Randy Pausch delivered his "Last Lecture", titled "Really Achieving Your Childhood Dreams", at Carnegie Mellon on September 18, 2007. This talk was modeled after an ongoing series of lectures where top academics are asked to think deeply about what matters to them, and then give a hypothetical "final talk", i.e., "what wisdom would you try to impart to the world if you knew it was your last chance?" A month before giving the lecture, Pausch had received a prognosis that the pancreatic cancer, with which he had been diagnosed a year earlier, was terminal. Before speaking, Pausch received a long standing ovation from a large crowd of over 400 colleagues and students. When he motioned them to sit down, saying, "Make me earn it", someone in the audience shouted back, "You did!" During the lecture Pausch was upbeat and humorous, shrugging off the pity often given to those diagnosed with terminal illness. At one point, to prove his own vitality, Pausch dropped down and did push-ups on stage. Pausch begins by setting up the various topics being discussed. The first of three subjects, his childhood dreams, is introduced by relaying the overall premise of why he is stating his dreams, saying, "inspiration and permission to dream are huge". The second topic in "Really Achieving Your Childhood Dreams" is titled "Enabling the Dreams of Others". In this section, Pausch discusses his creation of the course "Building Virtual Worlds" that involves the student development of virtual realities. Through this course, Pausch creates a program called "Alice- The Infinitely Scalable Dream Factory" because he wants tens of millions of people to chase their dreams. This software allows kids to make movies and games, giving them the opportunity to learn something hard while still having fun. He believes that "the best way to teach somebody something is to have them think that they're learning something else." For the third and final topic in his lecture, called "Lessons Learned", Dr. Pausch reiterates and introduces a few new lessons that he has learned and accumulated over his lifetime. Arguably the most meaningful point Pausch made comes at the very end of his lecture, when he states: "It's not about how to achieve your dreams, it's about how to lead your life. If you lead your life the right way, the karma will take care of itself, the dreams will come to you.”
The Last Lecture fleshes out Pausch's lecture and discusses everything he wanted his children to know after his pancreatic cancer had taken his life. It includes stories of his childhood, lessons he wants his children to learn, and things he wants his children to know about him. He repeatedly stresses that one should have fun in everything one does, and that one should live life to its fullest because one never knows when it might be taken. In the book, Pausch remarks that people told him he looked like he was in perfect health, even though he was dying of cancer. He discusses finding a happy medium between denial and being overwhelmed. He also states that he would rather have cancer than be hit by a bus, because if he were hit by a bus, he would not have had the time he spent with his family nor the opportunity to prepare them for his death. The 2012 edition of the book features a short foreword written by Jai, his widow, reflecting on the time since her husband's death.