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Carrying Things to Term: Why Patience Is So Difficult

October 14, 2021


It was pretty awkward.

They all just stood there staring at me. And the sweat just trickled down the back of my neck.

Let me start by saying that it had been a long night. I was a freshly minted third-year medical student. Awash in book knowledge but bereft of experience, I began my internal medicine rotation at Abbott Northwestern Hospital, with my short, white medical student coat stuffed with books, a stethoscope, and a reflex hammer. Of course, I would be on overnight call the first day, and, as luck would have it, I would get the complicated late-night patient admission: a seventy-three year old woman with new-onset thyroid storm.

Susan (let us call her) came into my life with a plethora of complaints, including sweats, weight loss, a racing heart, heart failure (and swelling from her toes to her hips), and eyes that were bulging out of her head. Her lab tests were profoundly abnormal, indicating that her thyroid was wildly overproducing its hormone and causing grave danger to this lovely woman. Because of the rarity of this case, Susan was seen by every member of the medical hierarchy until lowly ol’ me had a chance to perform a full history and physical (near midnight) and record it on the endless eight-page form we, as medical students, were expected to fill out.

Well, the night was long and sleep was short. I had so many questions and so little guidance. In the midst of my confusion, fatigue, and anxiety, I wasn’t sure I could capably organize my thoughts, much less my written history and physical. Nonetheless, early the next morning, I found myself asked to make a bedside presentation before the patient, her family, my senior residents, fellow medical students, and the most intimidating stony-faced and venerated attending physician I have ever had. Not being adept at making such a presentation (crafting a smooth narrative and triaging salient points), I fumbled and stumbled through what must have been an agonizing, interminable story. As the sweat rolled down my neck, the room was as silent as the grave. The patient looked at me with her big eyes. And the only reaction I evoked from my daunting attending physician was a furrowed brow and an exasperated and emphatic look at his watch.

As I drove home that night, I called my wife. “There is no way I will ever be an internal medicine physician. I just don’t think I have what it takes.” She laughed and consoled me. “You just have to be patient.”

But patience is hard.

The trouble with patience is that it runs counter to what we want. We want what we want and we want it now. We want suffering to end, sadness to be gone, and pleasure to be nary a moment away. Remember when you were a kid and your parents told you to wait? Or they quantified it by telling you it would “only be ten minutes”? As soon as the duration slipped from their lips, the hands of the clock would instantly freeze. The watched pot would never boil. My mother-in-law is famous for quipping, “Don’t pray for patience because then you’ll have to use it.” Patience is hard.

But it is necessary.

As I teach medical students and internal medicine residents in my daily practice, I can sense their nervous impatience. Oh, they are sweet and kind and indulgent of all that I am teaching them, but they are impatient with themselves. They just want to get better. They want to know more. They want to be more comfortable and less worried. And they want it all now. Now, this isn’t necessarily bad; it just isn’t realistic. One thing I have learned in medical practice (if not in life) is that you cannot rush experience. So much of what we know begins in instinct, habit, or book knowledge, but then we need life to teach us what it looks like, what it means. In living life—in gaining experience—we mold our intuition, form our common sense, and cultivate our judgment. We enflesh the bones of fact with the sinews of sense. We inch beyond intelligence toward wisdom. And this doesn’t just happen overnight. It requires patience.

Being impatient isn’t simply galling; it can be dangerous. We are at risk of making hasty, ill-considered decisions simply because we don’t allow ourselves time to discern, time for the circumstance to unfold. We are obsessed with the mantra, “Don’t just sit there, do something!” Respecting this tendency, Blaise Pascal saw the dark side, “All the unhappiness of men arises from one single fact, that they cannot stay quietly in their own chamber.” In War and Peace, Leo Tolstoy would add, “The strongest of all warriors are these two—time and patience.” In the daily rush of medicine, I have seen patients stifled by an eager student’s feverish pace of questioning. But I have also witnessed patients reveal something dramatic simply because a student sat still and said nothing.

Exchanging letters with a young poet eager to “arrive” at a place of poetic greatness, German poet Rainer Maria Rilke counseled patience.

Allow your verdicts their own quiet, untroubled development which like all progress must come from deep within and cannot be forced or accelerated. Everything must be carried to term before it is born. To let every impression and the germ of every feeling come to completion inside, in the dark, in the unsayable, the unconscious, in what is unattainable to one’s own intellect, and to wait with deep humility and patience for the hour when a new clarity is delivered: that alone is to live as an artist. . . . 

Contending with his young friend’s tenacious impatience three months later, Rilke would sigh, 

You are so young, all still lies ahead of you, and I should like to ask you, as best I can, dear Sir, to be patient towards all that is unresolved in your heart and to try to love the questions themselves like locked rooms, like books written in a foreign tongue. Do not now strive to uncover answers: they cannot be given you because you have not been able to live them. And what matters is to live everything. Live the questions for now. Perhaps then you will gradually, without noticing it, live your way into the answer, one distant day in the future.

It has been twenty-three years since I stood in Susan’s room before the teeming millions with sweat trickling down my neck. It has been a long time since I first doubted I could ever make a go of this specialty. Today, I am an internal medicine physician. I teach residents and medical students in the clinic as well as at the medical school. I understand my student’s and resident’s impatience because I was just like them. Perhaps my wife was right. Perhaps, I did just need to be patient.

Everything must be carried to term before it is born.