‘‘Screw-ups’’ 121
officer: ‘‘I’m going to wait till tomorrow to take it.’’ But that
caused a whole big fuss, so I just took it. The next time, I went on
strike! Eventually my attending wrote a better order.
These ill physicians’ providers frequently failed to grasp the impor-
tance of timing in patients’ lives and quality of life. Sally continued:
One doctor tapered me off steroids too quickly before Passover.
I said, ‘‘Can’t we wait a week? I have sixteen people coming over
for Passover.’’ He said, ‘‘No, I want you to do it now.’’ He went
into this whole thing about his own family’s dynamics—he grew
up in an Orthodox Jewish home, and it was awful. I said, ‘‘But
that’s not our house. I really treasure it!’’ I followed the taper, but
it was too fast. I had to be readmitted. My kids came to the hos-
pital and we had the seder there. They brought a few things I had
made, and we set the table in the hospital. My doctor had no
remorse. It wasn’t a medical necessity to taper me then.
Thus, the medical profession does not follow patient time, but physician
time and hospital time. Increased physician appreciation of these differ-
ences could help improve patients’ quality of life and care.
Defining ‘‘the Future’’
These competing timetables led to different, frequently contrasting defi-
nitions, and hence understandings, of prognoses. In discussing the future,
doctors and patients regularly communicated about time, but disagreed
about the precise meanings of descriptive terms. How long is ‘‘long’’?
How short is ‘‘short’’: hours, days, weeks, months, or years? Doctors and
patients may define ‘‘fast’’ and ‘‘slow’’ very differently. A doctors can say,
‘‘We have plenty of time,’’ but both objectively and subjectively, for a
particular patient, the disease may progress much faster. Walter reported:
My doctor said that Hodgkin’s doesn’t spread that quickly. . . . But
once you’re told that you have a serious illness, it’s very hard to
have that overall perspective.
Moreover, competing views of time can be hard to address or reconcile.
Physicians’ arrogance may lead them to defend their predictions and
interpretations of the durations of periods. Walter continued: