New York Times End of Life Series

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This is a powerful , insightful essay about a subject we all will face sooner or later. . . . end of life issues.  If you have time, I highly recommend that you read it. This young doctor is an exquisite writer who shares herself during the process of life and death  with her husband. 

My Marriage Didn’t End When I Became a Widow

By LUCY KALANITHI JANUARY 6, 2016 6:45 AM January 6, 2016 6:45 am Comment

The End is a series about end-of-life issues.

When my husband died from cancer last March at age 37, I was so grief-stricken I could barely sleep. One afternoon, I visited his grave — in a field high in the Santa Cruz Mountains, overlooking the Pacific Ocean — and lay on top of it. I slept more soundly than I had in weeks. It wasn’t the vista that calmed my restless body; it was Paul, just there, under the earth. His body was so easy to conjure — limbs that had linked with mine at night, soft hands that I had grasped during the birth of our daughter, eyes that had remained piercing even as cancer thinned his face — and yet, impossible to hold. I lay on the grass instead, my cheek against the ground.

I had loved Paul since we met in 2003 as first-year medical students. He was the kind of person who makes truly funny people laugh (as an undergraduate, he visited London in a full gorilla suit — posing by the gates at Buckingham Palace, riding the tube). But he was also deeply intellectual. He considered following his master’s degree in English literature with a Ph.D., but entered medical school instead, yearning, as he later wrote, “to find answers that are not in books … to keep following the question of what makes human life meaningful, even in the face of death and decay.”

We married on the shores of the Long Island Sound before driving across the country to start our residencies. In the hospital, we worked 80-hour weeks; outside of it, we hiked the winding trails near our California home, holding hands and planning our future.
Then, 10 years after we met, while we were finishing our final years of training at Stanford, Paul’s health began to falter. After a battery of tests, we learned that his back pain and weight loss were not symptoms of exhaustion, but metastatic lung cancer. It was now our turn to face mortality and, more than ever, to follow the question of what makes human life meaningful.

We had always planned to return to Portugal, where we spent our honeymoon, for our 20th anniversary; instead, in the wake of Paul’s diagnosis, we made plans to go immediately. We savored the sweet wine and the time together. Back home, we continued our work as physicians as long as Paul’s health allowed. We talked honestly about his prognosis. To ease his burden, I managed his 15-plus medications, slipping anti-nausea pills into his pockets when we kissed goodbye each morning. When pain wracked his body, I drew hot baths, kneaded his muscles, and offered anti-inflammatories, music and the simple act of witnessing.

We found new depths of trust and confidence in each other — as husband and now patient, wife and now caregiver and, soon, as new parents to a baby girl. We joyfully welcomed our daughter into the world three days after Paul came home from a weekslong hospitalization.

And Paul began to write. First, an essay — about training as a neurosurgeon and then learning that he had only a year or two to live — which led to a book proposal. When chemotherapy ravaged his skin, even typing became painful. I found silver-threaded, conductive gloves that protected his cracked fingertips while still allowing him to use his laptop’s trackpad as he lay in bed.

How Long Have I Got Left?

Paul Kalanithi, the author’s husband, wrote in January 2014 about confronting his mortality.
By the time he had become too sick to continue working in the operating room, he was writing furiously about his struggles — as a physician, a lover of literature and a terminally ill patient — to continuously seek and live his values. Returning to writing kept him serving others and helped him to live well. I believe he died fulfilled — not feeling he was leaving everything he wanted, but having everything he wanted.

I held Paul during his last hours, lying with him in his hospital bed, comforting and singing softly to him until he died. The last one in the room, I cupped his head in my hands and kissed him. It wasn’t until I closed the curtain that I suddenly began to keen.

“I can’t leave him alone,” I cried to my sister-in-law.

“He’s not here,” she repeated over and over, “you’re not leaving him,” as she coaxed me down the hallway and out into the night.

The transition from married to bereaved was disorienting. At first I could scarcely grasp what widowhood meant; I was too busy looking for ways to comfort Paul even after he died. When the funeral home asked me to bring a set of clothes for Paul to be buried in, I wore them first, thinking I will make these clothes warm and redolent of us. I put a pair of our daughter’s socks in his pants pocket. On the day of the burial, I stepped out from the procession and moved ahead of the pallbearers, compelled to lead his coffin down the hill. I can’t take your hand, but I will guide you; you will not go alone. For several months, I slept with my head on the pillow he had died on, left his medications in their drawer, wore his clothes to bed. Still today, months after his death, I go and sit at his grave, absent-mindedly stroking the grass as if it were his hair, talking to him using nicknames only he would understand.

One night recently, alone in bed, I read “A Grief Observed” by C.­S. Lewis, and I came across the observation that “bereavement is not the truncation of married love but one of its regular phases.” He writes that “what we want is to live our marriage well and faithfully through that phase, too.” Yes, I breathed. Bereavement is more than learning to separate from a spouse. Though I can no longer comfort Paul, the other vows I made on our wedding day — to love Paul, to honor and keep him — stretch well beyond death. The commitment and loyalty, my desire to do right by him, especially as I raise our daughter, will never end. And I am keeping another final promise.

Before he died, Paul asked me to shepherd the manuscript of his book to publication. Doing so, over the past months, I have felt I am continuing to help Paul live out his life, and to give this gift to our daughter.

And now, as I prepare to watch Paul’s work take on a life of its own, I begin to take on a life of my own. Our home is now a home for our daughter and me. I have kept Paul’s favorite clothes and books, but he no longer has a sock drawer or his own bookcase. I bought a new bed. I have gone back to work. Six months after Paul died, I removed my wedding ring because it felt right to do so in that moment; only minutes before, I had not yet considered it. I’ve learned that the timing of bereavement — perhaps like the initial stages of falling in love — is utterly unpredictable.

As a child, I was always told that a grave should be stepped around, not onto, that only flowers should touch it. With Paul, the rules feel reversed. Just as it felt right to lie with him, finally restful on that spring afternoon a few weeks after his death, it feels right to bring friends there now, to watch the sunset and pour a beer out for him. And it feels right for our bright-eyed 1-year-old daughter to crawl among the flowers I’ve placed on the grave. We are making this place ours, and his.

Lucy Kalanithi is an internist at Stanford University’s Clinical Excellence Research Center. She wrote the epilogue to her late husband Paul Kalanithi’s forthcoming book, “When Breath Becomes Air.”

Dr. Kalanithi’s Sunday Review essay from January 2014.



About annetbell

I am a retired elementary teacher, well seasoned world traveler,new blogger, grandmother, and a new enthusiastic discoverer of the wonderfully complex country of India. Anne
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