The Tincture of Time: A Memoir of (Medical) Uncertainty

by Elizabeth L. Silver

Set against the unexplained stroke of the author’s newborn daughter, this stunning, unflinchingly honest memoir is a thought-provoking reflection on uncertainty in medicine and in life.


Growing up as the daughter of a dedicated surgeon, Elizabeth L. Silver felt an unquestioned faith in medicine. When her six-week-old daughter, Abby, was rushed to the Neonatal Intensive Care Unit with sudden seizures, and scans revealed a serious brain bleed, her relationship to medicine began to change.

The Tincture of Time is Silver’s gorgeous and haunting chronicle of Abby’s first year. It’s a year of unending tests, doctors’ opinions, sleepless nights, promising signs and steps backward, and above all, The mysterious circumstances of Abby’s hospitalization attract dozens of specialists, none of whom can offer a conclusive answer about what went wrong or what the future holds. As Silver explores what it means to cope with uncertainty as a patient and parent and seeks peace in the reality that Abby’s injury may never be fully understood, she looks beyond her own story for comfort, probing literature and religion, examining the practice of medicine throughout history, and reporting the experiences of doctors, patients, and fellow caretakers. The result is a brilliant blend of personal narrative and cultural analysis, at once a poignant snapshot of a parent’s struggle and a wise meditation on the reality of uncertainty, in and out of medicine, and the hard-won truth that time is often its only cure.

Heart-wrenching, unflinchingly honest, and beautifully written, The Tincture of Time is a powerful story of parenthood, an astute examination of the boundaries of medicine, and an inspiring reminder of life’s precariousness.

Genres: Memoir, Nonfiction, Medical, Health, Audiobook, Medicine, Biography Memoir

272 pages, Hardcover

First published April 25, 2017

About the author

Elizabeth L. Silver is the author of The Majority (Riverhead), The Tincture of Time (Penguin Press), The Execution of Noa P. Singleton (Crown), and more. A graduate of the University of Pennsylvania, the University of East Anglia’s Creative Writing MA, and Temple University Beasley School of Law, Elizabeth has written for New York Magazine, Harper’s Bazaar, Ms. Magazine, The Guardian, The Washington Post, and McSweeney’s. She currently teaches creative writing with UCLA and is the founder and director of Onward Literary, a writing mentorship program. She lives in Los Angeles with her family.

Reviews

[Always Pouting · Rating 3 out of 5]

Elizabeth Silver writes a memoir about her experience when her infant daughter has an unexplained brain bleed and how she copes with the uncertainty afterward. Like a lot of memoirs the problem I had with this one is that I didn't really get much out of it. I know it's scary to have a child in the hospital but I thought that she would talk more about medical uncertainties and connect her experience to the larger picture, especially after I read the introduction. I don't think it was effective to write 100 pages about how afraid you were while making questionable allusions and connections to literature or popular philosophical theories. I think she would have been much more successful if she had spent the time talking about and focusing on what happens when medicine can't give us answers. I did enjoy the writing though, she writes well.

[Rebecca · Rating 3 out of 5]

At the age of six weeks, Silver’s daughter suffered a massive brain bleed for no reason that doctors could ever determine. Thanks to the brain’s plasticity, especially in infants, the bleed was reabsorbed and Abby has developed normally, although the worry never goes away. Silver, a former lawyer who worked on medical malpractice suits, is now a novelist – she had to cancel most of the promotion for The Execution of Noa P. Singleton while Abby was hospitalized.

Alongside the narrative of Abby’s baffling medical crisis, Silver tells of other health experiences in her family. Her father is a doctor and when she was ten he had to take her into the hospital with him when he was on call to perform an emergency appendectomy that turned out to be cancer instead. Her husband, Amir, a rheumatologist, had his own appendectomy and an arachnoid brain cyst.

It’s sometimes hard to see what role all this context plays, or why passages about the Heisenberg uncertainty principle, the Wild Boy of Aveyron, or various spiritual approaches to calamity are here – apart from to expand what I’m sure started off as a fine longform essay into book length (I feel like I’ve been saying this a lot lately). Ultimately, there’s not all that much you can do with the basic story line “it looked like everything would be horrible, but then it turned out okay.”

