years. You walk around thinking it's the end of history illusion of like I'm me. I've made it here. I've got it sorted. Here we go. You know, and then in 10 years you'll be like a whole different you with like different sensibility or like different frameworks. Like isn't that crazy? Yeah. So I don't know. I find that really helpful. I don't know why. Yeah. Yeah. Yeah. Yeah. Allowing ourselves to you in different. I mean it changes when you first said that question. I was like oh, I'd say I haven't changed much in the last 10 years. My doubt 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 there's there's there's also an end of history illusion from 10 years ago. Yeah. Yeah. Yeah. That's interesting. Yeah. I made up my mind who I was 10 years ago in my head. It stopped then. And I stopped then. And it's like well, that's not obviously true. Yeah. Yeah. That's fascinating. That's that's really cool to play with. Yeah. 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 then when a big, hard thing happens, you're like, oh, it's going to make the me. Yeah. Yeah. Yeah. Yeah. I like Dan's works. I love to tell you that. Yeah. I wanted to ask you if you're going back to something you said earlier. What about Katie? Katie reminds you most about poor. Her eyes in her hands, her stubbornness, it's like infuriating. She very much knows her own mind, which is infuriating. I love it. Yeah. It's like an entire parenting toolboxes are unavailable to me because she's thought of fleezer. And then she's like an incredible physical comedian, which Paul was also those are the things I think 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 sort of like why he's like when breath becomes a response out of his illness because he was like turning and processing and reading and writing. And she's introverted like that. But then she'll give you like, you know, like a little gleam, you know, of some things she's thinking. Yeah. Yeah. As she ever asked you anything about Paul, like from her own curiosity. Totally. And she's actually so interesting. You ask that because I was going to say, of course. And then, but it's not necessarily, of course, she's just sort of in the mix, cleaning, but recently she started too. She said, "Could you make me an album of videos of daddy?" And I was like, "Sure." And it's like, I so badly want to be like, "What's she watching? When's she watching them?" Because she's having eye-pad time. But there's a bunch of videos. There's some interviews, and there's some goofy sketch comedy stuff, and there's some Thanksgiving, someone shot a video of whatever. And so she can look at that. And then she asks for stories. I'll tell her a story of, like, "Oh, yeah, here's a story about daddy. Chess tournament when he was in seventh grade, and he was really bratty, and a terrible loser." So there's a lesson in that. And she recently, of her own volition, put a small photo of the two of them next to her bed. And I was like, "Aw, so interesting." She's claiming him. That's beautiful. You know what else is interesting, though, is like, she doesn't have a sibling. Like, it's me and her. And she really wants a sibling. She wants a little sister, specifically. She really wants me to keep dating so she can have a sibling, like, "We can't engineer that whole thing," I think you posted. 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. 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. And it's a thing. So it's actually kind of interesting because it's not the only thing. You know, it's like, she's piecing together, like, you know, all of it, like, the structure of everything, as every kid is doing, right? Yeah. About that. I mean, you mentioned earlier that Paul obviously wanted you to remarry. Obviously, Katie's encouraging to date. Like, what was that process like for you? Because you can say it when he's there. And so I can understand that that's how you love me in that forever way. Yeah. 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 to open your heart and mind to that possibility? And when did it feel possible? I wasn't, like, trying to open my heart. So I was just, like, it was just pure intuition. I was just sort of, like, well, I'll know when I know, 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 leak and was like, oh, I think I'm not going to put it back on. And then, like, right now, I have, like, my engagement ring and Paul's wedding ring on this hand. Just interesting. But maybe I'll take them off. Like, if I were, like, dating someone really seriously, I think I would take off Paul's ring, you know? So I was in this, like, support group called Hot Young Widows Club. After Paul died, it was Nora Mackinari made it. It was incredible. And there was actually a lot of conversation in the group. It was a, it was on Facebook at the time. There's a lot of conversation about, like, what did your person say about dating again? Like, did you have this conversation or not? Because I think a lot of people who had had that conversation felt really freed by it. Some people thought, like, what would they want me to do? Or like, is it a transgression or is it a disloyalty? And I don't think so at all. Like, I think, like, not at all. But I think, like, I'll also always love Paul. It's really interesting. And I think, like, the analogy for me, I mean, it's just, like, love is infinite. Like, there's totally enough love to go around. And I think for me, it's not a perfect analogy. But it feels a little bit like, if someone's child had died, and then they had another child, you would never think, like, oh, this child replaced the other child or do they have enough space to, like, love the new child? You'd be like, no, they're just different. Like, it's a little different when it's your partner, right? But I'm like, Paul, the way I think of it now is like, Paul's my family. He's my family. His family's my family. Like, he's my family forever. And I absolutely, like, can fall in love, have fun and love. Like, it's just like, there's enough love to go around. 