Intended for healthcare professionals


Waiting with time

BMJ 2000; 321 doi: (Published 14 October 2000) Cite this as: BMJ 2000;321:940
  1. Gordon McLeay, general practitioner
  1. Perthshire

    Waiting lists. Waiting rooms. Sorry to keep you waiting. Until recently the word “waiting” interfered little with my day to day thoughts. Usually apologetic to patients who had spent too long in the waiting room; guilty of medical “be with you in a minute” reassurances which frequently extended to half an hour. Chambers dictionary defines waiting as “to keep watch, be on guard; to remain in expectation or readiness.” But what it means to wait.

    Recently, or was it years ago, my wife found a breast lump which turned out to be malignant. She's 36. Since then, time has become distorted, the objective measures of calendars and clocks becoming meaningless as appointments, results, operations, and treatments have approached and passed. Minutes, hours, and days have become prolonged and compressed, depending on the clinical and emotional situation. Six months have sped by while at the same time the memory of the uncomfortable and “excessively long” half hour wait for confirmation of results at outpatients is as fresh as ever.

    The chance finding of a lump and subsequent referral to the appropriate consultant (“the chances are that it is nothing”) seemed speedy enough. But when the diagnosis was suspected and confirmed, the subjective perception of delay crept in. Why does it take so long to arrange staging investigations and set a date for definitive surgery? Evidence based medicine suggests that these timescales are not a significant factor in determining outcome.

    But what about the waiting? What to say to each other at the start and end of each day when there is only one date, and time, and result on your minds? What to tell relatives and friends who ache to do more, but who must wait with you, unable to change time and its snail-like progress. And then it's back to the waiting room. Wishing that time would pass quickly to get results and decisions over with, but at the same time wishing to prolong the ignorance of not knowing.

    Then it's on to radiotherapy. Daily travel and a different kind of waiting—technical problems broken machines. Will I or won't I get treatment today? Five long weeks stretch out to a distant horizon. And then it too is over. Where has all the time gone? Only the chemotherapy to go—four and a half months/18 weeks/126 days. Blood results, delays at pharmacy, the consultant wants to see you before treatment. A 30 minute procedure extends to three hours.

    And now, as the end of active treatment looms, there is the hardest wait of all. Life is no longer measured in terms of “expectancy” but rather as “survival.”

    So what have I learnt during this interaction with time? Almost all the health professionals we have met have been caring, conscientious, and good at their job, but they seem to have little appreciation of the stress of waiting, or the practical knock-on effects—for example with children school, and work. Those who did were like an oasis in a sand-filled hourglass. It took only a few seconds to listen and a few words to show understanding.

    Time is impossible to contain, and the only certainty is its passing. I no longer wait until a better time to do or arrange something, I do it now. Saving for a rainy day has been part of my reserved Presbyterian upbringing. Despite living in Scotland all my life, it has taken me until now to realise that it might rain later today, or tomorrow. Why wait to find out?

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