E18: 7 Domains of Time

What is your relationship with time? There's that wonderful little saying, "Time flies like an arrow and fruit flies like a banana." So what is your relationship of time? And how do you think about time? And we're going to talk about that in the 7 Domains today. We talk about the seven domains of time.

We use time all the time, when we are interviewing and doing examination on patients. And I will say that the most important time that we pay attention to is heartbeat. That business of listening with a stethoscope to another person's heartbeat is one of the most powerful, I would say privileged, to have someone's body between my hands, one hand with a stethoscope, listening to someone's heartbeat.

Now, what's normal heartbeat? Well, normal heartbeats are somewhere between 60 and 100. But to me, it's just wonderful that our heart beats about once a second. Some, of course, are faster, and some, like my husband, who is an athlete, routinely, when he is resting, can run at about 40. And of course, children can run a little faster because they're still smaller and their hearts aren't that big, and they can often be a little at the higher end.

We call rapid heartbeat, over a 100 beats per minute, as tachycardia. And we call slow heartbeats, below 60, as bradycardia. But the fact that our heart beats about once a minute, and if we pay attention, we might be able to feel our own pulse, or we maybe even can hear our heartbeat in our ears if we're working out really hard.

When our heart is pumping hard, we can hear that blood flow every second. That's a wonderful connection to time and it's extremely personal, but it's something in medicine, we pay a lot of attention to heartbeat. When it's too fast and when it's too slow, and when we're listening to the heartbeat, does it have any extra whooshes? Does it have any extra sound in there?

So the archetypal time in medicine, is the heartbeat, and it is precious. It is precious when women are pregnant and the very first time, even before they have a fetus that looks very much like a fetus, you can use Doppler ultrasound, looking at sound waves and look at the heartbeat.

It's not really even a heart yet, but at about six weeks of gestation, there's a little tube that's working on making itself into a heart that has a beat to it, and that heartbeat, when you go to your OB visits, when they listen to the baby's heartbeat, is one of the most powerful emotional connections with a mom and maybe a dad, or a grandma or a sister, or of a new brother, listening to the baby's heartbeat is a wonderful thing, and it matters how fast it is and how slow it is.

Now, there are other things in medicine that we measure in time because there are other rhythmic things that happen, and I would say that if you're in labor, for women especially, regular contractions in active labor is one about every three minutes. And in fact, it doesn't last a minute. It lasts maybe a minute and a half, and then you have a little rest time, and of course the time of the contraction is eternally long. And the rest period, when the uterus is resting between its squeezing, is way too short. But we think about defining active labor as contraction's there about every three minutes.

So our body is filled with smooth muscles, muscles that we don't have control over, that beat in their own rhythm. So the ureter which carries urine from the kidneys to the bladder, contracts rhythmically. The gut contracts rhythmically, and our uterus, when we are in labor, contracts rhythmically, and our heartbeat contracts rhythmically, and that rhythm is the pace which those muscles tend to work at. Each one is a little different and is different person-to-person, but when we think about rhythm, we think about time, and it's very personal.

Another rhythmic thing that happens is, a woman's period. So time matters. Women often mark on their calendar how often they have their periods, and for women, who are regular, they have their periods on time, their period is about once a month. And it just happens to be that a frequent once a month is about every 28 days, which is actually about the time of a moon cycle. So most women who are pretty regular, have about 13 periods a year, but they mark it by time and that time is another anchor to a rhythmic process that anchors us all to health.

Women who have periods that are not on time, when they say, "My period isn't on time," it could be pregnant, it could have medical problems. It could be that their periods are slowing down because they're ending the end of their reproductive life and moving towards menopause. So having your period on-time is a marker of good health.

Now, if you're taking birth control pills and you take them so that you have a period once a month, that time is totally artificial. But for women who are making their own time and marking their own time by their periods, it's about once a month. And all of this actually helps us think about time as both linear and cyclic. Linear, meaning moving forward, like an arrow, time flies like an arrow. Cyclic, in the terms of once a month, once a year, those things tend to be more recurring at a specific time. And this is all part of how important time is to your physical health.