Still, this is an interesting exploration of the things we can’t control and how we get beyond notions of guilt and blame to accept that time may be the only healer.

Best line:

“And so we go, heart first into the global and uniformly accepted religion of anxiety that is part of the parenthood badge.”

[Jeanette · Rating 3 out of 5]

I read this book slowly. It took much longer than a book of this size usually takes me. And I read the second half on a long walk for the most part. Sunny day, beautiful flowers- this book neither of those things. In fact, I left it early about 3 times when more cheerful missives beckoned during the first parts.

But it's done. And it does hold a certain regard that I seldom see in medical non-fiction, so I will review it more than my entertainment went. Which was nearly nil. But it was quite real in the time and situations that having a sick child immerse you within to drowning levels. Because this is a story- not just about Abby the baby, but about her parents and especially her mother.

The parts of this book that relate how in the midst of crisis (brain bleed and seizures very grave) these parents were required to watch a video. (Oh God, am I sick of the do gooders and law makers putting themselves forever and ever within the "know better" positions. They DO NOT know better.) And how they were then put through daunting and lengthy inquisitions in two sectors (one is now a "specialty" for ferreting out child abuse). Intrusive and insulting in nature is saying it mildly- but "necessary" re the law and with the usual gentleness of social services. That's facetious, if you haven't guessed. Those who have been there, you have no idea how despicable these "sessions" can be- especially with extremely educated to the science fields parents, as happens here.

But other than those parts, every single issue, procedure, MRI, surgery, back watch, front possibles of prognosis etc. etc. are all Elizabeth L. Silver's emotion based. The Mother reaction. And she is learned. So great gobs of this (knowledge specifics AND the emotion) are linked (in high word count) to allusions for a literary figure or a Shakespeare plot or a "Wild Boy' reference of Psychology study. All very linked to the erudite and subjective "world wide" emotive nuance of the highly and long years educated?? Yes, that's not clear. It's very hard to describe as it went over my head on purpose more often than I usually allow for a book I finish. But either and any way you take it, it IS the nature of some of these parsing thoughts- as she waits with UNCERTAINTY. And it cores that UNCERTAINTY state but then it also placates it. It plainly diverted her mind? Regardless, the onus is that there are never any givens. The more simple would say "that's the way it is, we don't know". And while they (doctors)see horses, you may definitely be owning a zebra. And I have been there myself, so I had to finish the book to see the outcomes, despite not being in line with her wandering style or subject matter. Not only for Abby's outcome, but especially for Elizabeth's husband, Amir.

The last quarter of the book is more Elizabeth's relating of family history (again), philosophy of medicine (with which I somewhat agree) and more and more doctoring and using her phone to video Abby or take her picture. And guilt parsing/whining?

I would not recommend this book. Not even if I had a sick child, maybe especially not then. It is instructive. But there is too much of the too much. Trusting doctors to the extent that is so commonly held now- I will never "get" it. So I'm the wrong audience for this book on top of it.

The title means that "tincture of time" when there are no answers and you just "have to wait". She also includes memoir of her father's case and the suing craze for putting blame onto any issue of mischance or unfortunate consequence.

Honestly, I can clearly remember when nearly every condition that occurred was in that category medically. No one I knew ever had a second thought or any inkling to be suing some one else for our own bad luck or misfortune.

[Peebee · Rating 4 out of 5]

Elizabeth L. Silver came to my attention with her first book, The Education of Noa P. Singleton, which I found fascinating. I liked this book as well, but I do hope Silver will write more fiction. Her writing talent is undeniable, and I really enjoy the turns of phrase she employs. However, (and this is an occupational hazard for attorneys) I felt she overthought this story, and virtually every aspect of it, way too much.

