#542： When Breath Becomes Air
Episode Stats
Summary
When Paul Kalanithi was diagnosed with stage 4 lung cancer in 2013, he was on the cusp of finishing a decade's worth of training to become a neurosurgeon, a profession he felt called to. In his last few months, he wrote a memoir about the search for meaning in life and death, as well as his experience as a medical student and a cancer patient. Entitled When Breath Becomes Air, the book was published early after he died and was nominated for a Pulitzer Prize. Today, I talk to his widow about his journey to uncover insights about meaning and significance during his time as both doctor and patient.
Transcript
00:00:00.000
Brett McKay here, and welcome to another edition of the Art of Manliness podcast.
00:00:11.000
When Paul Kalanithi was 36 years old, he was on the cusp of finishing a decade's worth
00:00:15.040
of training to become a neurosurgeon, a profession he felt called to.
00:00:18.080
But then he learned he had a terminal stage four lung cancer.
00:00:20.720
In a single moment, everything changed in his life.
00:00:23.600
The next 22 months, Paul and his wife, Lucy, grappled with how to live life, even when
00:00:29.740
In his last few months, Paul wrote a memoir about the search for meaning in life and
00:00:33.360
death, as well as his experience as a medical student, neurosurgeon, and cancer patient.
00:00:37.260
Entitled When Breath Becomes Air, the book was published early after he died and was nominated
00:00:42.020
Today, I talked to Paul's widow, Dr. Lucy Kalanithi, about Paul's journey to uncover insights about
00:00:46.320
meaning and significance during his time as both doctor and patient.
00:00:49.440
Along the way, Lucy shares insights about the human side of healthcare, delivering and receiving
00:00:53.680
bad news, and how your identity and sense of self changes when you're diagnosed with a terminal
00:00:58.100
She also shares her experience of being a widow and of the grieving process, as well
00:01:02.000
as what to say and not to say, someone who's grappling with a tragedy.
00:01:05.620
After the show's over, check out our show notes at aom.is slash breathbecomesair.
00:01:09.480
All right, Lucy Kalanithi, welcome to the show.
00:01:24.920
So your late husband was Paul Kalanithi, and he wrote the memoir, When Breath Becomes Air,
00:01:31.860
and he wrote the manuscript in his last few months of life, right before he died of stage
00:01:36.680
four lung cancer. Your husband started the book in a hospital room as a patient staring
00:01:44.360
at his own CT scan images. So let's begin there. What led to that moment when you and
00:01:51.820
Yeah, sure. So that was in 2013 in the spring, and he was a rising chief resident in neurosurgery
00:02:00.060
at Stanford. So he was just about to finish his long years of training as a neurosurgeon
00:02:04.560
when he started to develop these really ominous symptoms. He lost 15 pounds kind of inexplicably
00:02:10.580
and developed a cough and just wasn't feeling good. But at the same time, he had lost 15 pounds
00:02:16.060
like a few years before as an intern just from working so hard. And it like took a while to get
00:02:21.060
to figuring out exactly what was going on. But ultimately, it was stage four lung cancer,
00:02:27.120
really surprisingly, of course. And I'm a physician too. And he was diagnosed at the hospital where we
00:02:33.980
work, where he worked and I work. And so it was this sort of strange, unmediated experience of
00:02:40.620
having the CT scan and then logging in with your own credentials to the hospital computer and
00:02:46.340
pulling it up and kind of wordlessly scrolling through the images. And we knew right away what
00:02:53.620
the diagnosis likely was and what it meant in terms of a prognosis of months to a few years
00:03:00.880
with maybe some more hopeful advances, but you never know. And for people who've read the memoir
00:03:08.240
or who haven't, in the prologue, he describes that moment of looking at his own scan. And
00:03:13.920
then he says something like, the future I had imagined, the one just about to be realized,
00:03:20.540
evaporated. And that really was the feeling in that moment was just this disappearing of who you
00:03:28.500
thought you were. It's like who you are is so tied up in your future. And you're the same person you
00:03:34.260
were five minutes ago. And you are also a totally different person in a new world, you know, when
00:03:40.040
you get a diagnosis like that. And that's one of the major themes running throughout the book is
00:03:45.640
what does your identity mean when you have an event like this happen to you? And we'll talk about that
00:03:51.560
here in a bit. But another theme that runs throughout the book is this question of what makes human life
00:03:57.440
meaningful? And this is a question your husband grappled with long before that moment where you
00:04:04.140
two were in a hospital room looking at CT scans. Like, can you tell us about his intellectual journey
00:04:09.080
seeking answers to this question? Yeah, sure. So this was one of the things that made me fall in love
00:04:14.700
with him. Because I just thought he was a really interesting, curious, moral person. And I think a lot
00:04:21.720
of us are asking ourselves that question, you know, like, what's the meaning of life? What's the
00:04:26.200
meaning of my life? And he, as a young person, had actually thought maybe he would be a philosopher or
00:04:32.520
an English professor. He went to Stanford as an undergrad and studied English literature and human
00:04:39.460
biology, thinking he had some interest in, like, the mind-brain connection and how do you connect your
00:04:46.340
own identity and morality to, like, living in a physical body. And then ultimately then went on to study
00:04:53.520
a graduate degree in literature and in history and philosophy of science and medicine. So was pretty
00:04:58.880
into philosophy and bioethics and literature. And then shocked himself by going into medicine,
00:05:04.940
but had become so intoxicated by the thought of the brain as a physical, as physical matter,
00:05:12.420
but also the seat of identity and love and honor and morality. And so ended up at medical school,
00:05:19.540
which is where I met him and then was one of those people who walks into the operating room and,
00:05:23.580
like, never walks out. So ultimately became a neurosurgeon, again, sort of out of this,
00:05:28.020
like, real curiosity. But I think he had initially thought he would be a professor engaging with ideas.
00:05:34.480
And then at a certain point in his mid-20s thought, I think what I want to do is be involved with real
00:05:40.980
people facing big identity upheavals and big questions about how to proceed with thorny medical
00:05:48.820
decision-making. And, you know, when you're a neurosurgeon, you deal with tumors and trauma and
00:05:55.140
seizures and aneurysms and epilepsy and mental illness and all these things where it's like,
00:06:01.020
your brain is you, you know? And if something goes wrong with it, then something goes wrong with
00:06:05.460
your, your identity in your life. And I think he, that was who he wanted to be around was those
00:06:11.020
patients. That's what, one of the things, that's one thing that really impressed me about Paul
00:06:15.140
was because, you know, a lot of people, when they grapple with this question of what gives life
00:06:18.920
meaning, they do in a very abstract way. So they, they sit and they read the books and they discuss,
00:06:24.200
like, Paul wanted to, like, touch it. Like, he wanted to experience firsthand.
