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.)
Tags: grief, lucy kalanithi
Comments
97 commentsI found the book life-changing, and I love this essay too. The very best to you and your sweet girl.
I was recently asked what my favourite book was and Paul’s book immediately came to mind, the detail too, which included you, Lucy taking it over the finish line by writing the epilogue. It found me at a very low time in my life, having just lost my father and father in law within a span of three weeks and really helped me to appreciate the value of time, whether as a tincture or memory or just an ordinary staple we so often take for granted. Now with two tween/teenage girls (who were not much older than Cady at the time) I am so grateful for this piece and the way in which your words continue to resonate. X
The hardest part of life it seems.. the in-between moments and what if’s. We just have to keep putting one foot in front of the other and ‘meet each other there’. Such a beautiful piece of writing, Lucy! Thank you for sharing. Paul’s writing has stayed with me, too since the moment I read When Breath Becomes Air!!
Gorgeous, as wonderful a writer as you are a mother. Thank you for this today, it’s wise and thought provoking in all the important ways.
When I was a kid, the absolute worst thing I could think of was my mom dying. My mom was not sick, but my anxious kidbrain could wind me up and have me cry myself to sleep just thinking about it. Then the fast-forward button is pressed and I am in my thirties sitting next to her hospital bed holding her hand in disbelief. Part of my grief process was realizing that the only thing I could do for her was to be OK. It is what I would want for my kids. The “tincture of time” works. Even when it seems like it is impossible that it could.
Thank you so much for sharing the richness of your lives—the joys, the sorrows, and everything in between. After reading Lucy’s essay, I find myself wondering if your mom and dad might share what it’s been like to witness their adult children experience heart ache? It is so difficult when our kids, no matter their age, are hurting. I would love to hear how your parents have navigated this.
This is such a beautiful thought, would love to read this too.
What a touching, beautiful essay. Thank you so much for sharing. :)
Loved hearing from Lucy :-) She writes so beautifully. I found WBBA in my little local libary a few weeks ago and started reading it on the shelf right there and then. As a long time CoJ reader (way back before Jo owned the CoJ the URL / circa 2011) I’ve loved seeing Lucy’s journey unfold and the sibling / twin bond. More Lucy pls!
Thank you for sharing your thoughts and writing, Lucy. Your story has been sitting with me and I’ve been mulling over my own thoughts on dying and living and how I can’t be wasting a single moment.
This moved me immensely, having read When Breath Becomes Air many years ago. This season of my life has been about allowing time to do its thing. As a writer mothering a beautiful three-year-old boy, words aren’t as fluent as they once were. I am beginning to accept that it is simply time ripening them until they are ready. As we tentatively introduce our son to the fact that we adopted him, I watch him grasp at the periphery of the idea and I wait, allowing time to deepen his understanding. As I worry about my parents ageing an ocean away from me, I teach myself to pause before panicking. It is a season, or many, of pause and slowness, and I am so grateful for Lucy’s words illuminating that reality to me.
Such a wise perspective. Thank you for sharing your voice!
This is beautiful. I’m in awe of your strength.
So amazing to finally get a column from the famous Lucy!
Thanks Luce! This is lovely!! One of my attendings in residency used to always tell me “Don’t just do something, stand there.” Telling me to take a moment. Watch how this plays out. See if it’s going where you think it will. Now I get to tell my patients in the ED “The CT didn’t tell us anything about why you are in horrible pain but it doesn’t seem like it’s something dangerous. This is actually great, we don’t have to rush. We can be thoughtful and elegant about how we take care of you.” Now, looking at my toddler swinging a rake around his head, I don’t feel the need to do something. He’ll stop when he gets bored or hurts himself. Neither will be an emergency.
What a special gift this piece was. Both for the important reminder of the healing qualities of time and, even more importantly, the reminder embodied by Lucy herself that life goes on to be rich and beautiful even after unimaginable loss. Thank you for these gems of wisdom.
Thank you. What a good word on “wait and see.”