I understand why -- there's both an intellectual need when you're trained to solve problems, and certainly an emotional need when it's your child and you're looking for answers that trained medical professionals cannot readily provide. If I were a mother, I might connect to this story a little more closely, but as it was, I think it should be edited down a little to make it less of a meandering story, with interludes about medical history, and focused even more on the concepts of "the tincture of time," -- what it's like to have to patiently wait for time to work its restorative properties, and uncertainty -- what it means to live with a situation where certainty is impossible. (I have a friend's wife in a similar situation, with a rare but deadly cancer in remission, and he has explained the agony of that uncertainty and its impact on their life.)

But it was a very good book, and if you like medical mysteries (a la House) or the impact of a sick child on a family, you will most likely appreciate this book, even if it's not "enjoyable."

NOTE: I received a review copy for free from NetGalley in exchange for an honest review.

[Chris · Rating 4 out of 5]

In a world of disease memoirs in which the protagonist either survives a known acute (e.g., MaryElizabeth Williams' "A Series of Catastrophes & Miracles") or chronic (e.g., memoirs of living with chronic illnesses such as type 1 diabetes) condition or doesn't (e.g., Paul Kalanithi's posthumously published "When Breath Becomes Air"), "The Tincture of Time" is a refreshingly ambiguous read. After her very young daughter suffers a serious brain bleed, Silver writes about her own experience of "acute uncertainty" during a "sub-acute period of waiting" for answers and prognoses. Would her daughter suffer short- or long-term repercussions? Only "the tincture of time" would tell--and time even beyond the span of the book. So, if you're looking for a strong narrative arc or "closure" to a story of illness (one way or the other), this is not the book for you. However, if you have found that "Scientific truth is powerful, but not all-powerful" (p. 236), it will resonate with you.

A couple other notes:
- I love her observation that, when it comes to looking up health info online, "Google needs a bouncer" (p. 223).
- I found it strange that of all the cultural allusions Silver drops, the only one they felt they had to footnote was Schroedinger's cat (p. 87).

[Amber Saunders · Rating 3 out of 5]

Closer to a 2.75.

The author does have potential as a writer, and I'd be open to reading novels by her in the future. She does manage to capture some of the pain of parenting generally, through the lens of her experience of a v sick infant. I do not want to take away from what I'm hoping was an incredibly cathartic experience for her - getting to author and publish this book about her harrowing time with her infant in an unknown medical space. I am glad she got to write this book. That said, with better editing, this could (and probably should) have been a long-form article.

I wouldn't recommend this unless someone needed something specifically in this genre and could relate to the author.

[Kristin Boldon · Rating 4 out of 5]

Silver's engrossing amd well written tale about her daughter's brain bleed is a memoir and a history of medicine, with its inherent uncertainty in the face of our overwhelming desire for complete answers.

[Maudaevee · Rating 4 out of 5]

Received ARC from GR giveaways...

Silver, did an excellent job placing you in her story, specially capturing the emotion of a parent going through medical uncertainty with a newborn. I was also very impressed with the technical and mythological details she added (I was uncertain how that would be when reading the description) but she managed to tie it all together beautifully!

[Cyndi Beane-Henry · Rating 5 out of 5]

In this brave, fierce, shattered, devastated tale of uncertainty, Silver takes us on a roller coaster ride! One moment up, the next down. One moment determined. the next full of uncertainty. But always with hope that there will be a tomorrow.

Silver will touch you like no other author ever has. You will find moments of smiling. And others where you will need tissues for the tears.

Silver touches us, in this unforgettable story of medical uncertainty. Her baby girl has a brain bleed. And what comes from that knowledge is enough to drive any mother over the edge.

Silver finds a way to rise above all of the pain and uncertainty. And she shares with you this very personal, very real story. An intimacy is there, like a best friend.

You won't be the same after reading this.

Just try to read it over several days. You can't. you will sit down with it, and you won't stop turning the pages until you are done. Because, like a good friend, you will be there to the very end. Your heart breaking. Your eyes tearing. Your emotions taxed.

I give this five stars,




a big thumbs up,




and I highly recommend it.

