The Hospital’s Gift of Downtime

Christmas week is a strange time in the hospital.

There’s an added melancholy for patients who spend the holidays hospitalized — a sense that their illness, whatever it might be, is so bad they must lie in bed while the world hangs ornaments and roasts chestnuts on open fires. It’s a time when the doctors and nurses on call start to feel the weight of jobs that too often keep them close to computers and far from their families.

And yet, a certain camaraderie emerges, an extra measure of meaning and gratitude growing from the recognition that we’re all there together. Santa hats emerge. Ugly sweaters replace white coats. Candy canes flow freely.

I remember caring for one patient, a retired college professor who was having trouble breathing, during this strange holiday time. His lungs had slowly scarred over, and now, only small patches performed their basic functions. He could barely walk to the bathroom without gasping for air. His speech grew staccato, short sentences punctuated by deep breaths.

His adult son, who hadn’t seen him in years, had flown across the country to take an oral history of his life. Each morning when I stopped in to check on him I had to interrupt their recording sessions, hearing the son ask: What did you love most about Mom? Did you really like your job? What were you most proud of?

“I’m asking him the questions I never did,” his son said. “I’ve learned more this week than in all the years before.”

The hospital, for all its pain and misery, often imposes a kind of downtime that creates a space for the reflection we forgo in our daily lives. It’s not uncommon to hear a family member say they finally understand their loved one, or that they’ve reconnected after years apart. It’s more routine still to hear talk of time squandered — moments that might have been, conversations that should have happened.

None of this happens on command. It requires patience, attention and, most important, time. Not minutes, flipping between tasks, tapping out emails while squeezing in a quick call on FaceTime or Skype — but hours, bordering on boredom, in person.

The hospital, especially during the holidays, crystallizes an unavoidable truth: There’s simply no substitute for being there.

That’s as true for doctors as it is for families. The moments that made me the doctor I am didn’t come while reading X-rays on a computer or rushing from patient to patient on morning rounds. They came late in the afternoon when a family wanted to talk prognosis, or in the middle of the night when a patient couldn’t breathe — and I was the only one around.

We know from decades of research that there’s nothing more important than nurturing our relationships for long-term health and happiness. We’re also beginning to understand the significance of uninterrupted downtime — not just for creativity and productivity, but also for developing and maintaining bonds with friends and family.

But far too often we don’t act on these insights. We leave weeks of paid vacation time on the table, instead opting for more work. We eat nearly three-quarters of meals outside the home and 20 percent in a car, knowing that family dinners have myriad benefits. Half of American parents say they spend too little time with their children.

The hospital, by necessity, imposes time for contemplation and intimacy. Of course, it is not an imposition I’d wish on anyone. But still, there is a lesson to be learned: We need to create environments that facilitate downtime with loved ones.

Behavioral science suggests that when there is opportunity for distraction, the human mind will take it. Technology is too seductive; our jobs too demanding. Creating the space for quality time takes work — and foresight.

The trick is to intentionally construct protected spaces that make it easier to spend time with loved ones — places and times where no other options exist. Commit to meaningful experiences far in advance, to guard from the inevitable obligations and distractions that arise. Outlaw phones in particular rooms and at particular times. Create traditions that turn decisions about whether and when to spend time together into rituals of how and where to spend time together. Make it easier to do what’s hard by replacing in-the-moment choices with premeditated commitments.

Because too often we wait until tragedy strikes.

My patient got to narrate only half his life story before his breathing grew so labored he could no longer speak. As his condition deteriorated, I interrupted not excited chatter, but a father and son sitting silently, together. He took his last breath on Christmas Eve.

“I got to know him,” his son said. “I got to know him because I was there.”

Dhruv Khullar, M.D., M.P.P. (@DhruvKhullar) is a physician at NewYork-Presbyterian Hospital, an assistant professor in the departments of medicine and health care policy at Weill Cornell, and director of policy dissemination at the Physicians Foundation Center for Physician Practice and Leadership.

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