Primary care physicians like me talk a lot about “the tincture of time.” It is one of our most effective treatments: wait a few days and see. It’s not always an easy recipe to swallow when you’re the one on the examination table. When MRI Could Explain Back Pain. When your child’s sore throat continues to burn, even though the strep test is negative. Of course, sometimes we move forward quickly; We order the examination or rush the antibiotics. There are good reasons: immunosuppression or a fear that doesn’t let us go. But most of the time a well-thought-out plan and a little more time is enough.
I was also on the other side of the exam table. In the case of my late husband Paul, the tincture of time for his back pain led to something neither of us expected: terminal cancer. To die at 37 years old. And yet, almost always, time heals. The symptoms disappear. The path becomes clearer. The boy jumps out of bed.
Paul was also a doctor. We used to talk about the patients, their stories, the responsibility of deciding what mattered and what could wait. Now, 11 years after losing him, I see 21 patients in my office most days. Usually two are sick enough to need the emergency department. Every morning as I review my list, the question arises: which two? Perhaps this young teacher has pelvic inflammatory disease, not a yeast infection. Perhaps this widower’s racing heart is an arrhythmia, or crushing loneliness, not simple dehydration. Sometimes, at the end of the day, the answer has not yet been revealed. “His white blood cell count will come back overnight, and if it’s elevated, we need to do a CT scan.” “Would you text me on Thursday? The antibiotic should work in two days, so that’s our moment of truth.” A little more time. We will meet again in the next step.
General internists, like myself, do not specialize in a single organ system. If we specialize in anything, it may be learning how and when to wait. More testing can bring peace of mind, but it can also bring harm: side effects, radiation exposure, new stress. So we often take a wait-and-see approach, relying on the patient’s knowledge of their body and my intuition shaped by years of seeing patterns. What I can promise is not certainty, it is 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 about losing him is that he never saw his book find readers. But it’s also one of the beautiful parts: it has a legacy.
He has another one he never got to know.
These days, when I come home from the clinic, I’m greeted by big brown eyes that look like Paul’s, framed by the same long eyelashes. They belong to his daughter, our daughter, Cady, now a wry and mischievous seventh grader. I drop my bag, thank our babysitter, and settle in to listen to the latest tween sagas and slang, and realize that my next big wait is with her.
She is the next great love of my life. And for a parent, every decision—discipline, independence, praise, saying no, whether or not to get the watch—is a best guess. Was changing schools the right decision? What could adolescence bring? More than anything, am I doing right by this girl whose childhood is so different from mine?
With my patients, I actively cycle through potential catastrophic outcomes in my mind: If things go wrong, I need to be prepared to rush, IMMEDIATELY. Later, at home, looking at my daughter, my brain sometimes jumps to clinical vigilance. But as a parent, when the catastrophic thought arises, I urge myself to breathe. It is growing and is not a differential diagnosis. There is not just one correct answer.
Cady hasn’t read her father’s book yet, although she knows it will be there for her whenever she wants it. Our shelves, between poetry anthologies and Warrior Cats novels, are full of copies. Will he get one when he’s a teenager? Will Paul feel closer when she does it, or further away? What will you carry forward or could you put the book aside? She will find her own answers.
I make well thought out plans and allow time to do your work. It’s my daughter’s trip. I offer what I know. Then we wait, together.
Lucy Kalanithi is an associate clinical professor of medicine at Stanford University. She wrote the afterword to When Breath Becomes Air, her late husband Paul Kalanithi’s best-selling memoir. She lives with her daughter in the Bay Area, where Joanna, her twin sister, enjoys visiting her regularly and getting crushed by her niece in Block Blast.
PS: The beautiful renovation of Lucy’s house and Lucy’s Big Salad Problem. xoxo
(Illustration by Abbey losing for the Cup of Jo. Beach photo by Jenny Nelson Photography.)
