Precious Time

(Jennifer has served as CEO for two large physician practices, authored 55+ published pieces, and has given many presentations on end-of- life care.  She holds a bachelor’s degree from Boston University and a master’s degree in organization development from Loyola University – Chicago. She lives in Little Rock, Arkansas, where she is an artist and advocate for family caregivers and end-of-life preparation.)

Some evenings at our little dinner table for two, my late husband, Bob Lehmberg, a palliative care and hospice physician, would say, “I told the patient and family, they were into Precious Time.” The emphasis is on “Precious.” I can still hear his soft, fatigued voice saying it:

Precious Time

Precious Time

Precious Time

A type of time, a distinct period of life, its end. My husband, having been through end of life countless times professionally, and I, having been through it many times personally, both of us felt that someone outliving a loved one and feeling or saying, “I thought we had more time,” was simply a far greater failure than introducing the reality of an impending death. Many clinicians do not want to tell a patient/family that death is approaching. So, my Bob in his compassionate, wise way termed it Precious Time. Patients and families consider being told that they are into Precious Time a true gift. I know this because Bob received handwritten notes from surviving loved ones thanking him for letting them know.

Another few short sentences Bob would frequently put together when talking with me or a colleague were, “I have seen death thousands of times; it is peaceful. The patient is going to be fine. It’s the family I worry about.” In other words, Precious Time is when the loved ones have an opportunity for reflection, being fully present, saying what needs to be said and not saying what is better left unsaid. Precious Time is when the loved ones have an opportunity to start establishing the foundation for their survivorship. Being fully aware that a loved one is dying or will die soon is a chance to eliminate or minimize some regrets.

Using the term “death” or “dying” with a family can feel too harsh coming from a healthcare professional. Yet “transitioning” is too opaque and often misunderstood.  Bob would tell patients and families, “End of life is nearing” so you are into “Precious Time.” The language is clear, simple, understandable, and kind. It helps the loved ones understand, this doesn’t go on forever. This is difficult, beautiful, and fleeting.

Bob coined the term “Precious Time” as a type of time. The text on the page I devoted to Precious Time in my art journal, which became the book The Hospice Doctor’s Widow: A Journal, reads:

Precious Time

He has helped families understand

by telling them they were into

“Precious Time”

Meaning death is likely, if not imminent.

Precious Time is when you say

what you need to say and don’t say

what you will later regret.

Now, it is us. We are into Precious Time.

He is going to die of this disease and

I will go on and have to live with

how I handled our Precious Time.

Since the book was released in 2020, I have been elated to learn that healthcare professionals of all types have adopted the term “Precious Time”. An ICU nurse at a hospital in Canada wrote me to tell of how a patient in the unit was clearly dying but the attending did not want to call the family and tell them that their loved one would soon die. The nurse sat the attending down and explained, this is the family’s Precious Time. The doctor heard her, called the family, and they were able to make it to the hospital before the patient died.

Yet another nurse in a long-term care service, shared the term with a first-year resident who was then able to understand the importance of writing some orders that would create a more comfortable death for the patient, thereby for her family and close friends.

Precious Time has been included in my contributions to two other books. One is a textbook being published by Springer called Communication in Oncology: Candid Conversations about Death and Dying. My chapter includes a section on Precious Time and helps oncologists understand, this is when the family begins establishing the foundation for their survivorship. The Precious Time section asks oncologists to please give patients — moreover, their families (those who will survive them) — the gift of letting them know they are into Precious Time. Knowing that Precious Time has started is a significant element of regret prevention. I ask oncologists to get comfortable with the term, use it, and repeat it with patients (and especially families) so that they develop awareness. Every life ends with death. There will not be a chance to do it again, and they will go on after their loved one has died.

Frances Arnoldy’s latest book, The Death Doula’s Guide to Living Fully and Dying Prepared: An Essential Workbook to Help You Reflect Back, Plan Ahead, and Find Peace on Your Journey, scheduled for release in July 2023, includes a contribution on Precious Time.

I have absolutely no regrets that stem from the 22 months Bob was ill because we knew from the point of diagnosis we were into Precious Time. Perhaps it was early onset Precious Time. I am not sure Bob ever told a family they were into Precious Time nearly two years out, but I guess that’s how it goes when the guy who coins the term gets a terminal diagnosis. Every moment of our Precious Time was not picture perfect, but knowing that death was in the near future helped me focus on knowing I would go on and have to live with how I handled our Precious Time. Not everyone gets Precious Time. It is a blessing if we recognize it for what it is, name it, and face it.

Bob would be so happy to know that “Precious Time” is helping clinicians offer the gift of clear, kind communication about an impending death. Please, use the term. Practice it, and perhaps role play with it so that you feel comfortable sharing it and engaging the patient and family when their Precious Time comes.

Jennifer’s art journal was published as The Hospice Doctor’s Widow: A Journal in February 2020 and has won four awards including a Nautilus silver award in the Death & Dying/Grief & Loss category. It is available at https://www.amazon.com/Hospice-Doctors-Widow-Journal/dp/1944528091  She can be reached at https://www.hospicedrswidow.com/ and https://www.facebook.com/hospicedrswidow.

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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.

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