00:06:27.940
That's right. And he was interested in suffering too, you know? Like,
00:06:30.840
just, I don't know. I think the fact that everybody suffers is like so obvious, but also
00:06:38.200
kind of hidden, especially when we have so many fixes to our problems and we have like
00:06:43.060
glossy social media. And I think, I think he was interested in what do you do with suffering that
00:06:49.260
you can't ameliorate? Like there's some really gritty, interesting human connection to be found
00:06:55.920
there. And I think like heartbreak and suffering is what most of literature is about. And that was part
00:07:00.820
of it too. It's like being around sufferers or fellow sufferers, which I guess is like everybody.
00:07:07.140
And what did he learn about the connection of, you know, between meaning life and death while he was
00:07:12.540
in medical school? And also like, what did you, what did you learn too? Cause you're also in medical
00:07:19.880
school. You know, it's hard because medical school is just so practical. Like there's so much to learn
00:07:26.140
that just learning the science is kind of overwhelming. And so I kind of think there's
00:07:32.820
like the looming specter of these big moral questions, but at the same time, you're just
00:07:37.580
trying to impress your professors and learn what you can. So in a way, medical school was initially
00:07:44.140
not about big questions. It was about like grasping the concepts and then, but having the idea that
00:07:51.020
you were going to end up needing to bring your full self to this. And I, I remember in medical school
00:07:57.120
feeling like it was the first time that I had used all parts of my brain at one time, like a really
00:08:04.620
intellectual part and moral compass and tapping into my emotions and reactions. And I just remember
00:08:11.720
thinking like, Oh my gosh, I'm not sure there's a part of my brain that is not actively engaged in
00:08:17.080
this. And, and that was really exciting for me too. And then I was just going to mention this other
00:08:24.140
thing that also was the reason I fell in love with Paul. So when, when we first started school,
00:08:30.960
I knew he was kind of like this smart, nice guy in our class and there's a hundred people in the class.
00:08:36.260
So you're kind of getting a sense of who, you know, who's the jock and who's the, you know, whoever.
00:08:41.780
And, and then about three weeks into school, I realized that Paul on his medical student ID was
00:08:48.260
wearing a fake mustache and he had been a comedy writer in college and done a lot of sketch comedy
00:08:54.040
and showed up in medical school and immediately pulled this like fake, big bushy, like fake mustache
00:09:01.120
out of his pocket onto his face right before they shot the photo at Yale for the medical student ID.
00:09:06.680
And it was this kind of like technically really transgressive thing to do, of course, entering
00:09:12.200
professional school. And, and it stuck around on his ID the whole time he's applying to be a
00:09:17.340
neurosurgeon three years later. And all of the senior neurosurgeons are seeing this like ID face
00:09:21.600
sheet and, you know, with this fake mustache on it. And we never talked about why he did that apart from
00:09:28.000
just like this pure slapstick of it. But I always wonder like, was that, was that something that he was
00:09:34.420
doing because he was worried that medicine was also going to change him? You know, I think
00:09:39.620
medicine has a lot of really formal structures, hierarchy, and it's just arduous and tedious at
00:09:47.840
times. And so, I don't know, I think when we were entering medical school, we were dealing with the
00:09:52.000
pure complexity and work of it, but also it is something you have to kind of figure out
00:09:58.920
how you're going to become you and also be a physician at the same time, you know? So I think that
00:10:03.460
was the other question we were thinking about. Yeah. I mean, it's a way to keep his humanity.
00:10:07.540
And he talks about in the book, you know, one of the reasons why he fell in love with you is
00:10:10.620
you were looking at an EKG scan and you started crying because you saw that someone, someone died.
00:10:17.260
Right. Right. We were just studying in a textbook and it's like, that stuff is,
00:10:22.180
is not abstract. You know, I was like, oh man, like this scan that we're looking at literally is a
00:10:28.860
picture of somebody dying. That's wild. And yeah, that's, that's like when breath becomes air,
00:10:33.980
right? It's just like, you see those moments all the time. And I also remember we were studying on
00:10:37.760
his sofa in his apartment and it's like, he got this look in his eyes and I was like, this guy loves
00:10:41.800
me. Okay. This is my guy. This is your guy. You know, I've got a few friends that have gone to medical
00:10:53.300
school and they're doctors now. And when they originally went into medical school, they had these very high
00:10:57.060
ideals of wanting to care for their patients and bring a human element to the practice. But all of
00:11:02.240
them admitted while they were in medical school, that the grind of medical school and the residency
00:11:06.540
kind of made them jaded and hardened to the suffering of their patients. It's sort of a, you know, they
00:11:11.840
said, there's a way for me just to get through the day. Is that a pretty common experience?
00:11:17.540
Yes, it's really common. It's actually a big cultural phenomenon that's being addressed in medicine
00:11:22.320
right now. I'm glad your friends are telling you about that. And like the major word that's getting
00:11:27.380
used for it is burnout, which is like an actual syndrome of like depersonalization and lack of
00:11:33.180
self-efficacy. There's like a syndrome and there's some, it's interesting because I'm really interested
00:11:38.900
in this question actually, because it's really depressing. It's like you take, I think this
00:11:42.860
happens in a lot of fields actually. Like you take people who go into something really for the love of
00:11:47.500
the game and then something detaches them from being able to do what they hoped. And I think
00:11:52.940
some people are using the term moral injury actually for this, which is, I think was first
00:11:58.500
used for soldiers. And it's, it's this, it occurs when you're trying to do a job for which you have
00:12:06.920
highly conflicted allegiances. Like, and in medicine, it's like you're, you have a fiduciary
00:12:12.600
responsibility to your patient who you love in many cases, you know, you're really connected to
00:12:17.820
them as a person, but then you're also responsible to the hospital administration. And you're also
00:12:23.940
trying to fight an insurance company. And you also are, you know, overwhelmed with how busy you are.
