Lose Track of Time

This past Monday, I had the privilege of helping to facilitate Schwartz Center Rounds at my hospital. In 1995, Kenneth B. Schwartz, at age 40, was diagnosed with metastatic lung cancer. Before he died, he set up a foundation at Massachusetts General Hospital to strengthen the compassionate bond between patients and their caregivers. Today, about 375 hospital organizations in the US and Canada are members of the Schwartz Center along with 120 in the UK.

The member organizations of the Schwartz Center participate in rounds to discuss cases in a way they are usually not discussed. Instead of talking about what was done or not done in a case, members of the healthcare team talk about how the case made them feel. In the words of one rounds participant, “Rounds are an opportunity for dialogue that doesn’t happen anywhere else in the hospital.”

At my hospital, we assembled a panel of presenters based on the February theme of “Share the Love.”

• A trauma nurse who became a patient on her own unit shared eloquently of how a patient’s family were able to minister to her own family when they met in the Trauma ICU waiting area.
• A nurse from the Neurosurgical ICU team talked of how her unyielding advocacy for a young woman with an aneurysmal brain bleed led to the young woman’s full recovery against monumental odds.
• A third nurse shared the story of how his sister’s untimely death led to his decision to pursue nursing, and how, as a nervous young nursing student, he was cared for by his first patient, a man who kept his kindness and dignity in spite of progressive terminal illness.

Kenneth Schwartz’s struggle and his insights into the value of caregiver support is available from the Schwartz Center website. One paragraph in his story stood out for me.

Time is a prerequisite for real engagement between caregiver and patient. Even the most compassionate caregivers cannot use their healing gifts if they don’t have time to do so. A friend who worked at the National Cancer Institute, in Maryland, quoted his mentor as saying that when physicians give bad news to a patient, they must give that person more of their time—to explain, to answer questions, and to provide comfort.

While I definitely agree with the quote, I would like to make a subtle distinction, so that my colleagues don’t come away with the impression that it takes time to be compassionate. While I clearly understand the time stress that clinicians are under, especially in the age of electronic documentation, it doesn’t take any extra time to make a connection.

The Greeks had two words for time, chronos and kairos. Chronos refers to chronological or sequential time, the stress-inducing kind. Kairos signifies a moment of indeterminate time, almost a space in time, the way time feels when you lose track of it. It lengthens or shortens according to its own internal logic.

So while I agree that time is a prerequisite for engagement between caregiver and patient, that doesn’t necessarily mean chronos. In Kenneth’s story, he tells of a stressed, hurried nurse who paused, took a deep breath, and began to truly listen to him, losing her cool, brusque manner. She slipped from chronos into kairos. I love the feeling when that happens.

Question: When was the last time you took the time, chronos or kairos, to connect with someone you were caring for?