Novelist Eric Kraft writes in Leaving Small’s Hotel that if events or periods of time do not have a marked end, even such mundane phenomena as a weekend, or even a day, then time has no rhythm and thus no meaning. I get a taste of what the lack of this rhythm is like from my experience with hospice residences and nursing homes. When I went to work on a recent Sunday, it struck me how that day felt like any weekday. I was expecting a different feel, a different mood to set apart the day. I thought it would at least feel quieter with less staff, somehow slower. Or that there would be say, a Sunday brunch option instead of the usual breakfast, or different kinds of activities than on a weekday, or maybe more informal dress on the part of staff. Nor did anyone seemed surprised that I was there on a typical day off, saying, “What are you doing here on a Sunday?” I actually felt let down. Not only had I given up part of my weekend, I had stepped out of time into a perpetual hell of monotony.
Then I thought about how much worse this must be for my alert patients, and how when I visit them and at times ask what’s new, they frequently say every day is the same. It came home to me how a lot more than boredom is at stake here when a patient anxiously asked me for a pocket calendar. “I want to know what day it is. Can you bring me a calendar?” When I did, she was remarkably relieved. She took it like it was a gift of great moment and said: “I will mark off each day, and now know where I am and what’s going on.” Before getting the calendar she implied she felt disoriented and lost. She made me realize how strange the artificial environment of a facility is, including the deprivation of a sense of time passing, despite efforts to decorate for holidays and the like. Residents might as well be in a space vehicle between worlds. (Which reminds me of a concern among some Jewish sages as to how to observe the start of the Sabbath if you were to find yourself on another planet. It cannot make sense to ask what time it is or what day it is except on a purely arbitrary basis such as the actual time it is in a given location such as your hometown.)
We tend to think that endings, however necessary, are undesirable. We may think we want our vacations to go on forever or have a festive occasion go on and on. But if they did, the experience of these periods would be subverted. An endless vacation would be a void rather than a vacation. A festive day that went on indefinitely would cease to be festive. We end up with nothing when we do not place boundaries on events and periods of time such as the seasons. We remove the meaning that accrues from going forward in time. Perhaps we can restore a sense of a patient’s life unfolding in time by at least referring to how that is happening in our relationship with them. I can mention to a patient how long we have known each other. I can refer to some of our earlier conversations and how they connect with the current one. I can acknowledge what I have learned from them and that I like to see them and look forward to seeing them again. Relationships with patients are not static; they are evolving. Let us at least refer to that.
Observing this temporal isolation of my patients makes me more conscious of how I should honor, as Eric Kraft urges, the end of such things even as seemingly trivial as one day. I rarely, for example, work on the computer past midnight (though the writing of this post on this particular day is taking me just past!) I am looking ahead, dear readers, for your responses, in good time.