00:12:30.600
And I think there's a form of like systemic pressure that actually puts people's moral impulses,
00:12:39.040
like, like squishes them a little bit. And I think, I think it's really hard. And it's funny
00:12:45.620
because maybe 10 years ago, 15 years ago, when this phenomenon was getting named and it was being
00:12:50.640
called burnout, it was thought of as kind of like a lack of personal resilience. Like people,
00:12:57.260
people need to work on their coping skills, you know? And, but I think the thinking since then is
00:13:03.620
like, if you take a bunch of highly resilient people, like the people who enter the health
00:13:07.760
health professions, it's not, I've heard someone say, you know, if there's a canary in the coal
00:13:12.840
mine, you can't just teach the canary to meditate, which is so smart. And it's like, it's not,
00:13:18.220
it's not just a personal issue. It's like a systemic, systemic structural thing. And so I think
00:13:26.300
everybody's thinking about how to, how to reintroduce humanity, everything from, you know, the, the
00:13:33.240
payment structures to clinic timing to, of course, the electronic medical record. So yeah, I, it's,
00:13:40.360
it's something that doctors are talking about all the time at cocktail parties and elsewhere.
00:13:46.100
Right. And Paul described, he had a friend that ended up committing suicide.
00:13:50.220
Because of that, right? For that pressure he felt.
00:13:52.220
That's right. A brilliant surgeon who jumps off of a building and it was, I'm glad he wrote about it
00:13:58.980
because that was so personally devastating to Paul and is one of like the other deaths in When Breath
00:14:06.120
Becomes Air. And I, I'm glad he wrote about it.
00:14:08.620
And how do you, I mean, it seems like Paul and yourself were able to, I don't know, rise above
00:14:14.160
that cynicism that can come with being in that situation. I mean, how did, how do you think you
00:14:20.200
two were able to do that? You mean in our medical careers, even before Paul got sick?
00:14:24.780
Yeah, in your medical career. Yeah. Even, even before Paul got sick in your medical careers,
00:14:27.980
it seems like there was like this, Paul had this striving to like, to keep his humanity
00:14:31.460
in his profession. Totally. I think some of it was recognizing it as a personally important thing
00:14:38.580
so that you can at least be trying to do that. And we had a lot of dinner table conversations about
00:14:44.080
that, but also both of us really burned out at times. I had an episode of depression in
00:14:49.920
residency and developed a lot of skills actually at that time, including meditation that helped me
00:14:58.340
later when Paul got sick, actually. Like I had better coping skills as a result of having gone
00:15:02.700
through that. And, and Paul just kind of thought about it a lot. And, you know, there's a lot of
00:15:07.860
gallows humor and camaraderie in medicine, which actually really helps. But then I think, you know,
00:15:13.640
people aren't, you're not immune to it. I think you really do have to be looking for,
00:15:18.360
for ways to hold onto that or like stoke yourself as a person, you know? And then I think when Paul
00:15:24.240
was a patient, he himself became the vulnerable person who is a hospital patient, who's like
00:15:31.120
literally naked in a hospital bed. And, and then we had a couple of really difficult interactions
00:15:37.120
with healthcare professionals that like, I recognized that maybe the person who was treating
00:15:43.200
him was burned out or having a really hard day or whatever. And I just remember thinking like,
00:15:48.800
you know, it's, it's something that I'm, I'm wondering how this person is doing, but they,
00:15:54.620
like the moral obligations is so high to be, to be a humane, just person, you know, that I was like,
00:16:02.820
I kind of don't forgive this guy. Like, this is like, it's not okay.
00:16:07.400
I was, I mean, I imagine his, you know, his study in literature and philosophy helped too,
00:16:13.760
because he's, he, he, he, those issues were top of mind for him.
00:16:17.360
Yeah, I think so. And I think like in a job like medicine, as in many others, I'm assuming,
00:16:22.340
I would imagine like there's like the tedium of the day to day, but then there's also the sense of
00:16:29.460
moral mission is always there. So it's like when you're on hold, you know, waiting to talk to the
00:16:36.440
prior authorization for an insurance company, like you are realizing that you're on a moral
00:16:41.100
mission, you know, you're like, it's not just a tedious task. It's like, it's like a crusade on
00:16:47.320
behalf of your patient, you know? So I think you feel it all the time and it's actually really
00:16:52.160
sustaining. But yeah, I think Paul's sense of, of, you know, like, yeah, the, the human mission
00:16:57.560
of medicine and his connection to literature and the human experience and the human condition.
00:17:01.440
Sure. It was like there, it's there all the time. It's really fun.
00:17:04.580
And how did, you know, as a neurosurgeon, Paul had to often deliver bad news to patients
00:17:10.140
and their families. Did he have an approach that he kind of settled on and how to make
00:17:17.600
Yeah. You know, I can't remember exactly if he had a, a really standardized approach for himself.
00:17:25.240
He, when you're a neurosurgeon, you see a lot of terrible things all the time. So anything from
00:17:31.300
a terrible bike accident to a ruptured aneurysm to a brain tumor in a young person, it's sort of like
00:17:38.100
as bad as it gets on a daily basis. And so he delivered a lot of bad news. And I think he writes
00:17:46.140
in the book about really trying to figure out how much a person can handle and understanding that
00:17:53.260
the delivery of bad news isn't even a one-time event. It kind of happens over time. And then the,
00:17:59.140
the news itself or its impact also changes over time. So I think Paul said something like
00:18:05.500
a terrain of tragedy is best allotted by the spoonful. And he also talked about something like
00:18:13.200
meeting a patient in the narthex, not the nave, meaning like wherever they are, you go find them
00:18:19.620
there. And then you try to bring them where they need to be. But a lot of it is on their terms. And I
00:18:25.880
think he really did think about that a lot. And I think it's actually being taught in medical school,
00:18:32.240
like formal ways to deliver bad news. Like for example, there's this acronym called SPIKES,
00:18:37.280
S-P-I-K-E-S, which is like, it's something like set up the scene. And then the P is assess the
00:18:44.120
patient's perception. And then I is get an invitation to give the bad news. And then K is give the
00:18:51.920
knowledge and E is acknowledge emotion. And so, you know, I think it is a, it's a art and a science.
00:19:01.780
So there's a, we do a lot of like practice role-playing in medical schools about delivering
00:19:07.500
bad news. And so I think it is one of those things where just because you're a nice person doesn't
00:19:13.140
mean that you can do that artfully without practice or reflection, you know, but it's one of the things
00:19:20.000
that Paul had decided was really important to him to try to be good at.