Having a regular heartbeat is precious and I hope everyone who is listening can listen to their own heartbeat, or feel it on occasion. Feel it pick up when you're excited or anxious, or working out hard. Those of us who work out, try to get our heartbeat going faster because that's a sign that you're working hard enough to get cardiovascular fitness.

Okay, now we're going to move away from the importance of time in the medical, physical sense. So I'm pulling in my producer Chloé, who is my resident millennial. I am our resident boomer, and we're going to talk about what it means to be on time.

 

Dr. Jones: So Chloé? Chloé is here, and Chloé, tell me what you think is on time?

Chloé: So, for me, being on time there's two-folds. There's one for just general Chloé, the person. The other one is Chloé, the woman. I think as a person, I kind of think about my age right now. I am 31. I think I'm at that point in my life where I think about my career and whether or not, I'm at the point where I would like to be or if I need to change my career. I've been thinking a lot about getting my PhD as well. Each year I go, "I'm going to get my PhD this year," and then the year passes and I'm like, "Well, there goes one year." And I have also noticed a year goes by a lot faster.

Dr. Jones: Ah, yes.

Chloé: I don't know if it's because it's COVID and we're stuck inside.

Dr. Jones: No, no, I'm sorry, Chloé. This is the nature of getting older and it's an interesting, both emotional phenomenon and we're going to talk about this. We're going to talk about the emotional aspect of how time changes, but as you get older, remember when you were 15 and the summers just lasted forever?

Chloé: Oh forever, forever.

Dr. Jones: Or, if you were in a classroom, you could barely get the clock ticking all the way from five minutes till to on to when the class changed. Well, getting older is it means that time passes in a different way. So how does that make you feel? Do you feel like you have less time than you did 10 years ago when you were 20?

Chloé: I really don't think about it as less time. I think more about I need to do more with my time. Yeah, so it's a different kind of mindset but at the same time . . .

Dr. Jones: The same time . . .

Chloé: At the same time, I feel like there's so much stuff that I need to be doing.

Dr. Jones: Right.

Chloé: Do I have enough time to do it all? And, in relations to that as well, then it goes back to that other side of me who is a woman. You know, our bodies, they always call it the ticking . . . it's a clock, right. Yeah, it's a ticking clock and I currently don't have a significant other yet. Start a family, it's a bit further out there and it's just well, do I have enough time to do all that, to meet somebody, to feel comfortable enough to start a family with them, and then to actually start the family, how long that's going to take? And so it's all up there in my mind right now.

Dr. Jones: I think that's exactly right and there are developmental issues for people who are at 30, that recognize that the choices that you make in your early 30s will both open and close doors. Part of being in your early 20s is that all the doors are open, you could be anything. And then part of being in your 30s is, if you're going to get really good at something, now is the time to put the time into it, but doors are closing.

You don't have forever to do some things, some things biologically, like having kids, or some things with respect to your career or education. You know, there are times when things really need to move along. And I think just part of that, that what time means and there's a little more pressure, and it turns out that if you look at depression and anxiety, I think women begin to feel this pressure in their 30s that they didn't feel in their 20s.

Not that anyone is necessarily depressed or anxious about being in their 30s, but the realization that there isn't infinite time left. A lot of time, you can reach for being at the top of your field, if you choose to. You can reach for being a mother of many, if you choose to, but now is when the time you've got to choose.

Chloé: Yeah, it's difficult. But Dr. Jones, how do you feel about your time?

Dr. Jones: Well, I'm a little melancholy about my time, I'd say, and well, I was. So I was thinking, "Okay, I have about ten years of life yet." I've always said I had about five years left of a good brain, but only ten years of my life, and I was thinking okay, what am I going to do with these ten years, because the last ten years went by like an arrow. It flew by. So there wasn't much time and I thought wait, wait, wait, this is where I'm going to ask Google how much time I have left.

Chloé: Because Google can answer that question for you?

Dr. Jones: Well, Google will lead me. Google won't, but Google will tell me. So I went to, I plugged in longevity predictions. And lo and behold, it turns out if you do that, you do lifetime expectation or life expectancy is really two good words. They're good here.