So moving… I cried. We love you
Waiting for the result of a blood test, biopsy or a medical procedure that you have to do because something feels off is one of the worst kind of waiting. I feel terrible receiving bad news, I’ve sometimes wondered how doctors feel about delivering it. This line is the second best thing to hear from your doctor – What I can promise isn’t certainty, it’s presence. If we need to change course, I’ll be there. The first is – it’s benign!
Sent this beautiful poignant essay to my extended family text chain, and discovered some of them had never read “When Breath Becomes Air”, which I view to be required reading for all humanity. Lovely to hear Lucy’s voice, thank you for sharing.
Seconding the “required reading for all humanity.” <3
gorgeous, Lucy. You and Cady are a love story for the ages. xx
Lucy and Joanna, you are incredible humans giving back to the world in your own unique ways. Thank you for this piece.
Yes agreed. You put it beautifully
Yes! Incredible humans. I “found” Lucy and Joanna separately, many years ago. I’ll never forget the day I learned they were sisters (twin sisters!). It blew my mind, hahaha. You are both extraordinary women. Thank you for all that you share with the world.
Beautiful 🥹🙏🏽
This is so beautiful Lucy! I read Paul’s book when it came out and loved and and now, 44 years old and living with stage 4 breast cancer (my tincture sadly meant metastasis to my bones) I plan to read it again, between drop off and pick up of my tween, with a new found (for better or worse) bond with the writer. This was beautiful. Thank you!
Molly, I am sending love and light your way as you navigate the daily hum of drop off and pick up and continue to beautifully stitch your quilt of life ❤️
fuck, Molly. I am so sorry. sending you love and healing.
I’m so sorry to hear this, how hard. You may also deeply resonate with The Bright Hour by Nina Riggs. Sending you and your so much love and light.
How deeply unfair.
Sending you a big hug! There is a runner and podcaster, Ali on the Run who recently had this diagnosis and has NED as of this week. If her story is of interest to you – check out Ali on the Run. She is really open about everything.
Beautifully written, and I echo the sentiment of having Lucy contribute again to the blog. Do you have any information on the artist who did the cover art for this piece – it’s so beautiful. Was is a commission?
Hi Lindsey! The illustration was commissioned from the wonderful artist, Abbey Lossing. You can find her info linked in the credit at the bottom of the piece. :)
How utterly beautiful. Cady’s blessed to have such a thoughtful, considered mom.
What a stunningly beautiful essay. These are the words I needed to hear today: ‘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.’ Thank you Lucy.
Just beautiful, thank you!
Lucy, thank you. First for the work you do every day. Thank you also for your thoughtful perspective, one of which resonates with me. Right down to the Warriors reference. As I’ve aged giving things time has become somewhat easier. What never seems to get easier Is what you describe about parenting. The questions you ask yourself. My kids are now both around your daughter’s age. Doesn’t it feel like such an important time? I was staring at my daughter this week after her 9 th grade end of year awards. Just staring at her face, trying to imprint her face in my mind. Maybe because I was just in wonder of this person I held, sung to sleep, watched yelling at the ocean in little green crocs she insisted I buy her no longer that little wild person. Now this adult, really. So smart and so kind. She caught me staring and of course was like, “Mom, whaaat?”
This made me burst into tears – Then burst into laughter at the last line! Thanks for your wonderful comment Eevie!
Your daughter will grow into an extraordinary person…how could she not? With parents who express themselves so eloquently, even though one is gone too soon, she has quite a legacy to draw on. I know I am grateful to have been privileged to read both Paul’s story and look forward to reading more of yours.
Prescribing the “tincture of time” asks for courage and patience from both sides. I’m so glad you are brave enough for this unusual approach. Also, it’s good to see you are parenting, loving, working – just living. Newly widowed at 53, I have no idea where my life is going, but I know: you are a role model for me! I’d love to read more of your writing, if you ever find the time for it?
Beautiful x
Thank you sooo much for these wise words ! I‘m a Family doctor in Germany and just love how you put into words what we do every day.
Gosh, your parents must be exploding with pride.