00:19:24.720
Yeah. I imagine it's super tricky because some people like, you don't want to like,
00:19:30.280
you want to give them hope, but like not too much hope, right? Because you want to still,
00:19:34.420
I mean, I imagine that's just super hard to figure out like what would be best for that person.
00:19:38.840
Totally. And sometimes you can just ask them what they think would be best, but that's exactly right.
00:19:43.640
There is this huge tension between, you know, letting them in on everything that you may know
00:19:49.540
about the course of their illness while at the same time, hope is like, it is a human thing to
00:19:56.200
hope, you know? And I think, I guess the thing that doctors think about or that we think about is
00:20:02.520
like, there's a lot of different ways to hope, right? There's like the battle metaphor, especially
00:20:07.460
in cancer of like, we'll fight it and we'll beat it. And we're not going to talk about any other
00:20:11.220
options other than that. But I think there's a lot of things people are fighting for. And,
00:20:15.940
you know, a big one is fighting to make sure that their family will be okay, no matter what happens.
00:20:22.340
And that requires like a sense of facing up to all the possibilities that could happen,
00:20:28.420
which oftentimes people are way better at doing for their families than themselves,
00:20:32.940
which is like so loving and brave. And then, and then I think there's the sort of like this battle
00:20:38.040
for meaning, you know, and like trying to figure out a new purpose in the face of whatever is
00:20:44.840
happening. And I think there's like all kinds of courage and bravery that happen. And it's not
00:20:50.180
just one brittle version of like, I'm going to fight this disease and put my head down and that's
00:20:56.880
it, I think. But again, it comes, it comes over time, you know?
00:21:00.300
I thought it was interesting that Paul said, you know, talking about his experiences,
00:21:04.100
his encounters with patients and delivering bad news, he said he felt almost like a pastor and
00:21:08.780
that if he'd had another life, he probably would have been a pastor.
00:21:11.860
I know. I thought that was lovely. I don't know if that's true or not, literally, but
00:21:17.980
No, it's not. It's all about the human, dealing with that aspect of human life that's not science,
00:21:23.640
right? It's like the love, hope, courage, all that stuff that's part of human reality.
00:21:29.040
So let's talk about when Paul gets his diagnosis. He wrote when he came face-to-face with mortality,
00:21:36.600
he got that diet and he had lung cancer, it was terminal. He said, I thought it was interesting,
00:21:41.720
he said that it changed everything and also nothing. What did he mean by that? Or what do
00:21:49.960
Yeah, it's interesting, right? That was in an essay that Paul wrote that ended up in the New
00:21:54.260
York Times and ultimately led to the chance to write the memoir. I guess he meant a couple of
00:22:00.440
things by that. So he was sort of getting at the idea of like, you know, I knew I was going to die
00:22:07.920
and I just didn't know when. And then I get this terrible diagnosis and I know I'm going to die and
00:22:13.800
I also still don't know when. So he was sort of saying like, well, is anything really different?
00:22:19.480
Um, but I think the thing that was so different is that his relationship to the future had totally
00:22:26.140
changed. And people always tell you, you know, like take it one day at a time. And his, the big
00:22:32.100
thing he grappled with was like, well, what is it that I'm supposed to do with, with the one day at a
00:22:37.740
time, especially when I don't know how much time I have left. And so it really changes. Like, am I still
00:22:44.300
going to be a neurosurgeon when I'm, I'm not actually going to do it for 30 years anymore? Like,
00:22:49.220
should I keep even going down that path? And so I think that was some of what he was getting at.
00:22:55.280
And then ultimately, so he lived for 22 months after getting that diagnosis. He died when he was
00:23:01.620
37. He was diagnosed when he was 35 or actually just turned 36. And he initially went back to work
00:23:08.300
as a neurosurgeon. And then when he became too debilitated to do that about a year later,
00:23:14.100
he had very fortuitously written a couple of things, one of which went viral and let him
00:23:22.720
ultimately start writing the manuscript for the memoir. And then we also had a baby during that
00:23:26.560
time. And so a number of things were like growing and changing and happening, even as his body was
00:23:34.040
diminishing. So yeah, just to give a sense of that too.
00:23:37.980
Yeah. I mean, that's the kind of, that's the paradox that Paul talks about, about having a terminal
00:23:41.200
disease. Cause, cause you know, very acutely that you are dying, right? Like you said,
00:23:45.360
you, you know, you're, we're all dying, right? This moment we're, we're all of us listening are
00:23:48.960
dying. We're kind of, it's like, it's so abstract, but like, you know, you're dying, but you're still
00:23:54.700
alive. So you have to like, you're not, you're not dead until you're dead. So you have to continue
00:24:00.140
to live until then. And like, what does that mean?
00:24:02.520
Yes. And, and when it's such a, yeah, I mean, it's like, I think, I think it's really interesting
00:24:10.900
to try to think about how to, how to rebuild what your life is when something big up ends it,
00:24:18.340
you know? And that happened for me after Paul died. And there's this, have you heard it or have
00:24:23.220
you seen or heard of this young lawyer activist, Adi Barkin, who has ALS?
00:24:28.520
He went to Yale law school around the time that we were there for med school and then
00:24:32.140
became an activist. And he's a, he's like a progressive activist. And he got diagnosed with
00:24:37.800
ALS when he was 32 with Lou Gehrig's disease. And now he's 35 and he's totally paralyzed in a
00:24:44.080
wheelchair and he speaks using eye gaze technology where he's moving his pupils. And so he's had this
00:24:49.060
huge thing to adjust to obviously. And he wrote a memoir that's coming out soon. It's called
00:24:54.760
Eyes to the Wind. But there's an interesting part in it where right after he gets diagnosed,
00:24:59.240
he tells his best friend, he's like, okay, I got to do three things. I have to do a bunch
00:25:05.960
of medical stuff and try to mitigate what's happening. I have to mourn what I thought I was
00:25:10.800
going to have that I'm not going to have anymore in my life. And then he says, then I have to enjoy
00:25:15.400
the moment. Those are the three things I have to do. And then he wakes up like two weeks later and
00:25:20.320
says, oh, wait a second, I need to go back to activism. Like that's my thing. That's the purpose
00:25:25.440
of my life. And ever since then, he's been doing a ton of activism that's actually been
00:25:30.020
even more powerful in a way because of his illness. But it's interesting because I actually
00:25:35.620
think he's right. It's like, it's like you mitigate what you can, you mitigate suffering,
00:25:41.040
you try to cope, you try to be mindful and present in the moment, and you try to build a
00:25:45.580
purpose in your life. And I kind of think those are the keys to coping in a lot of different
00:25:52.620
situations. So I think that's what Paul was doing too. And the question is just the whiplash of
00:26:00.680
having a really upending change in your life. And then in particular, trying to figure out what your
00:26:06.980
purpose will be. Because if you lose that, it's really hard. I think it's Viktor Frankl or Nietzsche
00:26:12.800
or somebody, it's like Frankl quoting Nietzsche or something who said something like,
00:26:17.080
he who has a why to live can bear almost any how. And it's kind of like Maslow's hierarchy
00:26:22.820
flipped over. It's like, if you feel a purpose and you feel connected to your sense of purpose
00:26:28.220
in your life, a lot of things could be going wrong, including in your body. And you can still
00:26:34.300
feel really solid. So I don't know. I think about that a lot in my own life or with my patients.