The Social Security Administration has a little expectation because you need to kind of know how much you're going to live. I mean, avoiding getting run over by a car, struck by lightning or getting cancer that's, you know, it's already growing in me now, the cancer that would kill me is already cooking, because I'm old enough for that to be an issue.

But the Social Security Administration suggested, and they only asked my sex and my age. And they said I had 17 more years, not 10, 17. I went, "Oh."

Chloé: That's seven whole years.

Dr. Jones: That's 7 whole years I just got given this gift, and it was a pretty good gift. I mean 80 to 87, oh okay, that's good. But then I thought, "No, wait a minute. I'm going to go to the actuaries."

Now, actuaries are people whose business it is to know the numbers of how long you're expected to live, given certain parameters. It's a person skilled in the application of the doctrine of chances to financial affairs. And so health insurance and insurance companies really want to know how much time you might have.

So I went to the Northwest Mutual website on life expectancy and they asked me a lot of questions. They asked my height and weight, and some family history and about my veggies and whether I smoked and what my alcohol was, and exercise, and I didn't fib on any of these, really truly. So they suggested my life expectancy was 100, and I went, "Oh no, no."

Chloé: That's like, in actual like 20 to 30 years.

Dr. Jones: I know. I know that's 20 years over what I had thought and I go, "No, I don't want that." I mean, I might want that when I get to be 85. That might look good, but from where I'm sitting now, and it's always where you're sitting now.

Chloé: Right.

Dr. Jones: 100 looks way too old. So I wanted a second opinion.

Chloé: Second opinion about how long you'll live?

Dr. Jones: Yes. What's my average life expectancy if I weigh this and I drink that little and I don't smoke and my family doesn't have heart disease and blah, blah, blah. So I went to John Hancock, another insurance company, and they asked a lot of questions, some of the same ones. And they calculated 97.

So here I was feeling melancholy that I was almost done, and now I have to worry about, if I . . . I have to take better care of myself. So I immediately took a walk on the lane and put up my TRX machine and started doing push-ups and . . .

But you do begin to feel that there isn't enough time to necessarily be with the people you love, and I find that I want to get in contact with people that I knew, back when I was 20 and 30, who I've lost touch with, as they were important to me. So, anyway, my melancholy went from melancholy to worried about I might live too long.

Chloé: Huh, that's such an interesting mindset because here I am at 30, I'm wondering do I have enough time to live, and I know 30 is a little bit earlier to be thinking about that.

Dr. Jones: No, no, no.

Chloé: But then here you are thinking about now there's too much time to live. And it's just like on the opposite spectrum, but it still worries. They're both very valid worries.

Dr. Jones: Exactly, exactly. Well, you can, after we finish, go right to plugin life expectancy and then you can go and do your own plugins and if you find out that you're going to be 110 because you're a slender Asian woman, then you've got lots of time to get your PhD.

Chloé: Well, lots of time will have to get a PhD.

Dr. Jones: But the baby doesn't matter then, the kids are . . . they work on a different time clock. So there you go.

Chloé: Yes, they do.

Dr. Jones: Well, so being on time is both an emotional domain about where you are in your life, but it's also a social thing. What is on time for you? I know you're always on time for me. So what is on time for you? And if I had invited you over for a drink on the deck and I said, "Come on over at 6:30." When would you arrive?

Chloé: I think I would arrive at 6:30.

Dr. Jones: Oh, good for you.

Chloé: I think I would be knocking on your door at 6:30, maybe at 6:29.

Dr. Jones: I'd be in the driveway at 6:25 hoping that you wouldn't see me and you wouldn't get nervous, but then I would be there on time because I could have been caught in traffic or maybe I would lost. Well, what about your peers? Do you think your peers would be?

Chloé: I think I have the same expectation of other people. I think you give people a certain time for a certain reason, but I am also very aware that things happen, traffic and whatnot, and I might not always be on time as well, but being on time depends on whether or not you're talking about yourself only or if it's another person into the scenario. So if I'm meeting somebody, I'm on somebody else's time.

Dr. Jones: Right.

Chloé: But if I set a time for myself to say, maybe I had to get this certain project done at a certain time, then I'm a little bit more flexible with myself.

Dr. Jones: Right.

