As an oncologist and palliative care specialist, Larry Cripe treats critically ill patients. Two years ago, he found himself on the other side of the healthcare system after his college-aged daughter suffered a 30-foot fall. In this series of essays, Dr. Cripe shares what he learned about how better to communicate with the critically ill and their families, and how to move forward in the face of an uncertain future.
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As I was sitting in the intensive care unit watching my daughter breathe, I realized time has width as well as length. The length of time was marked by the ever-changing bright red numbers of the digital clock at the head of her bed. I experienced the length of time as it passed faster or slower. If I watched the monitors that displayed the spikes of the electrical activity of her heart or the peaks and valleys signaling the rise and fall of her chest too closely, then time passed more slowly. If I willed myself to ignore the clock and monitors and instead watched the comings and goings outside of Millicent’s room, then time passed more quickly.
But as I was sitting with Millicent and my attention drifted away from the repetitive tracings on the monitors, I discovered the width of time. As she lay there battered, her left arm motionless, her hair disheveled and crusted with blood, I experienced her as the strong-willed and joyous child she had been, as the young woman she was before her fall—anxious to return to college after working for the President’s re-election campaign that autumn. Less distinctly, I also was aware of the future when, as an older woman, she would live a life different, in large and small ways, from the life she had planned before the fall.
There is mercy in wide time. During my long drive to the hospital in Washington DC, I was terrified that her injuries would prevent me from recognizing Millicent, that she would be lost to me among the tubes, the monitors, and the hustle of the intensive care unit. I was afraid the present would overwhelm the past. In the length of time, the past recedes into the chaos and uncertainty of a life-threatening injury; with wide time, it remains.
I used to think the photographs the patient's family brought in were to inform the doctors and the nurses about who the patient was. But they are to make sure we know who the patient IS. Because we are the futures we imagined as well as the past we have lived.
Perhaps I am merely offering a metaphor for the way in which I protected myself from the reality. But I don’t think so, because there was also terror in wide time. It was in the width of time I fully experienced the tragedy of her fall. I could not prevent myself from imagining some new and unsettled future so different from what we assumed would be true up until the moment of I heard of Millicent’s fall. I was fully aware of what we, what she might lose. Physicians—myself included—communicate a studied indifference to the passage of time. When caring for a person with a serious, life-threatening condition, we physicians often advise “wait and see’. We know the time to recovery varies widely and the path to recovery is often a series of steps forward and backward. We learn to counsel patients and their loved ones to be patient, to not celebrate or despair too soon.
As I sat next to Millicent I had to manage the present, past and future simultaneously. The experience has led me to think differently about how to speak with people who are critically ill. I remain focused on the present in order to make sure people are fully informed. But I understand the waiting differently now. I believe in order to be truly empathic, to truly imagine what their experience is like I need to ask about where they go in the width of time during the long hours of waiting.
I also look at the photographs people bring to the hospital differently. I used to think the photographs were to inform the doctors and the nurses about who the patient was. But they are to make sure we know who the patient IS. Because we are the futures we imagined as well as the past we have lived.
And so while wide time may be a metaphor, it is essential to making sense of tragedy. It is through wide time we grieve fully, honor completely the life we are trying to protect and ultimately restore.
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Larry Cripe, MD is a Hematologist and Oncologist Specializing in Palliative Care at Indiana University Hospital in Indianapolis, and a contributor to Sound Medicine. You can read and listen to part one of "Millicent's Fall" here. Part three will be posted next Thursday.