[Janday · Rating 3 out of 5]

Medicine is like faith, "a collection of interpretations...rife with conflict." Doctors interpret data and apply those interpretations to wholly unique circumstances. In this way medicine is an applied science, of a sort. Elizabeth L. Silver, with precision of language and fullness of thought, chronicles the years she spent inhabiting the uncertain spaces between treatment and trust in this open memoir that tears a heart in two, then mends it to the beating hearts of humanity.

[Katherine Lewis · Rating 5 out of 5]

This remarkable memoir about the author's sick baby is thought-provoking, inspiring and not a bit maudlin. The Tincture of Time is more about language, philosophy and how we live, I think, than a hospital drama.

I've picked up so many books about premature or sick children and they're often so difficult to read -- just too sad. This one I recommend 100%.

[Laurie · Rating 4 out of 5]

A ‘tincture of time’ is what is necessary for many, if not most, ailments to resolve one way or another. You give a patient antibiotics, and wait to for them to act. You cut a person open, and wait for them to knit back together. Or you wait, and the patient dies. Some ailments take longer to resolve than others. When Elizabeth Silver’s six week old daughter Abby starts having seizures, despite hundreds of ultrasounds, MRIs, and blood panels, in the end only time gives them an answer as to what will happen- a lot of time. Years.

While the book is based around little Abby’s medical problems, it’s about a lot more than that. It includes the history of how fever has been interpreted and treated since the ancient Greeks, Silver’s husband’s scare of an arachnoid cyst (a thing in his brain that’s harmless but looks terrible on a scan), how her sister-in-law organized 40 women to bake challah and chant prayers to have Abby cured, and much more. It’s also about how Silver is surrounded by doctors (her father, her sister, her husband) and so is right at home with medical stuff- her father, lacking a baby sitter one day when called in to do an emergency appendectomy, took 10 year old Silver to the hospital with him and then, since the nurses couldn’t provide child care, scrubbed her up and took her into the operating room with him- and how her faith in medical science is eroded by its inability to do something to help her daughter. It’s about how three different social workers came in and questioned them mercilessly as to whether one of them had abused, hit, or dropped Abby. It’s about how the fear that a medical problem- especially one that no one ever found out the reason for, and that had no ‘cure’ other than time- never really goes away. She likens, for a while, the mystery and the waiting of Abby’s disease to the disappearance of the Malaysian jet liner that had just vanished over the ocean; she feels like one of the loved ones, waiting on the ground for news, any news.

It’s an interesting story, but I felt the author wandered too much. I think perhaps the author was doing it to show how her mind wandered during the endless waiting, but it doesn’t help the narrative. The bit about fever was, perhaps, useful in the section when Abby runs a fever. The bit about the Wild Boy of Avignon less so, as is stuff about Shakespeare and quantum physics. The Malaysian jetliner is a great metaphor. I know the book originally started as an essay and an editor talked the author into expanding it into a book; I think perhaps it should have stayed a long essay. Four stars out of five.

[BOOKLOVER EB · Rating 4 out of 5]

Elizabeth Silver and her husband, Amir, were alarmed when their six-week old daughter, Abby, started vomiting and seizing. They took her to Children's Hospital in Los Angeles, and at first, the tests came back negative. However, a scan eventually revealed that Abby had bleeding in her brain. Silver describes her panic, guilt (although she had done nothing wrong), and fear that her baby's ability to function would be compromised. In addition, she and Amir endured a lengthy interrogation about whether they had hit, dropped, or shaken their infant.

"The Tincture of Time" is "an amalgamation of how [Silver] coped with Abby's hospitalization and rehabilitation." She emphasizes how difficult it is to wait for information—"the answers were comforting, available, and effortlessly clear, until they were not." She received insensitive, albeit, well-meaning advice, and stood by, exhausted and wrung out, while her precious child was prodded and probed in the Newborn and Infant Critical Care Unit.

Although this is an affecting and poignant memoir, it requires quite a bit of patience, since the author goes off on a number of tangents that are loosely tied to her central themes. She writes about the Malaysia Airlines disaster; unreliability of eyewitness testimony; the groundbreaking ideas of such luminaries as Hippocrates, Heisenberg, and Montessori; and whether medicine is an art, science, or both. Furthermore, she touches on her childhood; work as a lawyer and novelist; questions of faith and religion; and how she and Amir stayed sane while they were sick with worry. Mothers and fathers who undergo similar ordeals will appreciate Elizabeth Silver's perceptive observations. She expresses—using lyrical prose and literary references--the agony of distraught parents whose children struggle with serious illnesses and face an uncertain future.