Chloé: I say, "Oh, I should have lunch at noon." I used to ending up having lunch at like 2:00 p.m.

Dr. Jones: Well, there are cultural norms. In here in Utah, there is even something called Mormon Standard Time, MST, right. Mormon Standard Time is usually 15 minutes late and it's thought maybe because people have that much of kids and they're busy, busy, busy, all their kids are busy and you do so many things for your organization and your church. People are always out a little bit late. When I invite people over, I say, "Come on over. Is it going to be Kirtly time?" meaning you come on time, "or is it going to be Utah time?" meaning 15 minutes to half an hour late.

But in the U.S., when it's a meeting, it is considered disrespectful if you show up late. That's part of our British, Germanic culture. Americans follow British and Northern Europeans' idea of time. Time is something that's not to be wasted and being late or not being on time is considered to be discourteous. In my family, we have a quote, supposedly from my great grandfather but he may have gotten it up from someplace else, that being punctual was the characteristic of a gentleman and the prerogative of a lady.

Now, I think that's very old-fashioned but we're going back 100 years on that. It's expected in Japan or in Germany that you're there five minutes early so you could put out your papers. And so the clock ticks and then when it comes to that time, everybody is ready. You don't walk in the door at that time. You are totally ready to commence. So you have to get there early.

And it turns out that many places in the world, being on time is not a value. In fact, you might not even show up that day. So particularly in parts of the world where they haven't have a long history of industrial meetings, and I think of Malaysia where my brother lived for many years.

The culture, you could be an hour late, you could be longer, and of course, in Kuala Lumpur the traffic is completely horrendous. And the assumption is that you're never going to make it on time because the traffic is bad. Now, for me, that means I would leave an hour early, so I wouldn't be late. But that's not considered necessary.

So there are number of cultures where being on time is not considered of value, and there are certainly cultures where the value is different and if you bring your values to a meeting or a dinner, and the people you're inviting have a different set of values, you can end up with some social conflict. Are these people being disrespectful or inconsiderate of your time, whereas they just think that it's that's the way it is, or are they just flaky? You know, they didn't know. They don't wear a watch.

I think that being on time, I heard it framed instead of being inconsiderate that there are people who have a formal relationship with time and that time is what you wear on your watch, or Chloé, do you wear a watch?

Chloé: I wear a watch but not to tell time.

Dr. Jones: Oh. Is it a pretty watch?

Chloé: It's a pretty accessory.

Dr. Jones: I wear my watch to bed and I wear it in the shower, and I wear it when I go swimming. I have a kind of a watch thing to nice-looking watch, and it's solar-powered. So it doesn't have a battery that ever needs to be replaced. It just keeps on ticking.

 

Well, I think that there are social norms. There are people who have a formal relationship or a casual relationship with time, and there are cultural norms. I think it's good to know whose swimming pool are you swimming when . . . When you have people come to a meeting or come to dinner, there are people I just never make anything that can't be sitting bubbling on that stove for an hour, because they're always late, and I love them for it, because they're so predictably late. I could just say, "Come at 6:00," and I assume they're going to come at quarter to seven. So they're on time in their own way. Social time means something quite different to different people. That's social time. There you go.

And I'm going to take a detour here and I want to talk a little bit about the circadian clock. So there's some suggestion that we evolved life on this planet deep in the deep oceans next to thermal vents where hot steam and sulfur and everything is coming out deep in the ocean and that maybe where life evolved.

It was not in the sunlight and it was deep and dark and we weren't using oxygen. And we had very simple organisms that did not have a clock. But as these organisms, you know, wandered around our oceans, some got closer to the surface and the most magical thing that happened on our planet was the development of the molecule chlorophyll.

Chlorophyll allows an organism to make energy out of sunlight and carbon dioxide, and the product of that energy is oxygen. And then we started developing an oxygen-rich atmosphere. That allowed . . . this chlorophyll molecule allowed plants to grow. It allowed plants to make oxygen so that we could then evolve multispecialty organisms that actually could live and breathe oxygen.

So going back, these early bacteria or cyanobacteria, these early organisms, being in the sunshine was a very big deal and they evolved the clock genes. So our very first clock genes were in the earliest organisms that used the sun to make energy. So now we have clock genes that have gone through us.

