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Waiting

Published online by Cambridge University Press:  27 September 2006

WILLIAM BREITBART
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA
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Extract

Waiting…. We've all done it. We have all had that universal experience of waiting. Waiting for news; waiting in line; waiting in traffic. Waiting can be distressing, exciting, or a neutral experience. It all depends on the context. Waiting in line at the store is a rather neutral experience, especially if the line is short and you are not running late for something important. Waiting to see your child come off of the bus after a 3-day school trip can be exciting and full of joyous expectation. Waiting for the results of a biopsy, taken from your child's liver to determine if he has a life-threatening illness, is an experience filled with pain and fear. This last context of waiting is the subject of this brief essay.

Type
ESSAYS/PERSONAL REFLECTIONS
Copyright
© 2006 Cambridge University Press

Waiting…. We've all done it. We have all had that universal experience of waiting. Waiting for news; waiting in line; waiting in traffic. Waiting can be distressing, exciting, or a neutral experience. It all depends on the context. Waiting in line at the store is a rather neutral experience, especially if the line is short and you are not running late for something important. Waiting to see your child come off of the bus after a 3-day school trip can be exciting and full of joyous expectation. Waiting for the results of a biopsy, taken from your child's liver to determine if he has a life-threatening illness, is an experience filled with pain and fear. This last context of waiting is the subject of this brief essay.

Waiting…. It sounds like such a passive activity. We imagine that waiting is a state of suspension, of inactivity, a state of physical inactivity and lack of forward movement. Often, when we are waiting in traffic, we are prisoners, immobilized, forced to stop and wait. Waiting sounds mindless as well, as if it were a state of mental arrest similar to when our computer screen freezes. Nothing could be further from the truth. Waiting for news that will determine if your life is forever changed—the results of a biopsy, the findings on your mammogram, your blood tests results—is a state of physical, mental, and emotional turmoil that knows no equal in human experience. It is a state of hyperactivity, and hyperexperience. The French and German roots of the word “wait” include to “attend” to or to pay attention to; to “watch” or to “awaken.” Waiting is therefore more accurately a state of increased attention, and concern, and most interesting a state in which we wake up to see the truth of the human condition. “Wait and wake up.” I doubt that Schopenhauer or Nietzche ever wrote that specific phrase, but it does sound like an existential truism. Perhaps the dramatic and painful experience of waiting for news that has the potential to determine your fate, life or death, is the type of experience that has a purpose, and a meaning.

Psychologists, such as Lazarus, Folkman, and Park, have developed theories as to how we human beings cope with stressful events. Stress has been defined, by Lazarus and Folkman, as an event or circumstance that challenges or overwhelms one's resources. In their original theory of stress and coping, Lazarus and Folkman hypothesized that a stressful event leads to an evaluation or appraisal of that event (what does this mean to me, my life, to those I love). The appraisal of the event is influenced by one's goals and values (that which we hold dear) and one's beliefs about one's self and the world (personal vulnerability, sense of control, the world is a benevolent place, there is justice in the world). Following this appraisal we then attempt to cope with the stressful event and its threat. “Emotional coping” refers to the process of seeking emotional support, expressing our feelings, and engaging in activities such as prayer. “Problem focused coping” refers to the process of obtaining information, accessing knowledge, expert help, the best doctors, doing all you can to control or solve the problem, setting aside other concerns. Dr. Park, from the University of Connecticut, has suggested another important type of coping, “meaning-focused coping.” This type of “meaning” coping involves primarily changing one's attitude toward the stressful event, the way one thinks about the event. For someone who is diagnosed with cancer, for instance, this type of “meaning-focused” coping might involve assimilating the experience into one's identity, changing the meaning of cancer, finding benefit, changing goals and beliefs, seeing cancer as an opportunity to change one's life in positive ways.

We recently had a “waiting” experience in our family. It was the most painful and frightening experience of my life, and I write about it today only because I think it taught me an important lesson that I want to share with others. My only child, Samuel, is 15 years old and in his first year of high school. He has had type 1 diabetes for 3 years now, and has handled it in remarkable fashion. No father could be prouder of a son. No father could love a child more. Samuel is an athlete and plays on his high school basketball team. During the recent months he sometimes played 3–4 hours a day, every day of the week. Ten weeks ago, some abnormal blood tests were discovered when Samuel had a regular medical checkup. Several of his liver function tests were abnormal, and his platelet and white blood cell counts were somewhat lower than normal. My wife and I were concerned, but knew that tests are sometimes incorrect. The blood tests were repeated. The abnormalities were real. We were more frightened. More testing revealed a markedly enlarged spleen. As a medical physician, I became alarmed at that point. What proceeded over the next 6 weeks were multiple blood tests, consultations with hematologists, liver specialists, genetic disease specialists. There were several points where I was convinced that my son either had a genetic disease, a serious auto-immune liver disease that could lead to liver transplantation, or a lymphoma or leukemia. The internet and my books were a source of information, and terror. Samuel underwent a liver biopsy and eventually a bone marrow biopsy. This 10-week period was a period of intense and painful “waiting” and attempts at coping: seeking information, getting care from the best doctors available, talking to friends, family, praying. The experience was like white water rafting down a narrow, turbulent river, with jagged rocks jutting out from all angles, and trying to steer my family down this treacherous river on this little vulnerable rubber raft without getting hurt by the dangers all around. I truly did not think we would come out the other side unharmed. When I asked the doctors, they saw no chance of us coming through this process without some serious medical diagnosis.

Miraculously, none of the tests revealed a serious medical problem. Samuel probably had a viral infection (mononucleosis) that was missed and we were now seeing his body's reaction to having had this infection. But the “waiting” was so painful, and so frightening, and such a negative experience. Of course we were grateful and relieved that all turned out well, but what positive meaning could I give to this experience, especially the painful experience we experienced while “waiting”? Well, I can tell you that the distress of anticipating bad news made me understand, in the most powerful and physically visceral way possible, that I loved my son, and that I needed him in my life for my life to have meaning. The intensity of the fear of bad news is proportional to the love one has for life. Waiting is distressing because life is so precious and so valuable and must be lived everyday. Waiting awakens you to the truth of the human condition: that life is a precious gift that is finite and must be lived to the fullest and cherished every moment. Wait and awaken to the truth of life.