00:26:39.320
It's, you know. We're going to take a quick break for your word from our sponsors.
00:26:43.900
And now back to the show. And this idea of, you know, living while you're still alive,
00:26:48.560
I mean, is that one of the reasons why Paul wanted to have a child, even though he knew he might not
00:26:52.680
see her grow up? Definitely. It was kind of a crazy decision. We had a lot of support. So we had a lot
00:26:58.240
of luck and support and privilege that made it even possible to think about doing that when he was so
00:27:03.380
sick. But he said that we had a conversation, actually, that was really formative for me that
00:27:08.140
I've held on to since then, too, where he initially wanted to have a child more than I did at that time,
00:27:13.960
or he just was like, he was just really certain he wanted to, but he needed to make sure it would be
00:27:17.840
okay for me going forward. And I said, you know, I'm actually more worried about you. And I'm,
00:27:25.380
you know, don't you think that if we have a child, it's going to make
00:27:28.140
dying even more painful for you? And he said, wouldn't it be great if it did?
00:27:34.640
And I, that was just so formative for me, just thinking about anybody who,
00:27:40.680
anybody who decides to have a child, they are, they're not doing it because they think it's
00:27:47.000
going to be easy, you know, or like climbing a mountain or going through a really arduous
00:27:51.880
schooling. It's like, we do so many things that are difficult and beautiful at the same time,
00:27:57.380
or the difficulty is part of the beauty, you know? And I think Paul recognized that
00:28:02.740
having a child, even when you're dying, like that's, that's what that is, you know?
00:28:12.440
Yeah. That's the other thing that runs through the book, that connection between suffering and love.
00:28:17.660
Right. Like the people you love, like they're the ones that cause you to suffer the most,
00:28:21.060
but like, you're willing to do that because you love them.
00:28:23.880
Totally. It's either part of it or it's like worth, worth the risk. Yeah.
00:28:29.180
This idea of, you know, a big event happens to you like this, you have your, your priorities change
00:28:35.000
and even your identity changes. And for Paul, it was very visceral because he went from doctor
00:28:41.240
to patient. Was that, was that really hard for him?
00:28:44.920
Um, yes, it was really hard. I think yes and no. I mean, the fact of being a doctor makes it way easier
00:28:55.140
to handle being part of the medical system. So a lot of being a doctor was very helpful,
00:29:00.400
of course. But then I think Paul, A, sort of was surprised in a way by his own hubris where
00:29:09.000
I think he thought he kind of knew what it was going to be like to be a patient. And then he was
00:29:13.100
really shocked by how disorienting it was to face a serious illness. And he also had a lot of struggle
00:29:24.340
just with, with the fact of feeling like an object instead of a subject. And for a young neurosurgeon,
00:29:32.220
you're pretty used to being an agent, pretty in charge of everything. And then to be the one who's
00:29:39.600
the object and to be physically debilitated or just to be, you know, sitting and waiting or to be
00:29:48.940
not sure what's happening on a big or small scale was very hard.
00:29:54.200
Was there a moment where he finally kind of, I don't know, at least the word is like submitted,
00:29:58.040
like he became an object and he became okay with that?
00:30:00.560
Kind of. I think, yes, I guess, because he thought about it a lot and he got used to it.
00:30:08.340
And he also forged a different kind of agency as a writer and, you know, in, he, he sort of like
00:30:15.660
forged agency. But at the same time, I think one thing that did help was putting words on it,
00:30:21.800
like the mere act of describing it first to himself and then as a writer was really helpful.
00:30:27.340
And that was part of, you know, initially as a young person, he thought he would be a writer and
00:30:32.140
then he entered medicine so that he could, you know, have an unmediated experience of big questions.
00:30:37.420
And then I think once it became so fiery and he was the one who was sick, he kind of like retreated
00:30:43.100
to words again and flipping back and forth in that way was very helpful. And he was like gregarious,
00:30:50.180
but pretty introverted in a sense where like self-reflection and writing was the way that he
00:30:57.080
was, the way that he came to terms and actually process things was like kind of internal. And so
00:31:04.340
when he was writing the manuscript, even like I was reading it day to day or week to week, and
00:31:10.280
it was kind of a conversation tool, but like the manuscript was a big part of how he coped.
00:31:14.700
Yeah. Yeah. He was able to forge a new identity, a new purpose. And I thought it was interesting the
00:31:19.140
way he described it. I think it was really useful is that this didn't happen. Like it didn't like
00:31:23.320
switch on odd, like, you know, from one thing to the next, like it was a process that went back and
00:31:28.360
forth. It wasn't like he just knew all of a sudden, well, now I write. It was more of like, well,
00:31:33.720
am I a doctor? Well, I was a doctor. I mean, I think he did a great job showing that it's a very fluid
00:31:39.820
process and very messy and it's not very clean and one and done. Totally. I think that's a great
00:31:45.800
way to say it and important. And he did, he talked about verb tense, right? And he's like,
00:31:50.000
I am a neurosurgeon. I was a neurosurgeon. I had been, I will be. He like literally could not figure
00:31:55.840
out how to conjugate the verb for his own identity as a neurosurgeon, you know? Like, was it gone? Was
00:32:03.820
it still there? If he's not practicing, is he still a neurosurgeon? If he never will be, then does it
00:32:09.180
matter? Like, totally. And one thing that helped throughout this is that Paul had a great oncologist
00:32:14.680
that was very attuned to the human element of dealing with a terminal illness. How did she
00:32:21.340
help with that? Yeah. So the main thing was she just talked to him for real, like he was a real
00:32:29.840
person with agency, like we had said. And she would always ask him what he was up to and what was
00:32:36.060
important to him. And initially she was the first person who told him he could return to being a
00:32:40.440
neurosurgeon because initially we thought he would die within a few months. We actually weren't,
00:32:45.240
even as physicians, weren't even aware of the strides in cancer science and the tolerability
00:32:51.880
and efficacy of the treatment that he would end up using. So he had a great year on this one
00:32:56.260
treatment and she said, you can still be a neurosurgeon. He looked at her like she was insane
00:32:59.760
and then he was able to. And then similarly, once he was writing, she prescribed, here's an example,
00:33:10.300
she prescribed a stimulant medication, kind of similar to Ritalin, but not exactly the same so
00:33:16.540
that he could focus on writing when he was so punishingly tired and was having side effects from
00:33:21.840
other treatments. And she just was really creative in trying to tailor the medical treatment so that
00:33:29.680
he could keep being who he wanted to be as much as that was possible.
