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Medicine, the Novel, and the Passage of Time

Rita Charon, MD, PhD
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From College of Physicians & Surgeons of Columbia University, New York, New York.

Acknowledgments: The author acknowledges the contributions to her practice and of the two patients described herein, who have granted her permission to publish descriptions of their lives.

Requests for Reprints: Rita Charon, MD, PhD, Program in Humanities and Medicine, College of Physicians & Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Ann Intern Med. 2000;132(1):63-68. doi:10.7326/0003-4819-132-1-200001040-00011
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The care of the sick unfolds in the face of time. Medical practice abides by time's irrevocable forces—the entropy of disease, the dictates of aging, and the obligate end of life in death. We doctors do our best to slow time down or speed it up, outdo it in power, fool it with interventions. Not grandiose enough to believe we can actually alter the passage of time, we try to lessen its corporeal effects. We grin with delight as we outflank short kids' long bones' growth plates with a little exogenous growth hormone; we restore circadian rhythms to our sleep-disordered patients; we think we commute the premature neonate's sentence. By learning about such processes as apoptosis and senescence, we may soon postpone dementia, retard aging, and extend lives of vigor and health. In our more realistic modes, we might admit that, at best, we manage time or handle it, charting time's consequences on individual bodies and individual lives. We do what we can in the face of time and death to improve lives, reduce pain, and gain some wisdom ourselves about the meanings of both those passages.

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