It's been a 30 year career in Psycho-oncology and Palliative Care. The struggle, the central questions have always been the same, however I didn't always realize it. The struggle has always been “the struggle of the living against non-being,” as Kierkegard wrote two centuries ago. The questions have always been “How can we live knowing that we are mortal and we die?” “Is life worth living, knowing that it is finite?” “How can we live in the face of death?” “How can a human being with a diagnosis of metastatic incurable cancer and a prognosis of several months manage to not focus on the clock and the nearness of death, but rather still manage to live each day (or at least some days) experiencing moments of joy, meaning, and appreciation that they are alive today?” These questions raise our awareness of the temporality of life, the nature of time, the relationship of being to time, and the concepts of infinity and finiteness.
An esteemed oncologist colleague and I were chatting the other day about the challenges of working with patients who have advanced metastatic cancer and the attitudes that would be most helpful to patients who are dealing with a shortened life expectancy and the temporal nearness of death. “They have to take the attitude that they need to live in the moment” she said. “If there is one thing I've learned as an oncologist over my long career, it is that not only do patients have to learn to live in the moment, but so do I.” “There are no guarantees, so focus on living each day!”
Living in the “Moment” is certainly a common recommendation of clinicians, particularly those who see mindfulness meditation practice as beneficial. The benefits of Mindfulness meditation are advocated not only for patients dealing with a poor prognosis cancer, but for healthy individuals to practice in their everyday lives. In his book, Wherever You Go There You Are, Jon Kabat-Zinn (Reference Kabat-Zinn1994) writes that “this moment is all we really have to work with…. In every moment we find ourselves at the crossroads of here and now.” The here and now is also often described as the “present,” however the concept of living “in the moment” or the “present” has many limitations as a concept for me as a clinician and practically as a method of living, in my experience, for my patients. Part of the difficulty is that the “moment” or the “present” is quite brief and fleeting. It is hard to hold onto or grasp. The “present” is gone the moment you realize that it is here, and then you are in the future and a new present. On a practical level it seems more like there is only the past and the future, and the present is with us for too short a moment to appreciate or do anything with. This is particularly true if we experience the temporality of life or time in “chronological” terms.
The fact is that in the modern era we live “lives coupled to chronological time.” The ticking of seconds, minutes, hours, days, months, years; we experience life as a time based commodity that we are always running out of! The ancient Greeks had more complex and varied concepts of time that I think may be particularly helpful for those of us who are confronting the finiteness of life in direct and almost inescapable fashion due to life threatening illness. The ancient Greeks had two words for time, “Chronos” and “Kairos.” “Chronos” refers to chronological time or sequential time; the concept of time that we universally use today. “Kairos,” however, refers not to chronological time but rather to profound moments or milestones or events in life, particularly those that are most meaningful or transformative. The ancient Greeks also saw time as not necessarily only linear, but also as “cyclical.” The concept of cyclical time reflects the constant experience of the past and the future in each moment of the present. As we move through life and experience moments of profound emotion or meaning, we imbue that lived experience (moment) with the contributions of the past legacy we have inherited and experiences that have shaped the present moment, while anticipating how we will enact and shape the direction of the uncertain future that we are creating. Interestingly, the ancient Greeks saw the past as lying before us because we could see it and examine it. They felt the future was behind us because we could not yet see it. These alternative concepts of time, the past, present and future, can be very informative and helpful. I believe they can help us move towards an attitude of “living life uncoupled from chronological time.” A way of “Living Momentarily”; living life focused on the moments, and events and milestones of our lives that bring the experience of meaning, and the sense of being more fully alive.
“Momentary Living” is thus not an exhortation to live “in the moment,” but rather to live life uncoupled from chronological time; to live life for the moments of profound and meaningful experiences (living from moment to moment). Our patients, who are confronting their mortality and facing death in more concrete terms because of life threatening illness, would benefit, I believe, from this attitudinal shift in the perception of time from a chronological one to one based on meaningful moments and experiences. A cyclical concept of time is also intriguing and somehow resonates as being innate to our human experience as well. Old fashioned round clocks actually do tell time in a cyclical fashion. The hands of the clock go round and round and the hours keep repeating. In the digital era we see time reflected to us as a commodity that we are quickly running out of. “I just have so much time left!” It can be activating and a call to life, a call to action. But too often it is paralyzing and causes panic. The concept of Finiteness and infinity are also quite interesting to examine. A finite period of chronological time can be measured, but infinity cannot. Infinity is not a measure of time. Life is finite in time.
We live in finite lives based on chronologic time. Can we live an infinity within a finite lifetime. Infinity may in fact be a representation of cyclical time; a constant movement between the past, present and future that is constantly at play in each of our lived moments of meaningful experiences. What may be paradoxical is that true freedom (and the experience of the infinite in life) may be most tangible and possible within the limits of a finite, mortal, human life.