00:33:36.340
So yeah, Paul, he did a stint. He went back to work for a while as a neurosurgeon, but eventually
00:33:41.440
the disease progressed. How did he spend his last few weeks of life? And I mean, you hear people when
00:33:47.000
they know like, well, I've got a month, I'm going to live life to the fullest. Is that what he tried
00:33:53.160
He did something kind of different. I mean, okay, it sort of depends. I think there's this idea of like
00:33:59.160
people have this big bucket list and they're going to try to do it and they'll travel the
00:34:02.780
world or whatever. And I think Paul did something that was kind of the opposite, which was essentially
00:34:08.800
to like, there's another really interesting cancer patient writer named Kate Bowler who talked about
00:34:14.620
how when she got diagnosed, she chose to double down on the life she had, which I actually think
00:34:19.860
Paul did too. It was like, if you've made considered decisions through your whole life about what you
00:34:25.700
want to do and who you want to be and what's your career and who are you going to marry? And
00:34:29.920
like, if you're happy with that and you get diagnosed with a terminal illness, it's like
00:34:34.920
exciting and romantic to decide that like the way you wanted to spend your long life is also the way
00:34:40.640
you want to spend your short life. You know, it's like a, that's wonderful. So that's kind of what he
00:34:45.600
was doing. But I think his world became narrower and narrower. And in the very last few weeks of
00:34:55.080
his life, he was at home writing, like kind of furiously writing actually, knowing that he was
00:35:01.500
really getting very sick. And I remember he, there like a bunch of people wanted to visit and he kind
00:35:10.000
of didn't have the energy for it, even though he really wanted to. And he ended up writing this
00:35:14.120
beautiful email that was like kind of this love letter to his friends, but it ultimately said
00:35:18.820
like, you know, like I love you guys. And one more glass of Ardbeg 10 is not going to change that.
00:35:24.720
It's like, I think similarly, you know, I think his world just became smaller because he was so sick.
00:35:31.940
And so the very last weekend was, you know, at home writing. And then he, he died a little bit even
00:35:38.720
sooner than we thought. I think we thought he had a few weeks left and then he died kind of suddenly
00:35:44.120
because he had stopped taking one of his cancer medications, hoping that he could participate in
00:35:48.900
clinical trial. And that was just such bad luck. And then he ultimately, we called 911 and he wasn't
00:35:56.460
really able to breathe comfortably at all. So we went to the hospital, which wasn't totally ideal to be
00:36:01.920
away from home. But then our daughter's five now and she knows the story. So the way my daughter
00:36:07.840
would tell it is daddy was really sick and we went to the hospital and usually a baby is not allowed
00:36:14.540
to go to a hospital. But for me, they made a special rule. So she like knows about the special rule
00:36:19.660
where our daughter came to the hospital too. So he died in the hospital, but, but the thing that he
00:36:24.300
really wanted in the last like moments and last day was to, to be with our daughter who was eight
00:36:28.920
months at the time. I mean, what, what insights do you think Paul's experience, those last moments
00:36:35.120
can shed for people who are facing a similar situation? I'm just trying to think of like what
00:36:41.060
to share. I mean, I think the thing that like, I felt like Paul was a leader on or had deeply
00:36:49.620
considered was like this question of like quality, quality of life at the end of your life. And so he
00:36:57.140
faced a medical decision actually, which was whether to go on a ventilator and whether to be on life
00:37:02.940
support technology. And usually that stuff is not particularly helpful when you're really elderly or
00:37:10.380
when you're dying of a really progressive illness like cancer at the end of your life. And, but I
00:37:15.660
think there's a pressure, like a, like a cultural pressure and even some like medical cultural pressure
00:37:20.760
to like, quote unquote, do everything and, and use a technology like that or dialysis or whatever
00:37:28.360
it might be. And, and Paul ultimately said no at the very end that he didn't want to use any other
00:37:33.880
life extending technology. And I think it's funny how brave a decision that can be because it's sort
00:37:40.540
of an ancient wisdom, right? Is like at a certain point nature takes its course, but I think in a way,
00:37:47.060
like in a modern medical culture, it's sort of brave to decide not to do that. And, but as a
00:37:53.640
doctor, Paul had a sense that it wasn't going to help. And so then you like, then I think, you know,
00:37:58.720
what ended up for him was like the medical treatment was like for the nurses to sneak a baby in.
00:38:04.200
So I think that's one thing to think about is just like, like really trying to figure out what
00:38:09.000
makes sense for you medically. And it may not be the most intensive medical treatment. It may be
00:38:13.280
something else like staying home. And yeah, I mean, these are one big thing, you know?
00:38:18.300
Right. And that, and it's a very practical, um, sometimes like boring because that's advanced
00:38:22.720
directive type stuff, right? Totally. And like, people don't think about that because like, oh,
00:38:26.700
but like at that moment, like that's when you'd want to have one. Uh, so you can, you can be an
00:38:31.320
agent, right? And determining how your, how your end of life is. That's right. And it's like, not sexy,
00:38:36.820
you know, like I'm a primary care doctor, so I think that stuff is sexy, but most people don't.
00:38:40.840
And I think, but yeah, if you, I think instead of just the like pure paperworky part of it,
00:38:47.160
it's like, if you know who you are and you know, what's important to you, like for Paul,
00:38:51.580
Paul just wanted to be mentally lucid. He's like, I don't want to be alive if I'm not mentally lucid.
