Learning the Art of Patience

IN THE MIDDLE OF THE NIGHT on July 23, 2012, I slipped and fell in the bathroom of our hotel room in downtown Indianapolis during a family vacation. My head slammed onto the sink and then the floor.

The noise from my fall awakened my spouse, but when she asked me what happened as I lay on the floor, all I said was, “I’m okay.” Seeing no visible sign of injury, she returned to bed. A stomach bug was making the rounds, so she figured that it must have nabbed me. My vomiting every hour or so the remainder of the night only seemed to confirm this assumption.

At dawn, however, the first words out of my mouth were: “I think I cracked my skull. You’d better take me to the emergency room.” My wife knew something must be wrong, because I never suggest going to the hospital right away. The physician on duty thought I probably had a mild concussion and that I would be able to go home that day, but a CT scan was needed to make sure.

Afterward, he told me that his earlier hoped-for diagnosis was wrong. Instead, I had fractured my skull, with a subarachnoid hemorrhage and a small epidural hematoma under my left frontal region. In other words, I had a traumatic brain injury, and my life was at risk. In fact, I immediately was loaded into an ambulance and taken to a hospital nearby where neurosurgeons would be better able to treat me.

For the first time in my life, I was hospitalized for several days—in Indianapolis and then back home in St. Louis. Prior to this I had never experienced such a serious injury, even during my earlier years of working in law enforcement. I couldn’t keep much food down. I slept a lot. I was concerned about my family and, even though I was fortunate to have health insurance, I worried about the possible bills I might still have to pay. I also felt stressed about getting my syllabi ready for the courses I was supposed to start teaching in a few weeks. So I longed to get out of there as quickly as possible. In short, I was impatient.

I really didn’t realize how hurt I was, or how long it would take to heal. Indeed, it has taken every bit of the last three-and-a-half years to do so. I wanted to be normal, to be productive, and to move on. Even after I was able to go home, I discovered, to my chagrin, that I pretty much had to stay in bed for a month or so. I tried one day to walk outside, and I nearly passed out. I reluctantly agreed to a semester off from teaching, but I kept reading and writing at home. I resisted having to be patient, but it was as a patient—as blindsided, vulnerable, and unprepared as I felt—that I was forced to learn to practice patience. I was learning firsthand the truth in something I’d read by Stanley Hauerwas and Charles Pinches: “[I]f the first time we are called on to exercise patience is as patients, we will surely be unable, for there is no worse time to learn patience than when one is sick.”

The patient as person

Since then, I have noticed in my bioethics courses that when the practice of medicine is examined, usually what is in mind is what physicians, nurses, and other healthcare professionals do. But what about the patient?

Almost five decades ago, Methodist theologian Paul Ramsey, who was one of the pioneers of what would come to be known as medical ethics, published his book The Patient as Person: Explorations in Medical Ethics, which would become a classic in the field. It dealt with a number of burning issues at the time, which we continue to wrestle with now, including informed consent (especially in connection with research involving minors), the definition and diagnosis of death, end-of-life care and decision-making, organ transplantation, and the just allocation of medical resources.

Importantly, Ramsey held that these were not “problems on which only the expert (in this case, the physician) can have an opinion” but, rather, they have to do with “[b]irth and death, illness and injury,” which we all experience: “They are moments in every human life.” However, when I reread this book following my injury, I noticed that most of what Ramsey (as well as most subsequent bioethicists) wrote still was aimed toward physicians, policy makers, philosophers, and ethicists. Sure, the patient is regarded as a person, a subject, with moral agency, and not treated merely as a passive object; nevertheless, the patient does not have much of a role to play in this benchmark book.

Of course, simply emphasizing that the patient is a person was significant at the time as a counterweight to the paternalism of physicians. Ramsey emphasized that “partnership is a better term than contract in conceptualizing the relation between patient and physician,” but, curiously, most of his attention remained devoted to the physician’s part in all this—even though Ramsey alluded to “the need for a patient’s partnership in his own cure.”

Everything superfluous falls away

In my experience as a patient, there was something for me to do during my hospitalization and recovery—or, better yet, someone for me to be. Yes, I had to make decisions (of course, with my wife’s helpful input) and sign forms, and I had to do things such as take my medications and try to walk a bit more each day. But, more important, even though at times I was very impatient, I realized that I wanted to be a certain kind of patient, a good one. It wasn’t easy, but somehow, by the grace of God, I was able to be present, at least to some extent, to those who were caring for me.

It was difficult because, as M. Therese Lysaught insightfully observes, experiences of illness or pain “re-situate patients vis-à-vis their bodies, re-ordering taken-for-granted relationships between ‘self’ and ‘body.’” Such an experience can be alienating, Lysaught writes, and can occupy so much of one’s attention that it “crowds out awareness of anything else”—it can even “isolate patients from those close to them and prevent them from effectively communicating their distress to medical practitioners.”

