When Breath Becomes Air

The Epilogue is written by Paul’s wife, Lucy. In the time that Paul and Cady’s lives overlapped, there were countless moments of joy, including Cady enjoying mashed yams on Christmas, despite the sorrows experienced as Paul’s health declined.

After Paul is given supplemental oxygen starting in February, Lucy is unable to get him to eat even his favorite foods, such as her breakfast sandwiches or smoothies. The new, rare tumors that have formed in Paul’s brain, leptomeningeal carcinomatosis, mean not only a mere several months’ life expectancy, but also neurologic decline. This news hit Paul the hardest.

He agrees to enter into a clinical trial. To prepare, he’s stopped taking the daily targeted-therapy pill. Because there is a possibility of this causing a flare-up, Lucy has been videotaping him doing the same task daily to check for any inconsistencies in speech patterns. He reads T.S. Eliot’s The Wasteland, often from memory. During what ended up being his last Saturday, Lucy limits nonfamily visitors, and Paul holds Cady in his arms with his family in their living room. The manuscript for his book is only partially completed at this point, and he realizes he is unlikely to finish it.

The next day, Paul wakes up with a 104-degree fever. He is able to get some rest in the afternoon but is having trouble breathing by evening. Lucy calls the ambulance, and the hospital staff is quick to get to work when they see the condition Paul is in. He’s put on a machine, to assist his breathing, but the work of breathing spikes his blood’s carbon dioxide to dangerously-high levels.

The doctors and family discuss treatment options with Paul and agree that one night of rest should take place before any major decisions. The next morning, Lucy tells the doctors that Paul does not want more time if it means he will lose the ability to understand what is going on around him. When she returns to his bedside, he tells her “I’m ready” (210).

Paul’s family gathers in the room. He tells them he wants his manuscript published in some form. Lucy climbs into the bed and Paul holds Cady in his arms. During this time, Lucy reflects on all the beds they’ve shared. An hour later, his mask and monitors are off and he is given morphine. He soon slips into unconsciousness. The next nine hours are filled with the family’s love. Some more family members arrive, as well as the pastor. They share stories and jokes and they weep. Before Cady is taken home for the evening to sleep, Lucy sings their favorite bedtime song.

Paul takes his final breath just before nine o’clock that evening. Paul dies on Monday, March 9, 2015, eight months after Lucy was born.

Lucy recounts how Paul was determined to keep writing throughout his illness, even during chemotherapy. He wanted this book not to sensationalize death, but to make it more known to readers.

Paul is buried in a place laced with good memories: the Santa Cruz Mountains, overlooking the sea. Whenever Lucy goes to visit his grave, she brings a bottle of their honeymoon wine and pours some out for Paul. When deer nibble the flowers she leaves on his grave, it reminds her of the inextricability of life and death. She sees the book as a way for Paul to continue helping other humans, indefinitely.