00:38:55.920
I want to write and I want to be with my family and I want to hold my kid. And if this is the end of
00:39:00.280
that, then this is the end. And so that was, that it made it very clear for him because he knew who he
00:39:07.060
was, but it's also really hard. It's also like, you know, it's even as doctors, it was hard to
00:39:13.160
figure out like, Oh, is this really the moment? Like, I guess this is it. I guess this is really
00:39:17.800
the moment. And it's just so shocking when it actually is happening, you know? And I think,
00:39:23.060
um, yeah, it's just like when it's you, it's just so, so emotionally intense. And then I think for me,
00:39:30.780
it's like, I was so, I was so fused with Paul, like you're such a team at that time. And I was
00:39:36.260
really devoted to trying to figure out how to help him write and how to help him make medical
00:39:41.000
decisions. And like, I was sort of blocking and tackling everything the best I could. And then
00:39:46.100
suddenly he like, he dies and he just like disappears. It's like, he just disappears. And
00:39:52.780
it's so shocking. I mean, it's like, Oh my gosh, he was here yesterday and now he's,
00:39:57.020
now he just disappeared. Like it's, it's almost incomprehensible. I don't know for anybody who's
00:40:01.780
lost somebody. I think that itself is so wildly upending. Yeah. We've talked to someone who's,
00:40:08.000
you know, works with widowers and the one thing he mentioned is that they disappear,
00:40:12.240
but like, they're still there. You go home and you can still smell your spouse.
00:40:18.420
And it says it's so bizarre. I mean, let's talk about that. You know, the grief process that you've
00:40:23.460
gone through, you know, a lot of people assume that, you know, time heals all wounds and grief
00:40:28.460
progresses in this sort of linear fashion. Has that been your experience with grief?
00:40:33.140
No, I mean, yes and no. I think the pain is certainly less than it was before. So like it
00:40:40.540
has gotten better over time, of course, but I think the like linear stages of grief thing or predictable
00:40:46.820
stages is like, not, has not been my experience. I think it's much more like waves of an ocean or
00:40:53.120
like there's all kinds of other metaphors that people use. And then, I mean, I got to do a book
00:40:59.360
tour for Paul after Paul died and it was actually so amazing. Paul's book came out nine months after
00:41:05.700
he died and right around the time where I was like still so hungry to talk about him and he was still
00:41:12.680
so present in my everyday thoughts. And I love him no less than I did before. You know, he's like,
00:41:20.600
he's still a part of my experience and, and the chance to talk about him or even to you, you know,
00:41:27.440
he died four years ago and it's so fun to tell you about him. And I've even fallen in love since Paul
00:41:32.580
died. And I also still love Paul and Paul's still Katie's dad. And so I think the, the positive
00:41:39.760
experience of doing this book tour after Paul died has taught me so much about grief and how helpful it
00:41:46.140
can be to, to acknowledge that, like that love totally continues and the desire to, you know,
00:41:53.940
talk about the person continues. Sheryl Sandberg, after her husband died, suddenly wrote about going
00:41:59.380
to this dinner party and everybody was telling like the meet cute stories of how they met their spouses
00:42:04.500
and then they skipped over her. And I, and she was like, I totally have a story about how I met Dave.
00:42:11.040
And like people felt weird asking about it or maybe thought it wasn't important anymore. And she
00:42:16.560
was like so shocked and was ready to tell the story. And I've had so much opportunity to like tell the
00:42:22.540
stories and it's been so awesome. And then it's just been interesting, like raising a kid into a
00:42:29.020
world that includes like visiting a grave, you know, and she's like, that's just her world. And she's
00:42:35.160
totally, she takes it totally in stride. She gets it. I mean, going back to this idea of how other
00:42:41.280
people respond who are like outside of this process, right? I think all of us have known
00:42:46.200
someone who's going through a hard time. A spouse has a terminal illness. A friend has a terminal
00:42:49.920
illness. You know, someone loses their spouse suddenly and people want to help. They want to
00:42:55.820
say something, but they, they're afraid they're going to say the wrong thing. I mean, going through
00:43:00.700
your experience with, with Paul and even as your experience as a doctor, do you have any advice to
00:43:05.640
folks who want to help know someone who's having a hard time, but they just don't know what to do or
00:43:10.500
say? Sure. I mean, my main advice is just like, do the thing. So like, that's everything from like,
00:43:20.020
write the card, go to the memorial service, like knock on the door, say the thing, just like do the
00:43:26.120
thing. If you, if it occurs to you and it's just so much harder to feel isolated and disconnected.
00:43:32.320
And I think anytime somebody reached out to me with anything, which happened a lot, felt so good.
00:43:39.200
I was not analyzing what people were saying. I was just analyzing how it made me feel to be
00:43:44.240
connected. And then, and I think my mom always used to give us this advice growing up where she
00:43:49.900
would say, when in doubt, describe. And it was good relationship advice. It was like, you don't have to
00:43:55.480
have the perfect thing to say. You can just sort of describe even that. So it's like, you could say
00:44:01.380
to your friend, like, I was so sorry to hear your mom died. That hasn't happened to me. And I don't
00:44:07.600
even really know what to say about it. I've just been thinking about you so much and it brings tears
00:44:12.660
to my eyes and I just wanted to come over. And it's like, wouldn't that be such a nice thing to hear?
00:44:18.440
It's like, I think, I think when in doubt, describe is really pretty good. Um, because
00:44:23.120
even if all you can say is, I wish I knew what to say, I love you. That's awesome.
00:44:29.500
Is there, are there things that you, like people shouldn't say like ever, right?
00:44:34.480
Well, you don't, cause you, you don't appreciate it. It doesn't help.
