One of the most memorable scenes from the classic Humphrey Bogart movie Casablanca is when Ingrid Bergman turns to the piano player and says “Play it again, Sam” and the talented barroom performer begins to sing “As Time Goes By”.
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For many of us, time is not a REAL issue. Certainly there are deadlines to meet, appointments to keep and pressures to get more done is less time. If anything, we rush around in our daily lives competing with the clock. The worst that can happen is that a deadline is missed, a deal falls through or we lose a big account. For others, Time is the most precious commodity. Chronic diseases such as cancer and heart disease can come with a stopwatch. Certain cancers are very aggressive and have very limited survival times from diagnosis even with the best of therapies. Patients with end stage heart disease and serious congestive heart failure also face limited timelines. Individual perception of time varies greatly and is often dependent on both environmental/situational factors as well as one’s personality.
This week in the New York Times, author and cancer patient Susan Gubar explores her feelings of living with cancer’s timeline. Dr. Gubar gives us all pause to think about how chronically ill patients think about the concept of time and how we all can work to better enjoy the “now” rather than worry so much about the “tomorrow”. In addition, the ways in which our patients measure time may be very different from our own. As Dr Gubar relates, time may pass too slowly during cycles of chemotherapy or too quickly when facing one’s own mortality. As physicians, we must learn to better understand how our patients measure time. It may be measured in years, or it may be measured in the intervals between hospitalizations. Time, is in fact, a precious gift given to everyone in varying amounts.
Research has indicated that people do not perceive time objectively. Children feel that time passes far too slowly as they rapidly experience new and interesting things throughout their early years. By contrast, older adults feel that time moves far too quickly and they tend to cherish and savor each experience whether novel or mundane–especially when faced with the inevitability of their own mortality.
Patients with disease certainly have a different measure of time and individual perception may be affected by the nature of their disease. A great analogy to help illustrate time perception as perceived by patients confined to a hospital for chemotherapy or other prolonged admissions for disease management is that of a long-haul airplane flight. A direct flight from Los Angeles to Australia can average nearly 15 hours. Rarely do we willingly confine ourselves to a single space for hours on end. In the first few hours of a long haul flight, the time seems to pass relatively slowly. We are, however, eventually distracted by those around us and the in flight meal and conversation with the flight attendants. Time moves a bit more quickly as the next few hours pass. As the flight stretches on, we may read and sleep in intervals and ultimately we are able to remember very few details of the “middle hours” of the flight. In the time before landing, excitement builds and again time seems to slow down to a crawl. When on a trip, we tend to remember nearly every detail about the activities in the cabin during boarding and takeoff and then again in the hours before touchdown and landing. Patients that must deal with recurrent admissions for chemotherapy or congestive heart failure have reported similar experiences. Many may measure time in hospital hours, or days or in blood draws or in intervals without pain. It has been said that the good days “fly by” and time stands still when we are suffering. As caregivers it is important to remember that what may seem like a “brief” 5 day admission for a course of chemotherapy or a “routine” procedure may be perceived as anything but that by our patients. It’s all about one’s perspective.
Humans do not perceive time just as a clock ticks it away. Most of the time we do not think of time as second to second and minute to minute. Our perception of time is affected by environmental factors and this is particularly true for patients battling chronic disease. The beauty of the practice of medicine is the lessons we learn from our patients. Dr Gubar inspires us to take note of time; to cherish and respect time and to enjoy every minute–not as measured by a stopwatch but as measured in life experiences. As physicians we must make sure that we are able to synchronize our own “clocks” with the patients that we treat. Remaining sensitive to the subjective passage of time and how it affects both caregiver and patient will ultimately make us better and more effective both professionally and personally. So, breathe deeply and quietly listen…”Play it again Sam.”
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