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Editor's Comments on 'Giving Time'

 , October 02, 2015

Time is a precious commodity in the life of a first-year doctor. Every intern knows — perhaps far too well — the experience of waking up too late to grab breakfast, rushing off to work, running around hospitals and clinics finishing seemingly endless lists of to-dos, documenting and entering orders, and documenting more, until suddenly, the day has all but flown by. With little time left for loved ones, hobbies, and personal rest, there are no shortage of ways in which these pressures affect an intern’s life.

What’s perhaps less obvious, however, is that this frustration can arise as much out of loss of agency as it does out of lost time. It’s well documented that, even with time to spare, the inability to dictate one’s own schedule can create internal frustration for many people. The opposite also appears to be true: that a little control over one’s schedule — e.g. the ability to decide to attend yoga class one night, choose to take a long phone call from relatives, or pick where and when to eat out with friends — can make all the difference even amidst a grueling schedule. 

This is the intersection where we meet Sara Pozniak in her narrative piece, “Giving Time.” In it, Pozniak offers us a window into her struggle with time, and more specifically her pursuit of more of it. Her descriptive account will likely resonate with readers, who may easily empathize with her time struggles. 

To me, what is far more compelling is how Wozniak’s understanding about time, and her decision to take her patient up to the terrace for time away from the hospital ward, evolves in the piece. It’s clear that she continues to wrestle with the practical implications of her decision (what will she do about dinner? will she remember to buy her mother’s birthday present?) throughout the terrace encounter. However, she also recognizes the value of going out of her way to do this for the patient. 

This is an important realization because fundamentally, her decision to stay and spend time with her patient is about far more than lost time or the physical act of pushing a disabled man through the hospital. It is on some level a representation of our profession’s oldest rituals. In its inescapable simplicity — conceptualizing patients as people instead of as the collection of their maladies, going out of one’s way to put patient interests first — it echoes our profession’s deepest moral ideals. Pozniak is right in concluding that she has gained more than she has given. 

Ultimately, behind this narrative lies two enduring lessons for medical trainees and young physicians. The first centers on the need to look for opportunities for agency, and to remember that our ability to choose at all is itself something worth cherishing. Pozniak could have easily given into instincts or habits around time management. Instead, she fought urges to leave and made a deliberate choice around patient care. Conscious or not, that choice — and the agency it required — almost certainly played at least some role in her appreciation of the encounter. 

The second lesson highlighted by “Giving Time” was put beautifully by David Watts in an essay published a number of years ago in the New England Journal of Medicine. In it, Watts encourages his fellow clinicians by declaring that “we are not destroyed when patients suffer . . . but rather deepened, becoming better able to open ourselves to the complex lives of the distressed and infirm the next time around.” There is heady advice here for young physicians, namely that the empathy we all strive for is best exercised by entering into the uncertainty of our patients’ illness, confident we will emerge from it better, not broken.

Time is a precious commodity for first-year doctors, and every intern knows well the longing for more of it. While the experience of choosing to lean into others’ suffering, and emerging better and more committed to our profession, is far rarer, it’s one that every intern — present and past — would be lucky to experience, read about, and remember. 

Joshua M. Liao, MD