While working at Stanford, I occasionally visited Express care for those 19/21 non-life-threatening issues. I remember feeling star struck by Lucy’s portrait in the waiting room! Once, a kind older doctor ran very late to my appointment, apologizing because he had just been helping someone very seriously ill, one of the 2/21. I can still feel the gratitude I felt in that moment for my easily treatable ailment and the overwhelming sadness filling the room for the person who was not ok. My simple prescription actually cheered the doctor up under the weight of all the sickness he must have witnessed that day and week. I share the gratitude expressed here by others for the kind and caring primary care doctors who chose to listen and patiently help with issues big and small every day. In the end, Lucy was never my doctor, but I did get to witness her eloquence and grace at a department fireside chat about her and her husband’s book. Happy to hear her voice again here!
What a beautiful essay. I would read any essay, article, or book that Lucy writes. What a special pair of twins. I wept reading Paul’s book. I hope the entire rest of your life is so much more gentle than that loss.
Currently laying on the sofa with my toddler, who came home from daycare with a high fever, sleeping on top of me, and after reading through all the clinical red flags to monitor for, making a plan for emergency room trip if need, and rescheduling tomorrow’s meetings, came to COJ for some emotional comfort. Saw this title, then saw Lucy’s name in the bio line. Read the article and have tears quietly streaming down my face. I am not a doctor. I haven’t the slightest medical intuition, a fact that feels increasingly painfully true as I care for not only my child but also older relatives, but I see and value the deep care in what Lucy shares of her physician mind and practice. And as a fellow mom of a daughter, I deeply resonate with the complex emotions and ultimate trust in my child’s right to discover her own journey. Finally, I also feel much tenderness for Lucy, having “known” her for years through this blog. Sending you wishes for joy and wellness, Lucy. You are so resilient and wise, and this community is rooting for you and Cady ❤️
Lucy!! You sound like an amazing doctor. And an amazing mother. ❤️❤️❤️
This was gorgeous, and what a lovely meditation on parenting. So often I need to grant my daughters time–I’m going to hold this concept of a tincture of time close as a reminder. I hope we get to hear more of Lucy’s writing in the future!
Lucy – I ugly sobbed reading the end of When Breath Becomes Air 10 years ago and then was lucky enough to hear you speak in San Francisco at Grace Cathedral soon after that. I never would have guessed that my now fiance would also be diagnosed with stage 4 lung cancer in 2024 before age 40. He’s doing well right now, but when I can’t sleep at 2 am, I often think of you and the beautiful life that you seem to have created after losing Paul. I appreciate you continuing to share your story with us. Wishing you and Cady all the happiness in the world xo
Sending best wishes to you both Barb as you navigate this uncertain time ❤️
May we all have the wisdom to love this deeply. What a truly moving essay x
I’m so, so happy for Lucy that she has her amazing daughter Cady. And…. I’ve shared with the COJ community before that I’m in cancer treatment. My next scan is this Thursday. Please keep your fingers crossed for me!
Fingers crossed and positive thoughts sent your way!
We will, Bobby. Fingers and toes.
Wishing you all good things.
Sending you love
Praying for a positive result for you. You got this!
Bobby, I think of you often and hope you know that your previous comment was of value. Sending love for Thursday.
Crossing them right now. All best wishes to you!
Sending all the good wishes & energy & love your way. Fingers crossed you check back with us to tell us HAPPY NEWS!
Wishing you all the best Bobby with the scan! Love from Switzerland, you got this!
Fingers crossed and a hug sent your way!
I’ll be thinking of you Thursday, Bobby.
They’re crossed, Bobby! *hugs*
All the best Bobby
This felt like a giant mug of warm mint tea. So soothing, poignant, and drinkable Xo
Trying to imagine facing devastating loss with an 8-month-old baby. What enormous strength. I have gone through a long season of grief followed by becoming a mom. The joy of motherhood and falling in love with my son is often complicated by milestones that bring grief. I wonder if Lucy would ever consider sharing how she worked through loss.
Doctors have beautiful ways of describing that tension between uncertainty and resolution. My favorite is the diagnostic odyssey (people with rare disease, my heart is with you!). Add me to the chorus hoping that Lucy will at least be a semi-regular contributor? I admire her generous and loving spirit in the face of Paul’s illness and think of it when I find myself struggling to give grace to others around me. Hope she and Cady are doing well.