[Blue North · Rating 5 out of 5]

I immediately felt drawn into "The Tincture of Time" by Elizabeth L. Silver. Abby's Brain bleed is very serious. None of the doctors seem to know why it has happened. There are months and months of MRI's and other tests. While caring for her baby, Elizabeth L. Silver's mind traveled many different ways. Nothing seemed to escape this mother's mind.

In the Memoir, her thoughts travel from Faith thoughts to philosophical ones. She begins with this "tincture of time." Then, travels over to Macbeth and Hippocrates. Although some of her thoughts are above my head, they were still beautiful in writing. There is also Medical Art. Never having heard of Bioart I lost myself in the photos on the Internet.

Since the author is a lawyer, there is much to learn about malpractice. By forty years old, many doctors will have experienced one suing for malpractice. Elizabeth L. Silver's father, a doctor, suffered his share of traumatizing moments while practicing in the field. What a surprise to learn about the father of Abby's brain tumor.

What isn't in this memoir? Almost everything you can name in the human experience including Elizabeth L. Silver's Jewish experience. Along the way, there is the suspense of learning about Abby's growth development. By the way, "(Medical) Uncertainty" does exist. Still, there is grace and dignity shown by those involved with this little life.

[William Schram · Rating 4 out of 5]

Nothing is more terrible and horrifying to a parent than having something wrong with their child. In The Tincture of Time Elizabeth L Silver writes on such an experience with her first daughter, Abby. When Abby was six weeks old, she had bleeding in her brain. This event led to months of uncertainty. Doctors' visits and hospitalizations were rampant. Every little thing she did was scrutinized.

This is also a memoir on Silver’s Relationship with medicine itself. Since she grew up as the daughter of a surgeon, she had unquestioned faith in medicine to answer any question or problem thrown at it. In this case, her faith in medicine was shaken to the core. She would Google symptoms that Abby displayed, grasping for answers.

As is shown by the title, sometimes the only cure for your problems is in the form of time. Eventually, Abby was perfectly fine. Thanks to the power of her youthful brain, she was able to recover beautifully and now her neurologists can’t even tell that she ever had a problem.

The idea of lawsuits did come up, but Silver explores this train of thought, realizing that this is just another attempt to grasp for answers. Pointing blame is soothing when something happens without explanation.

This book is beautiful and poignant. It brings up a number of things to think about.

[Abby · Rating 4 out of 5]

I was lucky enough to receive this book from the publisher due to my interest in a similar book a year ago. I am so grateful to have had the chance to read this beautifully written book. The author writes in clean prose, a style I prefer. She shares the experience of her baby daughter's medical emergency and subsequent hospitalization (I don't want to reveal a lot about this) and explores the broader issue of medical uncertainty, touching on the concept of uncertainty in life. As the mother of a daughter with a genetic, life-threatening chronic disease, I related to much of this book and thought she captured so well the experience of being in a hospital, looking for answers, coping with fears about the immediate future and long-term future, and more. There was also a scene later in the book that took place in San Francisco that I identified with and cried along with, having experienced something similar in my own life. This book is not just for parents who have faced similar situations. It is a wonderful read for any fan of memoir.

[Smoochdog D. · Rating 2 out of 5]

I admire Silver for sharing such a personal piece of her life. I just didn't feel connected to the story at all. The emotional strings that I like to see in a memoir, the feelings that pull me into the story were not there for me. Perhaps it was the interweaving of everything else that left me feeling detached. While I could understand much of what she wrote I didn't feel it. I felt she was writing more from a medical respective than a parental one. Stoic almost. As someone who went through treatment and survived childhood cancer I know what my parents went through. Did she and her husband ever fight? Feel so exhausted they couldn't stand? Feel so helpless she crumbled? I'm glad the outcome was a good one for her daughter and her family, my rating matters not in comparison to that.

