Excerpt: THE TINCTURE OF TIME by Elizabeth L. Silver

  1. I was ten years old when I watched my first surgery.

It was an emergency appendectomy that turned out to be cancer of the appendix, and in hindsight, the procedure has grown to become an indelible marking of my childhood. A turning point, an experience earned like a divot on the wooden panel of my youth, watching a live operation was like growing an extra inch and marking it with a fat line. I think back to that night when, as a child, I watched another person befall the scalpel and willingly allow the body to unbolt. My adult eyes reimagine organs, multicolored and sealed with a mucous lining of blood, cleared for the taking, for rearranging, for tinkering; but at the time, it was probably just various shades of red.

My father and I were at home alone. It was 1989 and summer in New Orleans. Expats in the Bayou town, my family tasted the fried sweetness of beignets whenever guests visited, and shouted, “Throw me something, mister,” a Mardi Gras catchphrase, as frequently as “Are we there yet?” on one of our long car drives out of New Orleans to visit family in New York or California. The weather was humid, and thick, moist air traveled heavy into our daily lives, making it difficult to do just about anything. New Orleans was built below sea level, though I didn’t understand what that meant until I moved away at thirteen and learned that people in other places were ordinarily buried below ground. Exquisite aboveground tombs were the norm, jambalaya was on every menu, and Mardi Gras was a week off from school. New Orleans, a rare tourist haven for Americans to visit and feel as though they’d traveled abroad, was our hometown of narrative excess. Jazz, crime, historic architecture, culinary delight, and my family all mingled together.

For half of my childhood, our little family unit lived in Louisiana without a strong connection to the area, aside from the medical position that brought my father there. My parents had left their own parents, siblings, and friends behind in Los Angeles, where they had met and married. In New Orleans, we lived in a suburb on the West Bank of the Mississippi River in Algiers Parish. My father (an infant Holocaust survivor who was raised in Poland, Germany, and Baltimore) and my mother (born and raised in Brooklyn until she transplanted to Los Angeles with her family in the 1960s) settled in the Bayou suburbs to raise their three young children. Pregnant in the late 1970s with me, her third, my then urban-centric mother chose to drive an extra thirty minutes to give birth at a hospital inside the city limits purely so that the words “New Orleans” and not an unknown suburb would be written on my birth certificate. New Orleans, despite its welcome streets and pleasant reputation, was not my parents’ home, either. So without family to help, when the emergency call for an appendectomy came in the middle of the night, my father had no choice but to bring me with him.

He was in his surgical prime, the treasured midforties, and had been paged to the hospital for a routine operation. I don’t remember where I was sleeping or what I was wearing, but I do recall my father waking me up in the middle of the night telling me we had to go. Now.

“It’s just an appendectomy,” he said as I rubbed my tired eyes. “Shouldn’t take longer than half an hour.”

I nodded. My older sister was away at camp, and my mother was driving my older brother through a pop-up map of small towns in the South for sport competitions. My father was on call as a general surgeon. HIPPA, the Health Insurance Portability and Accountability Act, would not yet be enacted for another seven years, and anonymity in medicine was as present as, well, child voyeurs in operating rooms. At the time, no one seemed particularly concerned about his taking me inside. In fact, my father told me years later that he had wanted me to observe so that I could share the experience with him. He did the same for my sister, who eventually became a doctor herself.

Because it was late in the evening, there wasn’t anyone to sit with me in a waiting room, so the nurses scrubbed me in, fussing over me with juvenile exhilaration as people fuss over dolls. I was small, freckled, and brunette, a bit chubby around the knees, and dressed in oversized blue scrubs marked with an xs and stamped with the name of the hospital on the top and bottom. Mammoth sinks, great canyons of sterling silver, lined the walls. Someone scooped me up and leaned me over a sink to help me wash my hands. I remember learning the word “sterilization” that night.

My father stepped on a pedal beneath the sinks, and water appeared as if out of a fountain. A nurse then picked up two rubber gloves and opened them wide, directing my father’s small hands to slip into the powdery rubber, covering not only his hands but also the sleeves of his surgical gown, so that no skin was exposed. He was ready. He motioned to a nurse, who pulled down his surgical mask so I could see his face. By his expression, his silent words, I knew to pay attention.

“Stand right here,” someone told me once we’d entered the operating room, and I did, as if I had been put in a time-out and forced to stand in one place for hours as punishment. In reality, though, it was the opposite in every way that matters. I said nothing while I watched life transform from several feet away. I wasn’t observing from above in a surgical theater, nor was I a terrified loved one on the other side of the solid door. I was standing in the corner, shivering from the air-conditioning and trying to count the goosebumps as they rose from my skin. I was standing in the corner, smelling the iodine and alcohol-cleansed instruments. I was standing in the corner, on the inside.

Time has a way of stretching details to fit our present needs, but there are particulars that have remained as powerful today as they were twenty-five years ago. First, the stark color contrasts that accompanied the initial incision. The patient’s abdomen (though I can’t remember if it belonged to a man or a woman) was pale white against the iodine: a thick yellow was brushed over the skin to prevent infection, and the patient’s body no longer seemed human, but rather like a workbench.