Lucy, thank you for going into general medicine. You could’ve chosen a different focus, but gosh to have a gp, better yet good gp is getting harder in the US. Thank you for expressing your inner thoughts. Beautiful.
This reflection reminds me of God’s Hotel, one of those books that kinda changed my life. https://www.goodreads.com/en/book/show/13121912-god-s-hotel
Bawling, immediately. Lucy, your story is unforgettable. The way that both you and Paul encountered this thing we all fear, yet translated it into such beautiful and inspiring words, simply takes my breath away. Thank you.
I love this so much. What a gorgeous and true essay.
Lucy, I love hearing from you. I loved Paul’s memoir – it remains one of my top 10 books (and I read alot). Thank you for popping in here. I hope we hear more from you.
I loved this so much. Lucy, your afterward in When Breath Becomes Air has stayed with me for years – you are so gifted at conveying emotion through words. I love this tincture of time concept. I am pregnant after experiencing a loss. The waiting time between scans is so so scary for me right now. But maybe I can reframe that space between reassurances as the tincture of time… the baby needs that time to develop and grow. The waiting can be positive (I hope!). It’s so scary but this piece really resonated as someone on the waiting period before becoming a mom. Thank you.
I would love for Lucy to be a regular contributor – what beautiful words. And it’s lovely to hear from Lucy – we all care about her so deeply.
Lovely. Great advice for so many things in life.
Goodness this was just so beautiful – thank you for this Lucy.
I have never heard this perspective from a physician before, and I was a clinician at UCSF’s Osher Center for Integrative Medicine. What a beautiful thing it is. How good it is to hear your voice here, Lucy! It must be strange to have so many strangers know you. We care about you! I care about you. Thank you.
Lovely piece.
This is so beautiful. Amid the perils and pleasures of raising a tween daughter, I will remember this. Not everything is an emergency to be solved on the spot. Not all feelings are marching orders, with her, or anyone (self included). Last night she was angry with me (and vice versa). This morning she reaches up her arms, so long but still baby thin to pull me to her, saying “momma, my momma, my mommy, come here”. At this moment, it is all as it should be. Thank you Lucy, for these wise words.
Beautiful, beautiful wisdom. Thank you so much for this post
What an incredible piece of writing. As a sufferer from a sometimes-severe and always-present chronic condition that was just diagnosed after four years, and as a mother to four teens/pre-teens, this was incredibly comforting and hopeful and moving. Thank you.
This is beautiful. Thank you for sharing, Lucy.
Two sisters writers, that’s really something! Are there more writers in your family? How did it happen? I find it quite rare. Love from Paris
I read Paul’s book annually; I always walk away with a renewed sense of purpose and dedication to living a more meaningful life. Cady’s living in the shadow of his choices, and the choices he made were good and decent ones. What a wonderful legacy to leave behind!
I’m a big user of my local public library and so over the past decades I have rarely purchased books to keep. When Breath Becomes Air is one of the few that I own, not only for Paul Kalinithi’s wonderous writing, but also for Lucy’s epilogue that made me cry a thousand tears. Wishing all the best to this family that is so full of love. I hope we will hear more from Lucy in the years to come.
Kalanithi … sorry for the misspelling above.
lucy ❤️
This was beautiful. Thank you for letting us others into your life, in all its seasons.
I love that you call your daughter ‘the next great love of your life’. It seems very fitting.
I teared up at that part! and when she was hanging art in her house, I suggested she put a “we are so good together” letterpress print in her bedroom, but she said “I actually want it in the living room because it describes my daughter and me” sobbbbb
Paul’s book is one of a kind. I remember reading it when it came out and I recommend it quite often. Reading Lucy’s words make me so emotional. Making decisions on a daily basis is exhausting and doing so when it’s about people’s health is so brave and I admire that. Bravo Lucy, keep up the great work.
Beautiful.
Lucy, It’s so nice to hear from you and I can’t believe it’s been ten years since you lost Paul. His book and your epilogue impacted me greatly and today’s essay was beautiful. All the best to you and Cady.
How sweet to read an article by Lucy! Thank you!
thank you, Lucy! the way I weep for you, Cady, and Paul. So beautiful and profound. thank you for connecting us together