The Chronos and Kairos of Medicine

In classical Greek art, Kairos is portrayed in a manner similar to Hermes (the Roman Mercury). He is handsome, young, perpetually in motion, swift, constantly running; he has wings on his feet and on his back, he continually escapes the efforts of those who try to stop him. Cipriani

Kairos is the “fullness of time,” God’s time zone.  Kairos time conveys notions of unboundedness, of fluidity, of God’s purposes intersecting and overruling this finite world of chronological time,  Kairos thus refers to opportunity.  It represents “the arena of man’s decision on his way to an eternal destiny. Carl Henry

Every morning at 6:30am, my co-intern Lauren and I check labs in a darkened call-room. We are haggard and tired. We love and hate this ritual. There is melodic music and small-ante bets on patient potassium levels. At first interruptions would scare; but we now embrace them. Come into the dark and melodically start your day, we say. Few take us up on the offer. In a medical system organized chronologically, this ritual points us toward kairos. In moments of pause between checking labs come thoughts on love, family, and diagnostic theories. In language of modern psychology, these moments represent moments of “flow,” or nearing adjacent possibility. Perhaps a better explanation of what happens in these thirty minutes comes from the Greek distinction between chronos and kairos.

For the Greeks, chronos time referred to linear, measured time, whereas kairos “implicitly or explicitly carries with it a transcendent (meta-physical) existential significance.” (Cipriani) Kairos time is experienced moment by moment; with presence. In a word, it is unbounded. A hospital is a decidedly chronos oriented institution – that is, from the perspective of the practitioner. From the moment of admission, we measure and document the timing of vital signs, blood sugars, administration of medication, counseling services, and even the percentage of meals consumed. Measurement, after all, is the first step towards scientific progress. As the surgeon Atul Gawande stated, the first step towards making change in a hospital, is to “count something.” The practice of medicine itself could be seen as an extended sequence of isolated measurement. Laboratory data is bounded and finite, and interventions swift and linear. If the potassium is low, give more. If it is high, recheck, give calcium gluconate. Much of “good medicine” is creating clinicians with command of an increasing number of such algorithms.

From the perspective of the patient, the hospital is unstructured, unpredictable, and painfully irrational at times. We as practitioners measure disease to control its stochasticity, to tame its randomness. Meanwhile, our patients’ feel such randomness viscerally, in the form of intermittent pain, nausea or pangs of hunger.

What might a hospital look like that take the notion of kairos seriously? The field of palliative care brings us close to considering the dimensions of this possibility:

If prediction relies on statistical methods, the space of possibilities that unfolds the vision of a future is translated into a language of numbers… Hope is reduced to expectancy, which correlates to a probability of survival. In current language, somebody with a low chance of survival is said to have ‘little hope’. In reality, however, hope is not a function within the order of the probable; rather, it inhabits the order of  the possible. The space of possibilities is not tied to survival. (1)

To live in the world of chronos is to blind oneself to this reality – that what is possible may not be measurable. So as Lauren and I sit tiredly in the dark checking lab results, we allow ourselves brief moments to enter into kairos; to imagine the hospital as our patients’ see it, to ask what is possible for this patient to not just breath better or have a healthy kidney, but to live fully.

(1) Bernegger G et al. An alternative view on the task of prognosis. Crit Rev Oncol Hematol. 2012 Dec 31;84 Suppl 2:S17-24

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