[Kerri · Rating 3 out of 5]

Overall, I liked this memoir. To readers expecting "tragedy porn," I say to you: this is not it. It's more of an introspective journey that a parent takes when facing an unknown threat to their child. When Silver's daughter, Abby, develops a brain bleed at 6 weeks old, the hunt for a cause begins. Unfortunately, one is never found.

What follows is the inner workings of Silver's mind during Abby's hospitalization and recovery, and beyond - to when Abby is seemingly healthy but she can't stop waiting for the other shoe to drop. Guilt, anger, grief, fear, she runs the gamut. As a parent myself, I find this incredibly relatable. As a reader, I can see how many could find this meandering at times and slow.

I received a free ARC of this book in a Goodreads Giveaway.

[Linda Donohue · Rating 4 out of 5]

I received this book as a Goodreads Giveaway.

The book was more than the experience of an infant’s medical happening and the parent’s experience through the the diagnosis, treatment and hospitalization. The most harrowing of the experience is not having a definitive diagnosis and unpredictable future. Throughout the book the author side tracks to some history of medicine, her family’s past and her legal career. I was more interested in the child’s diagnosis and treatment rather than being distracted by superfluous information. I am pleased that the child healed and developed normally.

[Elizabeth Wiley · Rating 4 out of 5]

I'm very torn between four stars and five stars. I think the five star would be because of the interaction with my own experience and so I'm debating if that or the four-star without that reflection is more appropriate. The author does a great job of weaving in so many different disciplines and ideas to really be kind of a Renaissance woman in her writing. She is commenting on one specific event, but she takes this and provides larger and more universal commentary on the human experience.

[J.R. Alcyone · Rating 3 out of 5]

3.25 stars. Despite the (relatively) low rating, I would definitely read another book by the author. Her prose is excellent; I just couldn't quite connect with the story the way I usually do with a memoir because of the way the story wandered so much. There were just too many digressions. Nevertheless, the author is definitely a good writer.

[B Ware · Rating 3 out of 5]

Interprets true account of a couple's experience with their newborn's health problems. I was interested in the account of their experiences but got a little lost and tired of the lengthy medical or scientific sections.

[Lisa Clarke · Rating 1 out of 5]

Way too much garbage thrown in. It’s marketed as a memoir of your kid, not your opinion on medicine and cases that have nothing to do with you. You’re not a medical professional, your opinion holds no weight on these doctors.

[Emma Townshend · Rating 3 out of 5]

Really enjoyed this but felt there were strong structural issues and that the book was never quite allowed to develop or let fly or something.

[Mary Ellen · Rating 5 out of 5]

Heartfelt exploration of the pain of not knowing. I identified with this book from my own experience when my children were in the NICU.

[Anna Hawes · Rating 4 out of 5]

This was a quick read and very relatable to me, as a mother. I thought she did well incorporating larger issues of medicine and uncertainty into her personal experience.

[Siobhan Harrop-McDiarmid · Rating 3 out of 5]

Thoughtful exploration of how guilt, faith and reason play out when her infant daughter was in the hospital. Relevant for those facing chronic illness as well.

[Robyn Martin · Rating 5 out of 5]

Audible

[Karen DeBonis · Rating 5 out of 5]

A spell-binding read, a heart-stopping story. "The tincture of time" is medicalese for "wait and see," a torturous thing for new parents, or any parent, to endure.

[Rachel · Rating 3 out of 5]

My favorite part of this book was the first 10 pages, and then it just went downhill from there for me. Silver is clearly well-educated and potentially very smart, but these attributes unfortunately came across in her writing as the never ending references to classical literature and history. Eventually, each of these references makes sense and helps, or at least attempts to help, her express how she was feeling or what was happening while her daughter was sick. Perhaps her writing actually reflects how she thinks on a day to day basis, but most of it felt contrived. I only kept reading because I wanted to find out what happened to her daughter and because I liked the little bits when she talked about her daughter's medical care or what was happening to her and her husband, but overall is was not a great read.