Primary care physicians like me often talk about “tinctures of time.” This is one of our most effective treatments. Please wait a few days and see how it goes. When you step on the exam table, it’s not necessarily an easy prescription to swallow. If an MRI could explain your back pain. When a toddler’s throat is still sore even if the strep test is negative. Of course, sometimes we move forward quickly. We order tests or rush antibiotics. There are good reasons for this, such as a weakened immune system or fear that prevents you from letting go. But in most cases, thoughtful planning and a little more time are all you need.
I have also been on the other side of the examination table. In the case of my late husband Paul, the tinctures he took to treat his back pain led him to a place none of us expected: terminal cancer. He died at the age of 37. Still, in most cases, time heals. Symptoms will improve. The path becomes clearer. A toddler jumps out of bed.
Paul was also a doctor. We talked a lot about our patients, their stories, and our responsibility to decide what is important and what can wait. Now, 11 years after losing him, my office sees 21 patients every day. Usually, two people are sick enough to need a trip to the emergency room. As I look over my list each morning, two questions come to mind: Perhaps this young teacher has pelvic inflammatory disease rather than a yeast infection. Perhaps the widow’s pounding heart is due to an arrhythmia or an overwhelming feeling of loneliness rather than simple dehydration. In some cases, by the end of the day, the answer may not yet be clear. “The white blood cell count will come back overnight. If the white blood cell count is elevated, you might want to do a CT scan.” “Can you give me a message on Thursday? The antibiotics should work within two days, so that’s our moment.” Just a little more time. See you again in the next step.
General internists like me do not specialize in any particular organ. If there’s anything we specialize in, it might be learning when and how to wait. More tests can bring peace of mind, but they can also bring harm, including side effects, radiation exposure, and new stress. So we often take a wait-and-see approach, trusting my knowledge of the patient’s body and my intuition, formed by years of seeing patterns. What I can promise you is presence, not certainty. If you need to change course, I’ll be there.
Paul passed away in 2016, two years after his diagnosis and eight months after his birth. our daughter. He spent most of his later years writing his memoir, When Breath Becomes Air. One of the hardest things about losing him is that I never saw his books find an audience. But that’s also one of the beautiful parts. He has a legend.
There’s another person he hasn’t met yet.
These days, when I come home from the clinic, I’m greeted by big brown eyes framed by long eyelashes just like Paul’s. They belong to his daughter, our daughter Cady, now a grumpy, skittish seventh grader. I dropped off my bag, thanked my sitter, and settled in to listen to the latest preteen slang and slang. And then I realized that the next big wait was with her.
She is the next great love in my life. And for parents, every decision about discipline, independence, praise, saying no, whether to let a child have a watch or not is a best guess. Was changing schools the right decision? What will the teenage years bring? Most of all, am I doing the right thing by being around this girl whose childhood was so different from mine?
I actively circle potential catastrophic outcomes with my patients in my head. If the situation worsens, you must be ready to jump in at a moment’s notice. STAT. Then, when I get home and watch my daughter, my brain sometimes jumps into clinical alertness. But as a parent, when a catastrophic thought looms, I tell myself to breathe. She is growing and there is no differential diagnosis. There’s more than one right answer.
Cady hasn’t read her father’s book yet, but she knows she can have it if she chooses. Our bookshelves are littered with photocopied books, among poetry collections and warrior cat novels. Will she get it in her teens? Does the pole then feel closer or farther away? What does she plan on moving forward with, or might she put the book aside? She will find her own answer.
I try to make thoughtful plans and spend time on them. This is my daughter’s journey. I’ll give you what I know. Then we’ll wait together.
Lucy Kalanithi is a clinical associate professor of medicine at Stanford University. She wrote the epilogue to her late husband Paul Kalanithi’s best-selling memoir, When Breath Becomes Air. She lives in the Bay Area with her daughter, and her twin sister Joanna visits there regularly and enjoys being crushed by her niece at Block Blast.
PS Lucy’s beautiful home makeover and Lucy’s Big Salad. Shit
(Illustration: abby rossing For joe cups. beach photo credit Jenny Nelson Photos. )
Source: Cup of Jo – cupofjo.com