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. Let me know if you want to set me up. Yeah. Yeah. They have to have one daughter younger than a woman. Yes, Katie, you know, it's a little sister. I got it. That's a good cry to it. We're going to put it out on the show right now. Exactly. I'm hearing from you that it's that it's that intuitive tell. It's not, yeah, it's not something that you consciously pursue or prepare. It's like, it's 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 in a peve, all right? That's, like, also so, like, terribly hard. And so, I don't know. Then it's like, yeah, when are you ready? 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 like a tactical, practical thing that you can kind of put into a number of months or years. And yeah, it doesn't, it doesn't work that way. How do you define love today? 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 against you. And then you talked about how your wife, like, holds no judgment for you. And I was like, of course, of course, because you're you, like, and I don't mean you're Jay Shetty. I mean, like, you're, you're the person they love. So like, yeah, there's no judgment of whatever the thing is. There's just, like, partnership. It doesn't mean you could like endlessly hurt the person either. But like, I don't know, that's part of it. I think, I think there is like an unconditionality to love for sure. And at the same time, I think like that is more true for like children than adults. Like, you don't love adults unconditionally, right? You like have boundaries that like adults like can't actually cross. But like as long as you can like work a relationship within that, like, real, like, partnership and spaciousness and like, non-judgment. Yeah, it's a hard question. It's a really hard. What would you say? I'm always changing my mind. I think there's so many nuances and facets to it that it's so, it's such a hard question. I think that's why we all struggle with it so much in finding it and looking for it. That's the answer to, right? It's like, I would also be like fun and growth. Yeah. And then it's like, at the same time, you're like, it's sort of like that thing where it's like, you know, when you're not like, it's intuitive. Yeah. I mean, ultimately it's teamwork and teamwork requires all those things you just said. Yeah. Teamwork should be fun and it should have growth and it should have mutuality and it should have reciprocation and it should have connection and communicate. And so teamwork just feels very simplistic, but it gives you a good visual. Yeah. And at the same time, like, I do think it's like, I mean, you know this, but like, obviously it's never going to be perfect either. Like there's something actually really romantic and like choosing and like choosing like on a daily basis, you know, like that's very romantic. Yes. Of like, sometimes one person's up one person's down. Sometimes it's like, you know, difficult. Yeah. You know, but similarly, like, that's your team. Yeah. Yeah. Yeah. Exactly. Exactly. And it's it's shared. Yeah. It's a shared experience of the shared life. It's a co-created life. Yeah. Yeah. It's a co-creation, I think, is so important. And co-holding and co-everything. While also like, you're still like two beings. Like, correct. You're you. Correct. Absolutely. Yeah. Yeah. Yeah. It's complicated. I mean, it's like, it's a constant as you're saying this. It's like, similarly to the like end of illusion. Yeah. And of history illusion, it's like, it's never done and dusted. Like it's like, it's like constantly like work. Yeah. Yeah. Yeah. Absolutely. I wanted to talk to you a bit about this idea of, and I know you've spoken about this idea of like reimagining how we die. Because it kind of goes back to what you were saying earlier about the survivor or the beating cancer. Yeah. Yeah. My monk friend 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. So that was his version of how he dealt with it. Yeah. And as far as I know from him, I believe he was happy with that. Yeah. And then of course, at the end of his life, he needed support and help and everything. And he got that. I wonder what your take is on having obviously done this has 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 I'm just letting go. Like can you help make sense of that to some degree? Totally. I mean, no. I mean, I I mean, I I hear you about your friend and it really is like to each his own. Like people really have different ways of coping. It is a weird time to die in America and history. 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. 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. The way that they haven't been across history for people. 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 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 and maybe eating 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, 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 figure this out, 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. People get really scared around the word palliative. So like palliative care, hospice is a teeny part of it. So hospice is like palliative care for people who are actually dying soon. Like you literally have to be certified like very likely, more likely than not that you would die within six months. That's hospice. Then there's palliative care, which is huge. You could be like a 22 year old with Hodgkin's lymphoma who's going to be cured in two years. And it's like really struggling and suffering and they'll take care of you too. Or you could be someone with heart failure where it goes up and down and up and down for years. And you could have palliative care take care of you. And basically it's a concurrent care model, alongside whatever other care you're getting, alongside the oncologist, alongside the neurologist or whomever is taking care of you. It's actually a medical specialty that only was recognized in the US 20 years ago. It grew up just like a little bit before that. But they combine like chaplaincy, nurses, social workers, like doctors or other clinicians. And then they take care of your family too. So like when you walk in the door, they're like, who else is taking care of you? Who else is