The ‘Tincture’ of Time

Primary care doctors like me talk a lot about “the tincture of time.” It’s one of our most effective treatments: a few days’ dose of wait and see. It’s not always an easy prescription to swallow when you’re the one on the exam table. When the MRI might explain the back pain. When your toddler’s sore throat is still raging, even though the strep test is negative. Of course, sometimes we move forward quickly; we order the scan or rush the antibiotics. There are good reasons: immunocompromise, or a fear that won’t let go. But most often, a thoughtful plan and a little more time are enough.

I’ve been on the other side of the exam table, too. In my late husband Paul’s case, the tincture of time for his back pain led somewhere none of us expected: to terminal cancer. To dying at age 37. And yet, almost every time, time does heal. The symptoms lift. The path becomes clearer. The toddler bounces out of bed.

Paul was a doctor, too. We used to talk about patients, their stories, the responsibility of deciding what mattered and what could wait. Now 11 years out from losing him, I see 21 patients in my office most days. Usually two are sick enough to need the emergency department. Each morning as I scan my list, the question hovers: which two? Maybe this young teacher has pelvic inflammatory disease, not a yeast infection. Maybe this widower’s racing heart is an arrhythmia, or crushing loneliness, not simple dehydration. Sometimes by the end of the day, the answer still hasn’t revealed itself. “Your white blood cell count will come back overnight, and if it’s elevated, we should do the CT scan.” “Would you message me on Thursday? The antibiotic should work within two days — so that’s our moment of truth.” A little more time. We’ll meet again at the next step.

General internists, like me, don’t specialize in one organ system. If we specialize in anything, it may be learning how, and when, to wait. More testing can bring reassurance, but it can also bring harm: side effects, radiation exposure, new stress. So, often, we take the wait-and-see approach, trusting the patient’s knowledge of their body and my intuition shaped by years of seeing patterns. What I can promise isn’t certainty, it’s presence. If we need to change course, I’ll be there.

Paul died in 2016, two years after his diagnosis, eight months after the birth of our daughter. He spent much of those final years working on the manuscript that would become his memoir, When Breath Becomes Air. One of the hardest parts of losing him is that he never saw his book find its readers. But it’s also one of the beautiful parts: he has a legacy.

He has another one he never got to know.

These days, when I come home from clinic, I’m greeted by big brown eyes that look just like Paul’s, framed with the same long lashes. They belong to his daughter — our daughter — Cady, now a wry, scampy seventh-grader. I drop my bag, thank our sitter, and settle in to hear the latest preteen slang and sagas, and I realize my next big wait-and-see is with her.

She’s the next great love of my life. And for a parent, every decision — discipline, independence, praise, saying no, whether to get the watch — is a best guess. Was switching schools the right call? What might the teenage years bring? Most of all, am I doing right by this girl whose childhood looks so different from mine?

With my patients, I actively circle the potential catastrophic outcomes in my mind: if things go south, I need to be ready to rush, STAT. Later at home, looking at my daughter, my brain sometimes jumps to clinical vigilance. But as a parent, when the catastrophic thinking looms, I urge myself to breathe. She’s growing, and she’s not a differential diagnosis. There’s not just one right answer.

Cady hasn’t read her dad’s book yet — though she knows it’s there for her when she chooses. Our bookshelves, amidst poetry anthologies and Warrior Cats novels, are studded with copies. Will she reach for one as a teen? Will Paul feel nearer when she does, or further away? What will she carry forward, or might she leave the book aside? She’ll find her own answers.

I make thoughtful plans, and I allow time to do its work. It’s my daughter’s journey. I offer what I know. Then we wait, together.

Lucy Kalanithi is a clinical associate professor of medicine at Stanford University. She wrote the epilogue to When Breath Becomes Air, her late husband Paul Kalanithi’s bestselling memoir. She lives with her daughter in the Bay Area, where Joanna, her twin sister, enjoys visiting regularly and getting crushed by her niece in Block Blast.

P.S. Lucy’s beautiful home makeover, and Lucy’s Big Salad issue. xoxo

(Illustration by Abbey Lossing for Cup of Jo. Beach photo by Jenny Nelson Photography.)