The anguish of waiting

When the future kidnaps the present

"Doctor, I can't sleep. I spend my nights imagining all the possible scenarios. What if my baby has the gene? What if I have to make that decision? I can't stop thinking about it."

This was the call I received a few weeks ago. On the other end, one of my patients was pregnant with her second child. Her firstborn, "A," a vibrant two-year-old boy, had been diagnosed with childhood cancer. Now, in the midst of pregnancy, geneticists had presented her with a possibility she had never considered: her child could be a carrier of the TP53 gene, a gene associated with the development of certain types of cancer. And, in theory, that gene could be studied in the fetus.

The medical proposal was technically feasible: if "A" had the gene, they could look for its presence in the baby she was carrying. If the fetus carried it, she could decide to terminate the pregnancy.

But this "option" was not a solution. It was a door that opened onto an abyss of anguish.

The weight of possibilitie

In today's medicine, diagnostic capacity has advanced at a dizzying speed. We can detect, predict, and analyze. But this technical capacity is not always accompanied by emotional tools to manage what we discover.

The South Korean philosopher (raised in Germany) Byung-Chul Han talks in his work about how we live in a "society of fatigue," exhausted by an excess of possibilities. And that is precisely what modern predictive medicine generates: an excess of information, an excess of options, an excess of possible futures that colonize our present.

My patient wasn't living her pregnancy. She was living twenty simultaneous pregnancies in her head: the pregnancy where her child had the gene, the pregnancy where he didn't, the pregnancy where she terminated, the pregnancy where she continued, the pregnancy where she regretted every decision she made.

The future had completely invaded her present.

The consultation: return to the now

When we sat down for a consultation, I didn't take any genetic reports. We didn't talk about statistical probabilities. We didn't discuss protocols

I asked her, "What do you know right now, at this moment?

Silence. Tears. And then, a clear answer:

"That I'm pregnant. That A is fine now. That I haven't had any results yet."

"Exactly. That's the only thing that's real right now. Everything else is stories your mind is constructing about a future that doesn't yet exist."

I explained something fundamental to her: anxiety doesn't live in the present, it lives in an imagined future.

When we project our consciousness onto future scenarios—especially the most painful ones—the brain reacts as if those scenarios were already happening. The body secretes cortisol, the heart races, sleep disappears. We experience the pain of something that hasn't happened and may never happen.

Philosophy of presence: Byung-Chul Han and narrative time

Byung-Chul Han analyzes how modernity has robbed us of our ability to inhabit the present. We live in a state of perpetual anticipation, always projected toward the next moment, the next piece of news, the next result.

This acceleration of time has a brutal cost: the loss of lived experience.

In his book "The Scent of Time," Han explains that we have lost the ability to linger in the present. Everything is speed, information, data. But life—real life, the one we live and feel—only happens now.

My patient was trapped in what Han calls "the time of dispersion": fragmented between multiple possible futures, unable to find rest in any of them, exhausted by the impossibility of choosing a path when there were no real paths to choose yet.

I proposed a radical exercise: to inhabit the present until there was something concrete to decide.

—When we have the result of "A," then we will think about the next step. But until that moment, your only task is to be pregnant. To feel your baby. Take care of yourself. Be with "A." Live what's real now.

—But what if...?

—There are no "what ifs." Not yet. Now there's only "is." And what "is" is that you're pregnant, "A" is fine, and we haven't gotten any results.

The result: when the present is right

Three days ago, I received the email that opens this post.

The results had arrived: "A" doesn't have the TP53 gene. There's no inheritable genetic risk. There are no impossible decisions to make. No interruptions to consider.

All that anticipated suffering—those sleepless nights, that anguish that gripped her chest—had been for a future that never existed.

But the most important thing isn't that the result was favorable. The most important thing is what my patient wrote to me in her email.

"I listened to you and took sick leave to take care of myself and the life I'm creating and to be more connected. I'm so grateful for your time the other day in the office and for sharing those words with me, helping me see that life is about living in the present and trying to be well."

She learned something that will stay with her beyond this pregnancy, beyond this outcome: that we can only live in the moment we have.

Medicine and presence: the role of the doctor

As physicians, we have a responsibility that goes beyond providing technical information. We have a responsibility to navigate uncertainty.

We can't eliminate it—uncertainty is inherent to medicine and life—but we can help our patients avoid being overwhelmed by it.

This means:

1. Don't give information prematurely
   Not everything that's technically possible should be considered immediately. Sometimes, offering too many options too soon only creates anticipatory anxiety.
2. Validate Anxiety Without Fueling It
   "It's completely normal to feel fear. But that fear speaks to possible futures, not your present reality."
3. Help distinguish between present and projection
   "What is real now? What is only a future possibility?"
4. Offer concrete steps
   Not "wait and see," but "now we're going to do X, and when we have the result of X, we'll decide Y."
5. Accompanying without resolving
   We can't eliminate the patient's uncertainty. But we can walk alongside them as they navigate it.

The paradox of modern medicine

We live in an era of predictive, genetic, personalized medicine. We can anticipate risks, calculate probabilities, design scenarios.

But with each advance in our ability to predict the future, the psychological burden of living with those predictions also grows.

The paradox is this: the more information we have about what could happen, the more difficult it becomes to live with what is happening.

Therefore, recovering the philosophy of the present is not a spiritual luxury. It is a clinical necessity. It is mental health. It is emotional survival.

Conclusion: The gift of the present

My patient thanked me for my words during that consultation. But the truth is, the learning was mutual.

It reminded me that, as physicians, our job isn't just to diagnose and treat. It's also to bring our patients back to the present when the future threatens to devour them.

Life only happens now. Results will come when they need to. Decisions will be made when they need to be made. But in the meantime, all we have—all we are—is this moment.

And sometimes, amidst the noise, fear, and uncertainty, the most revolutionary thing we can do is simply be here. Breathe. Feel. Live. Now.

Bibliography

About the TP53 gene and hereditary cancer syndromes:

• Malkin D, et al. Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms. Science. 1990;250(4985):1233-1238.
• Bougeard G, et al. Revisiting Li-Fraumeni Syndrome From TP53 Mutation Carriers. J Clin Oncol. 2015;33(21):2345-2352.

On predictive medicine and psychological aspects:

• Tercyak KP, et al. Psychological issues among children of hereditary breast cancer gene (BRCA1/2) testing participants. Psychooncology. 2001;10(4):336-346.
• Shiloh S, et al. Cognitive and emotional representations of genetic testing: the patients' perspective. Br J Health Psychol. 2012;17(3):485-499.

On uncertainty in medicine:

• Han PKJ, et al. Varieties of Uncertainty in Health Care: A Conceptual Taxonomy. Med Decis Making. 2011;31(6):828-838.

Philosophy of the present:

• Han, Byung-Chul. El aroma del tiempo. Herder, 2015.
• Han, Byung-Chul. La sociedad del cansancio. Herder, 2012.