00:44:37.060
So I think I'm in a, um, Facebook group that's well, now it's on this other app platform called
00:44:44.400
band, but it's called hot young widows club. And it's, it was founded by Nora McInerney. And it's
00:44:49.180
a group of like all relatively young people who've lost their spouse or partner in their twenties or
00:44:53.760
thirties. And it's awesome. It's amazing. But the two things that people really don't like to hear
00:45:00.060
are, well, the main one is everything happens for a reason or like, like he's in a better
00:45:06.740
place. Like anything that feels like it's trying to explain something away or anything
00:45:13.460
that's trying to explain, explain it, which, because I think these things just are pretty
00:45:18.760
inexplicable. And oftentimes what you want is just someone to acknowledge how hard it is
00:45:26.120
and then like, see it and sit there and rather than trying to make it better or fix it, especially
00:45:33.140
when that's impossible. What, what have you noticed or been helpful or that you've appreciated
00:45:38.800
like in the months or years since Paul's death? Right. I mean, one thing I've, I've talked to people
00:45:45.080
who've lost a spouse, people remember you like right after, but then after a while the phone calls
00:45:50.380
start going away. People, I mean, did you have people who kept on, who kept in constant touch with
00:45:55.980
you even after months after it? Yes. Yeah, totally. And I think maybe my friends just knew
00:46:01.860
that intuitively or, or maybe it also really came out of Paul's book because there was enough to talk
00:46:08.980
about with the book and the book tour and how's the book doing. And you know, that it, Paul and the
00:46:14.500
book became really wrapped together. And so it's the degree to which I've had the chance to talk about
00:46:21.300
Paul's writing feels totally like commensurate with the need I have to talk about Paul. So,
00:46:28.140
and I think that's not true for everybody. So I think you're really hitting on something, which is
00:46:31.800
like, you know, I have a friend whose son died about a year after Paul died. And I like marked the
00:46:37.760
calendar for like the day of the month that he died to like send her a text every once in a while.
00:46:45.240
And he would have been starting kindergarten now. And she just mentioned that two people texted her to
00:46:50.180
say like, Hey, I see there's all the kindergarten photos on Facebook, like just checking in with
00:46:55.440
you. Cause I know that your son would have been starting kindergarten. It's like, it totally doesn't
00:46:59.920
go away. It's like, you think about the person at big milestones or the anniversary that they died on
00:47:05.200
or their birthday. It's like, if it would ever occur to you to mark your calendar, to check in with
00:47:10.320
someone, like I could almost guarantee that, that that person is thinking about it. And it feels
00:47:16.340
awesome to even just get a text. You're totally right.
00:47:20.820
So Paul was a philosopher. I'm going to say, I mean, I, that's what I think he was a, I think a
00:47:25.820
philosopher first, then he became a doctor. He's sort of like William James, like William James was
00:47:30.260
probably a philosopher and he became a psychologist because you want to understand things better.
00:47:34.700
But Montague, the French essayist, he said, the study of philosophy is to learn to die well.
00:47:43.760
Oh, um, I think so. I mean, I think he really faced up to it and he really tried to live authentically.
00:47:54.240
And I think, um, I think in a way, like, I don't know what a good death means or dying well means.
00:48:02.700
It's like, it's just, it's not something that we want to do. And, but I think like dying well,
00:48:10.440
to me is like pretty similar to living well, you know, it's like until you die, you're alive. And
00:48:15.920
so it's all, it's all your life, you know? So, yeah, I mean, I think so. I'm, I'm proud of him
00:48:26.760
And do you think that he got some of the answers to those questions you've had since he was a young
00:48:32.200
man, you know, in the Arizona desert, like he, he got an idea of what made human life meaningful?
00:48:40.600
No, but do you, do you think Paul had, maybe, maybe he couldn't articulate it,
00:48:44.780
but do you think he had a sense? Like he grasped it?
00:48:46.600
Yeah, I do. I do. Um, I do. And it's like one, after Paul died, one of his friends said,
00:48:52.220
you know, I wonder if Paul felt like the struggle to find meaning is the, is part of the meaning.
00:48:57.380
And I kind of do think that I think when breath becomes air is about what you mentioned. It's
00:49:04.340
like, it's about love and suffering and striving. And those are the things that Viktor Frankl said
00:49:11.340
were meaningful to, those are the things he said underpin meaning is like love and the people and
00:49:16.480
experiences we love work like our work or our purpose and then suffering and how facing suffering
00:49:23.780
is intrinsically meaningful, sort of counterintuitively. Right. And I think,
00:49:28.920
I think love and striving and suffering, um, were and service, you know, I think we're really
00:49:36.200
meaningful to Paul and they kind of swirl around in the book, but I picture Katie growing up to read
00:49:42.120
the book. And I think when she reads it, I hope that, that, you know, it's essentially saying like,
00:49:49.160
it's important to try hard and I love you. Like that's what the book's saying to Katie,
00:49:54.680
I think. And I, I kind of think that's indistinct from ultimately what Paul thought was really
00:49:59.900
important in his life. Well, Lucy, this has been a great conversation. Is there some place people
00:50:04.020
can go to learn more about the book? Well, let me think of what, so, so it's when breath becomes
00:50:09.700
air, it's wherever books are sold. There is a website called paulkalanathy.com that has some old
00:50:15.940
interviews with Paul and then some speaking events and other projects that I'm doing.
00:50:20.960
And then I'm on Twitter. If anybody wants to communicate with me, I'm at rocket girl MD
00:50:25.380
on Twitter. Awesome. Well, Lucy Kalanathy, thanks for your time. It's been a pleasure.
00:50:29.260
Thank you so much. My guest today was Lucy Kalanathy. She wrote the epilogue to her late
00:50:33.180
husband's book. His name was Paul Kalanathy. That book is when breath becomes air. It's available
00:50:37.560
on amazon.com in bookstores everywhere. You can find out more information about Paul and his work
00:50:41.540
at paulkalanathy.com. Also check out our show notes at aom.is slash breath becomes air.
00:50:47.260
We're going to find links to resources. We can delve deeper into this topic.
00:50:56.920
Well, that wraps up another edition of the AOM podcast. Check out our website at
00:51:00.240
artofmanlios.com where you can find our podcast archives. There's over 500 episodes there,
00:51:04.340
as well as thousands of articles written over the years on personal finance, physical fitness,
00:51:07.740
how to be a better husband, better father. And if you'd like to enjoy new episodes of the
00:51:11.020
Art of Manliness podcast ad-free, you can do so on Stitcher Premium. Head over to
00:51:14.340
stitcherpremium.com. Use code manliness for a month trial for free. Once you're signed up,
00:51:18.980
download the Stitcher app on Android or iOS, and you start enjoying ad-free episodes of the
00:51:23.000
Art of Manliness podcast. And if you haven't done so already, I'd appreciate it if you take one minute
00:51:26.340
to give us a review on iTunes or Stitcher. It helps out a lot. And if you've done that already,
00:51:29.540
thank you. Please consider sharing the show with a friend or family member who you think will get
00:51:33.180
something out of it. As always, thank you for the continued support. And until next time,
00:51:36.240
this is Brett McKay reminding you not only to listen to the AOM podcast, but put what you've heard into action.