Words were exchanged, and then almost out of nowhere, a line of dark crimson appeared. Centimeters, maybe; a foot long perhaps—I can’t recall. This was before laparoscopy and the preservation of bikini lines, so surgeons were able to cut wherever best for the surgery itself. I don’t even remember seeing the scalpel cut into flesh when the dark line appeared. The patient (was it a man or a woman?) was lying behind a curtain of blue paper, asleep, with her (or his?) belly intact, until the blood appeared. It’s this palette that I haven’t forgotten. Creamy white, bright yellow, and then the dark line of red. A sort of medical color primer for beginners.

My father and the others were talking, I know. I heard them, but I don’t recall a single word. I was fixated, trying to watch, hoping to see what I could from my little corner on the inside.

Once the incision was made, hands (presumably my father’s) opened the body and flipped the skin to the sides, like pages of a book. Years later, I realized that what I saw beneath the skin that day was an exceptional story, perhaps the most exceptional of my life. A profound origin parable for all. Inside this body—all bodies—was a basket of objects making life.

The second memory homes in on a dissonant sense of sound. Dark blood continued to fill the open body, making it difficult for the surgeons to navigate the organs and even more difficult to remove what wasn’t working. A nurse following my father’s orders used a long plastic tube to remove excess blood so that he could more clearly see the internal organs. Like the suctioning of saliva at the dentist, the suck-suck-suck of internal fluids traveling from a body to a bag through this plumbing device was all I could hear for the rest of the operation. It was the only part of the three-hour surgery that left me queasy.

After that, everything in my memory goes blank. A fast-forwarding of life, blackened by dim lights and dark colors. Twenty-five years later, my father and I both remember that evening with fondness. I suspect this shared moment of intimacy had as much impact on him as it did on me, because no matter how or when it comes up, his response is always the same:

“Lizzy, remember that time you came and watched me do surgery? It was supposed to be a little appendectomy, thirty minutes at most, and it turned out to be cancer of the appendix! You saw a good one.”

“I do!” I exclaim each time it comes up, which is more frequently than may seem healthy. We both get equally excited, particularly because the patient’s cancer was discovered and removed so early.

At ten, I had been reading Anne of Green Gables, learning fractions and decimals, and wanting to have sleepovers with my friends. Admittedly, I had been privileged. I’d seen little of violence or trauma in my young life, yet the crisp redness of blood hardly bothered me. In many ways, perhaps, it even fueled me to understand where it came from, what it did.

To some, this excess thrill may sound callous. To others, the joy surgeons take in a successful and life-affirming choice of work is obvious. They view a problem and are trained to go in and fix it, just like a repairman, which is why they are often nicknamed the mechanics of the medical world. Our excitement stemmed from my father’s having facilitated a clear solution to someone’s health problems. Removing that emotional bond empowers and enables these trained technicians to perform their highly skilled jobs effectively. So each time my father’s face lit with enthusiasm remembering the appendectomy, he was reliving that sense of challenge and accomplishment. At ten, this made perfect sense to me. When there is a problem, cut it out and allow the body to heal.

That evening spent with my father quickly became the guiding thread of my own medical story: that of a person who refused to find fear in an operating room or hospital, who trusted medicine and those who practice it faithfully, who believed an answer existed where a doctorate resided, who silently judged those who questioned the clarity of science, who refused to worry about the answers, because they would come. They always did. Certainty in medicine, like the New York subway system, always seemed to arrive, even if occasionally a few minutes late. The answers were comforting, available, and effortlessly clear, until they were not.

From THE TINCTURE OF TIME by Elizabeth L. Silver. Reprinted by arrangement with Penguin Press, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © Elizabeth L. Silver, 2017.


READ about THE TINCTURE OF TIME in our inspiring Q&A with Elizabeth L. Silver here.


HEAR Elizabeth L. Silver (THE TINCTURE OF TIME) read at our final salon of the summer, featuring Julia Fierro (THE GYPSY MOTH SUMMER) in reading and conversation with Anthony Breznican (BRUTAL YOUTH), plus guest readers, including 2017 PEN Center USA Emerging Voices Fellow Peter H.Z. Hsu, THIS SUNDAY, July 30, 4-6 p.m. at Clifton’s in downtown Los Angeles. SEE YOU THERE! RSVP!


Elizabeth L. Silver

Elizabeth L. Silver is the author of the memoir, THE TINCTURE OF TIME: A Memoir of (Medical) Uncertainty (Penguin Press, 2017) and the critically acclaimed novel, THE EXECUTION OF NOA P. SINGLETON (Crown, 2013), which was the Amazon Best Debut of the Month, an Amazon Best Book of the Year, Kirkus Best Book of the Summer and published in seven languages. Elizabeth has been featured by PBS and NPR and her writing has appeared in McSweeney’s, Lenny Letter, New York Magazine and The Washington Post, among others. Elizabeth lives with her family in Los Angeles.