Whenever I have stubbed a toe over the years, that little appendage occupies my attention. As St. Paul wrote, “Indeed, the body does not consist of one member but many ... If one member suffers, all suffer together with it” (1 Corinthians 12:14, 26). Imagine if that member were one’s head. Lysaught adds that “patients often experience a loss or usurpation of their ‘voice’” because the pain or illness is inexpressible. Having to put a number on the level of my pain was as hard for me as writing an academic paper.

Sheila Crow, a medical ethicist who was diagnosed with cancer, writes that “everything superfluous falls away, leaving only what is truly important.” That was my experience, although I would qualify it a bit, making it only who is truly important.

Not long before his death, St. Thomas Aquinas, author of the Summa Theologica, reportedly said, “I have seen things which make all my writings like straw.” I realized in the hospital that what really mattered for me was who mattered to me: my family, for sure, but also many others, from the EMTs who transported me in their ambulance to the nurses who took time to talk with me as they checked my vital signs day and night, and from the hospital chaplains who chatted with me about theology to friends who visited me in the hospital and provided meals for my family and those on Facebook who sent their good wishes and prayers. Instead of an interruption, each was a gift to me. They taught me to be present, and each helped me to learn patience.

‘Patience is God’s nature’

Patience, after all, must be learned, and it must be learned through practice with other people. According to the early Christian writer Lactantius, patience “is the greatest of all the virtues.” Virtues are good habits and dispositions that form and shape our character, that make us who we are. At the same time, they express our character. So it wasn’t a good reflection on my character whenever I was impatient as a patient.

In an essay about Ramsey’s The Patient as Person, William F. May writes that patients are confronted “with something to do and things to decide, but, far more profoundly, such crises assault identity—they force their victims to decide who and how they will be.” Such crises, he adds, “must be faced rather than solved,” and doing so “demands a restructuring of habits and rituals” rather than formulating a solution.

Virtues—such as courage, wisdom, humility, self-restraint, and fidelity—are needed to help patients follow through with decisions they make. Interestingly, May leaves out the virtue of patience for patients.

Sadly, the virtue of patience has been largely ignored in Christian ethics. In the best book on the subject, Patience: How We Wait Upon the World, published in 1997, David Baily Harned observed, “In the course of a century and a quarter, scarcely a handful of books in Christian theology and ethics written in English have been devoted to the importance of patience.”

However, the virtue was prominent in earlier Christian accounts of the moral life, and while teaching my War and Peace in the Christian Tradition course this past year, I was struck by how this was especially true in connection with being a peaceable people. For Tertullian, an early church leader, “patience is God’s nature,” and Christians should likewise be patient by the grace of God. And because patience is “the mother of Mercy,” Christians are to be merciful toward others, including our enemies. Cyprian, bishop of Carthage, wrote similarly that we should have God’s patience “abide in us...the divine likeness, which Adam had lost by sin, be manifested and shine in our actions.”

Why we can’t wait, and why we must

Why was I initially impatient as a patient? Probably because I am a part of Generation X, with an attention span that resonated with MTV’s music videos. Also, I have become accustomed as part of contemporary U.S. culture to instant messaging, instant coffee, instant food, and instant gratification. Our lives today are really at odds with the virtue of patience.

Plus it is not to be denied that there is indeed a sense of urgency for us to address a number of major issues we face, including racism and climate change. Pope Francis, in his encyclical on the environment, Laudato Si’, refers to our “urgent challenge” and offers his urgent appeal to “protect our common home.” Likewise, the past year and a half of more than 1,000 police shootings that have killed fellow citizens, including a disproportionate number of African Americans, is an urgent matter demanding our attention and actions. Other matters likewise urgently demand our attention. Retrieving the virtue of patience is not meant at all to diminish the urgency of any of these important issues. Aquinas warned about vices that had a “semblance” of virtues, and there are vices that may resemble but aren’t patience, including a naïve assumption that everything will simply turn out for the best.

In Why We Can’t Wait, Martin Luther King Jr. noted the importance of understanding that it was not because “of a sudden loss of patience” on the part of African Americans that they undertook nonviolent direct action in 1963; after all, he said, they “had never really been patient in the pure sense of the word” since “waiting was forced upon” them by the psychological and physical shackles of society. In his “Letter from Birmingham Jail,” he explained how for hundreds of years African Americans had heard the word “Wait!” But that word “almost always meant ‘Never.’”

“There comes a time when the cup of endurance runs over,” King wrote, and there arises a “legitimate and unavoidable impatience.” However, although understandable, “unplanned spontaneity” was as wrong, in his view, as the “do-nothingism” of gradualism and complacency. He emphasized that demonstrations and protests should be carefully and prayerfully planned, with preparatory practice through training and workshops.

I confess that I’m not yet sure how the virtue of patience, which I learned is essential to being a patient, should factor into how we face climate change and racism and other urgent issues, but I believe that patient encounter with the “other” is key. For now, I have found that I am more patient with my students, including those who are late with their papers (don’t tell them) and those who are athletes with head injuries. I am also more patient with worship and the liturgy—and with those in the church who preside and participate. It is through the faces that I encounter in these places that I learn to practice patience, especially through their, and God’s, patience with me.