We have clock genes and our clock genes regulate our sleep and our awakeness and our psychological alertness and our intellectual capacity, but they also organize our metabolism and our digestion and potentially our microbiome. And when you don't live your life in terms of your eating and sleeping according to your clock genes, you can get sick.

Now, it turns out that there are many people who work shifts that are nighttime shifts, or they work swing shifts. So they work days for a couple of weeks and then they work evenings for a couple of weeks, and then they work nights for a couple of weeks, or they work in an emergency room and they just assign you to so many nights and so many days, so you're all over the planet.

Or maybe you have a nighttime job because you and your partner are raising children and someone needs to be home during the day. So one of you takes a night job and one of you takes a day job, so that there's always someone to take care of kids. But single moms who work nights, have to have a nighttime nursery. So there are some nurseries that are open nights.

Our country is filled with people who are working nights and they're working nights because it's a financial choice. There are some people who love to work nights because they're night people, but most people make it a financial choice and it has health consequences, because when you eat at times that your body isn't regularly ready to eat, if you're not sleeping very well because you're working nights and working days, it increases your risk of diabetes and obesity. You're often not at your best at work because you're tired, or you're not at your chief alert time.

So we often make financial decisions to take jobs because it pays more. People who work night shifts have a night shift differential, meaning they get paid a little bit more when they're working nights.

I thought once upon a time that I would write a book called A Thousand and One Nights On Call, kind of not refund the Arabian Nights, a thousand and one stories, a thousand and one stories of my training when I had a thousand nights on call. And then I thought I'd also write a book about sleeping with the enemy, which is me with a beeper next to me 24/7/365, because night times were unique times.

When you're in medicine, what happens at night is a little different and it's kind of unique and of course, OB is a 24/7/365 business, but it's hard and we make these decisions because we either love working nights or we have no choice as part of our career. But there are consequences to our health.

We live here in the Intermountain West and there are rocks around us everywhere, and we can see for a long ways. We can see the rocks that are in the mountains that are 30 miles away. And geologic time is very different. So when we are talking geologic time, we're talking about billions of years or hundreds of millions of years, and geologic time, sometimes when my clock time makes me nervous or worried or things are happening around me in my life, when I look at geologic time, it's much more reassuring to realize the earth has a different pacemaker some times. It certainly has the day and night pacemaker because the earth spins, but geologic time is quite different.

But going to earth spinning, we certainly not only spin around ourselves but we have our own little rotation. We have a moon spinning around us every 28 days, but we spin around the sun about once a year and we get closer and farther away from the sun, particularly at those of us in the temperate zones away from the equator, and time gets all fussed up when we have longer summer days and shorter winter days.

And once upon a time, it was decided in the U.S. and in Britain that we would have daylight savings time. And daylight savings time was, the farmers are going to get up when the roosters get up anyway, but it was so that their factories could keep people coming to work at the time when it was tend to be light. Although, there were 24/7 factories during the war anyway.

So daylight savings time is a leftover of an effort to try to manipulate people's times. I think there's an increasing movement to banish daylight savings time because we are a 24/7 economy and daylights savings times just bums people out. They forget it or they lose an hour of sleep and then they have more accidents on their way to work. And more and more people are thinking about eliminating daylight savings time. And that might actually happen.

So many of our times, geologic time, which is so reassuring because it is so long and so slow, and then there's the annual time and then there's the daily time and the monthly time. So we have many times in our environment and it makes a difference in terms of when we plant things, how we grow things, how we drive when we go out. How we look at the planet around us, which changes you know, in annual time.

So our environment has cues about what time it is, and those rhythms are supported in some environments in some cultures and in some religions have lots of different kinds of celebrations depending on what time it is, whether it's harvest time or whether it's planning time or whether it's the solstice, the sun coming back time. So time plays into our culture, our world around us in a way that's very reassuring and it's separate from this tick-tock, tick-tock clock on your wrist that tells you that you're going to be ten minutes late for a meeting and you better hurry up.

