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Medical Humanities

Giving Time

Sarah Pozniak

October 2, 2015

As an internal medicine intern on the wards, I often felt like I did not have enough time.  Too tired to get out of bed before the last minute, I didn’t have time to eat breakfast before I left the house.  When pre-rounding, I felt like I was rushing in and out of rooms with only five to ten minutes to spend with each of my patients.  During rounds the team fought a daily battle to be thorough, but efficient.  With progress notes to write, consults to call and patients to discharge, I felt like I did not have time to stop for lunch, noon conference or – sometimes – even a bathroom break.  In the evening, I typically had two or three free hours for some combination of eating, exercising, reading and socializing before going to bed.  I rarely felt like I was able to sleep enough to recover from the previous 16 to 18 hours. 

Time was always tapping me on the shoulder, reminding me that I was supposed to be somewhere else.  If I was talking with a patient, I was late to conference.  If I was awake, I should have been asleep two hours ago.  I would try to brush it off, but there was a continuous pull where the subsequent engagement was always the priority.  Intermittently, the monotonous shrill of my pager seemed to reaffirm my suspicion that I was not going to win.  I learned to find power and solace in surrender.  I learned that there were times when I had to let go of my urge to control the minutiae of my day.  This urge to maintain control almost felt pathological, as if without it, I would fail to do my job.  In surrendering control, I opened myself to chance interactions that proved my fear of encountering failure to be unsubstantiated. 

On my morning pre-rounds, I worked steadily in order to see all of my patients within a certain period of time.  I moved quickly between rooms, rarely stopping for extended conversations. One morning, my routine brought me to the room of a middle-aged man who had been admitted to receive intravenous antibiotics for osteomyelitis.  Many years prior, he had undergone bilateral, below-the-knee amputations.  He had limited resources to adequately care for himself at home and had developed an ulcer over his sacrum that had progressively worsened.  He was dependent on a colostomy and an indwelling Foley catheter.  

When I reached his room, I felt a stillness spreading over him like a shroud of gray clouds.  A heavy calmness hung over me as I stood next to his bed, creating a strong contrast to my usual sensation of passing time.  After a few days of visiting him on pre-rounds, I noticed that he never had any visitors.   

One afternoon, I was returning to the floor after seeing a new admission in the ED when I saw him, wheelchair-bound, sitting in the hallway.  I stopped to say hello.  He mentioned how he wished there was an area outside where he could sit.  I asked if he knew about the rooftop terrace that crowned the top floor of the children’s hospital.  He smiled, and I knew I had piqued his interest.  It was nearing the end of my work-day; my mind was heavy thinking about what I had left to finish.  I could feel the remainder of my to-do list spilling over into the few free hours I had at home.

I wouldn’t be able to exercise after work.  I wouldn’t want to make dinner when I got home: did I have any leftovers?  I needed to remember to buy my mother a birthday present.  When would I have time to go to shopping?  Staying late at work came at the price of falling behind on my personal life. In an effort to retain this control over my own time, I asked the nurses and nursing assistants if anyone could take my patient outside.  I knew this was a lot to ask of the staff  as it would involve a walk across the hospital to the opposite tower before going up to the terrace, a 20 minute trip further complicated by the need to gingerly guide the patient's wheelchair and IV pole along the way. 
I sat down to enter admission orders for the patient I had seen in the ED.  As I worked to finish my notes and to-do list, several nurses came over to me to report that no one would be able to take my patient outside.  

Two hours later, it was time for me to go home, and I was ready to leave.  The next morning felt so close, and I wanted a break. But I knew I had been presented with a greater opportunity to show compassion for my patient.  I walked to his room where he was watching T.V.  “Let’s go outside,” I said.  

I struggled with his wheelchair and IV pole.  Eventually, we got into a rhythm, and I noticed a few confused looks as passersby studied my long white coat and dangling stethoscope.  Finally, the elevator doors opened onto the terrace and blue sky came into view.  The humidity replaced the dry sterility of the hospital below us. 

The time I was desperately trying to hold onto had slipped away, as if dissolving into the humid air.  I knew I wouldn’t be able to accomplish anything on my personal to-do list when I got home, but in a rare moment of surrender, I was able to accept this and let go.  We talked until the sun began setting over the distant mountains.

I will never forget that experience.  For days, I had cared for this patient by reviewing lab results and vital signs.  I had managed abnormalities by adjusting medications, working to maximize benefit and minimize harm.  I’m sure he benefited from this daily intellectual exercise, but the evening on the terrace taught me that he also needed a different kind of medicine from me.  He needed me, as his physician, to listen to him, talk to him, and understand him.  He needed me to go beyond what was expected in order to show him that medicine can heal by providing comfort and support to those who are suffering.   

I became a physician to better the lives of others by connecting with them, not to sit in front of computer screens, entering orders and documenting plans of care.  While those aspects of care are needed, I realized through that journey to the terrace that if I was not able to give time to my patients, the time I spent studying, rounding and charting would ultimately be in vain.  The time that afternoon had not been lost as much as re-purposed.    

In giving time to my patient, I had allowed medicine to answer to its ideal.  In giving, I knew I had gained much more than I might have lost.  

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