Paul was buried in a willow casket at the edge of a field in the Santa Cruz Mountains, overlooking the Pacific Ocean and a coastline studded with memories—brisk hikes, seafood feasts, birthday cocktails. Two months before, on a warm weekend in January, we’d dipped Cady’s chubby feet into the briny water at a beach below. He was unattached to the fate of his body after he died, and he left it to us to make decisions on his behalf. I believe we chose well. Paul’s grave looks west, over five miles of green hillcrests, to the ocean. Around him are hills covered in wild grass, coniferous trees, and yellow euphorbia. As you sit down, you hear wind, chirping birds, the scuffling of chipmunks. He made it here on his own terms, and his grave site feels appropriately full of ruggedness and honor, a place he deserves to be—a place we all deserve to be. I am reminded of a line from a blessing my grandfather liked: “We shall rise insensibly, and reach the tops of the everlasting hills, where the winds are cool and the sight is glorious.”
And yet this is not always an easy place to be. The weather is unpredictable. Because Paul is buried on the windward side of the mountains, I have visited him in blazing sun, shrouding fog, and cold, stinging rain. It can be as uncomfortable as it is peaceful, both communal and lonely—like death, like grief—but there is beauty in all of it, and I think this is good and right.
I visit his grave often, taking a small bottle of Madeira, the wine of our honeymoon destination. Each time, I pour some out on the grass for Paul. When Paul’s parents and brothers are with me, we talk as I rub the grass as if it were Paul’s hair. Cady visits his grave before her nap, lying on a blanket, watching the clouds pass overhead and grabbing at the flowers we’ve laid down. The evening before Paul’s memorial service, our siblings and I gathered with twenty of Paul’s oldest, closest friends, and I wondered briefly if we’d mar the grass because we poured out so much whiskey.
Often I return to the grave after leaving flowers—tulips, lilies, carnations—to find the heads eaten by deer. It’s just as good a use for the flowers as any, and one Paul would have liked. The earth is quickly turned over by worms, the processes of nature marching on, reminding me of what Paul saw and what I now carry deep in my bones, too: the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this. What happened to Paul was tragic, but he was not a tragedy.
I expected to feel only empty and heartbroken after Paul died. It never occurred to me that you could love someone the same way after he was gone, that I would continue to feel such love and gratitude alongside the terrible sorrow, the grief so heavy that at times I shiver and moan under the weight of it. Paul is gone, and I miss him acutely nearly every moment, but I somehow feel I’m still taking part in the life we created together. “Bereavement is not the truncation of married love,” C. S. Lewis wrote, “but one of its regular phases—like the honeymoon. What we want is to live our marriage well and faithfully through that phase too.” Caring for our daughter, nurturing relationships with family, publishing this book, pursuing meaningful work, visiting Paul’s grave, grieving and honoring him, persisting…my love goes on—lives on—in a way I’d never expected.
When I see the hospital where Paul lived and died as a physician and a patient, I understand that had he lived, he would have made great contributions as a neurosurgeon and neuroscientist. He would have helped countless patients and their families through some of the most challenging moments of their lives, the task that drew him to neurosurgery in the first place. He was, and would have continued to be, a good person and a deep thinker. Instead, this book is a new way for him to help others, a contribution only he could make. This doesn’t make his death, our loss, any less painful. But he found meaning in the striving. On page 115 of this book, he wrote, “You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” It was arduous, bruising work, and he never faltered. This was the life he was given, and this is what he made of it. When Breath Becomes Air is complete, just as it is.
Two days after Paul died, I wrote a journal entry addressed to Cady: “When someone dies, people tend to say great things about him. Please know that all the wonderful things people are saying now about your dad are true. He really was that good and that brave.” Reflecting on his purpose, I often think of lyrics from the hymn derived from The Pilgrim’s Progress: “Who would true valour see, Let him come hither… Then fancies fly away, He’ll fear not what men say, He’ll labour night and day / To be a pilgrim.” Paul’s decision to look death in the eye was a testament not just to who he was in the final hours of his life but who he had always been. For much of his life, Paul wondered about death—and whether he could face it with integrity. In the end, the answer was yes.
I was his wife and a witness.