I think all of us know that our own chronobiology affects when is our best time to take a test. Clearly morning people, people who like to get up early, do very best on tests, particularly timed tests in the morning. And if you're a night person and you're not really totally awake until 10:00 in the morning, taking 8 o'clock test would be difficult and not necessarily your best performance.

Intellectual time is also creative time. People tend not to be terribly creative first thing in the morning. And we think about people who are poets and writers and singers, and all those things tend to be done in the evening time. So our cognitive time is going to be very personal, but our emotional time and our cognitive time is a function of our own chronotype.

Do we get up early, feel energized, we can solve problems, go run, go do something wonderful? Or, are we creative and we feel much more creative in the end of the day? We feel more social. We want to go hang out with friends. We want to listen to music. We want to make music. So our intellectual time is very personal, but it actually has some science behind it based on our chronotype, when our brain's most active, when we're the most thoughtful, when we're the most emotionally connected to what's going on with us.

Now, time, in a physical sense, doesn't always match what your clock is saying. It's not tick-tock, tick-tock. When you go to sleep at night, if you're fortunate enough to have, go to sleep when your body is tired, and it's appropriately tired with exercise and you didn't have a big meal and you didn't have caffeine in the afternoon, and you didn't drink too much alcohol, then you might go to sleep and not wake up for some hours, or maybe for eight hours, in which case time, at least to your conscious mind, completely disappeared.

You may not remember your dreams. You went to sleep and you woke up and it was light, and that eight hours was gone from your cognitive function. So that is where time moves so quickly. But for people with insomnia, or you had too much coffee in the afternoon, or you drank too much wine and now you're wide awake. You went to sleep a little bit for a while, made you sleepy, but now it's 2 o'clock in the morning and you're wide awake. And then you look at your clock and then you lay there and you look at your watch and it's 3 o'clock, and then you look at your watch and it's 3:10. And then an hour went by, and it's 3:15.

When you're hoping for something to happen, like you're waiting for someone to come home and they haven't arrived and you're worried about them, or you really want to go to sleep and you can't sleep, and your mind is racing, that's where time seems to be very attenuated, it lengthens out and you're just watching your clock and it goes by so slowly.

Perceptions of time can be quite different, depending on what your mental state is. So your heart can be racing and you can be racing, and time just seems like it's passing slowly because you're so busy worrying about whether you're going to go to sleep, or there's the very precious nature of being able to crawl into bed and get cozy and just turn off the switch. Then eight hours later, the switch turns back on, and those eight hours your brain was doing a lot of work, a lot of work during that time, and your heart was working that time.

People who are very good at meditating, who spend a lot of time in this trance-like state, lose time altogether. There is no concept of linear time in the deeply meditative state. MRIs looking at the brains of Buddhist monks who meditate, show that the part of their brain which connects them to their body, that recognizes their body, their inside, their outside, what's going on around them, tends to shut off and they would say that they feel like they're connected to cosmic time, and this is not seconds and this is not minutes or hours. This is a kind of time that is timeless.

So people who are deeply meditative in prayer or deeply meditative in meditation often say that time is completely different in that dissociated state when they're deeply into their spiritual life. So there's a lot to be said about being disconnected from the tick-tock, tick-tock of daily life, of being on time to meetings, of being on time for meals, to spend some time when that tick-tock, tick-tock no longer actually registers for people who are deeply engaged in their spiritual meditation. And there's a lot to be learned to uncouple your brain's processes from the dailyness, the quotidian nature of the tick-tock and intercosmic time.

So that kind of takes us through the seven domains of time and we're grateful that you joined us and you can join us anywhere that you get your podcasts, and The Scope has other wonderful podcasts that you might be interested in. Long-form shows about men's health and Clinical, about life in the hospital, and the Bundle of Hers, about life as young women becoming clinicians.

So join us wherever you get your podcasts and I'm going to leave now with the last little bit of the 7 Domain series, and that is a haiku.

 

Once every second
My heart connects me to life
The only real time.

 

And so now, to take us out, here's a clip from Judy Collins, one of the great voices of the 1960s and '70s with "Who Knows Where the Time Goes."

[Soundbite of "Who Knows Where the Time Goes" by Judy Collins]