with you? Hey, does this person need some? It's so incredible. It's like if you could just dissolve the healthcare system, which Walter Cronkite said is neither healthy nor caring nor a system. You would just like start with palliative care and then just like build everything else around that. There's a lot of like miss misunderstandings about what palliative care is. But if anybody's struggling and isn't sure where to turn for that, they're so incredible. And you could just ask, you can just be like, can I have a palliative care specialist to be part of what we're doing? Yeah, yeah, absolutely. Thank you for sharing that. It feels like there's all these hidden things that exist already that we miss out. And even like the, what was it, the hot widows? Hot young widows. Hot young widows. Yeah, like that's like, yeah. Even the camp you were talking about earlier when before we started recording. The kiddies at camp castle. Yeah, yeah. And just there's all these things out there that humans are doing so many beautiful things to help people at different stages. And you almost don't know. And hopefully people who are in the position know. But if they don't, it's, yeah, I really appreciate you sharing that. 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? I think 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 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, if you're in a health care 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 centrally, you know? Like there are flowers here, there's music here. 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. I also think like respecting what someone like cares about. 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. But he was very, very sick and ultimately got rushed to the ICU because 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, you know, where he's like, there's a chance if I get intubated, then I will not be extubated and instead, like we'll stop life support. And so for him, it was like the way to like maintain his dignity was like or align with his values was like, okay, if this is the end of mental lucidity, then this is the end and like, we'll listen to you, you know, like great, like we'll make that happen. - Yeah. - Which was when that was actually happening, it was like incredibly confusing, incredibly painful, incredibly so hard, but also like so there was a grounding thing which was like, what's important to Paul? - When I hear that, I think about how, usually when we're losing someone, we're worrying about how it affects us. - Yeah. - And they're the one who's going through loss two. - Right, right, right, right, right. - It's shared, it is two ways, right. But it's almost like, I think us, all of us naturally would want the person to stay. - Sure, totally. - 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 purpose and mission in the world. - 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, it's like, it can hurt everybody. - Do you believe anything needs to change from the standard protocol of how doctors deliver terminal news? - Totally. When I was in medical school, which was 20 years ago, they were just starting to teach like, hey, make sure you attend 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, it becomes part of you. 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 going to say that. I'm going to 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 and 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 want to have a baby? Like during the film this or not, you know? And then similarly, another way that we've been trained to tell people that 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 want to take to aim for the best, to prepare for the worst? And then they're kind of like, well, I'm still allowing space for the best. And in the meantime, I'll make sure my family knows what I want when I'm gone. So like, I think like doctors are being taught to allow just like space, space, space, and more like accuracy. Yeah, yeah, yeah, that's really helpful to hear. That's helpful to hear how humans process the really different kinds. It's also like not just one conversation. Like, of course. The first time you hear the news, like, you don't know you're anything else, right? Then you have to hear it again, you know? You heard it from different people. But yes, it needs to change. And it is changing, I think, in this. I think right now in the world, we're talking a lot about aging well. Yeah. What's your sense of what it means to die well? I think that living well is the same. I think like the wait. 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 content 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? So I don't know, it hasn't happened to me yet, so it'll be a surprise. - That's a really powerful answer and quite an unfathomable mindset because you could argue, he could have felt, he didn't have everything, like he hadn't had Katie, and you know, like hadn't had that experience and which seems like the natural thing we all feel at that time, we're like, haven't done this yet or haven't seen this or wanna make it to this and so to really say, or they'll always be true. - Yeah. - They'll be true for everyone. - But he was able to say he had everything, he felt that. - Yeah, or enough, like enough. - Enough, yeah, enough, yeah. - 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? - I said, thank you so much. - Thanks for having me. - So grateful, truly, I'm so grateful to meet you. - So grateful for your openness, so grateful to learn about Katie and Paul and yourself and. - Thank you. - Truly, in awe of your resilience and courage. - That's like wild to hear. - I think it's true, I really mean it. - Yeah, what a treat, I mean, truly, yeah. - No, it's mounted my heart, truly, I really mean that. Thank you. - Yeah, my pleasure. - Thank you, yeah, such a joy. - If you love this episode, you'll love my conversation with Malala Yusufzai, on how she transformed extreme adversity into global purpose. - I was hanging out with some friends, and what was like supposed to be a fun night, just took a sharp turn, and immediately I froze.