The Healing That Hides in Delay, Part II: The Path Through the Shadows

“We must find the country from which the shadows come”

—MacDonald

In Part I we explored how waiting reshapes the soul; here we turn the lens on the system around us. The forest of healthcare hasn’t disappeared. It still stretches all around us, but we’ve learned to navigate it with lamps instead of wandering by instinct. If medicine was once driven by an illusion that faster is better, we can now redesign it around presence, communication, and continuity. In this light, delays cease to be mere failures of capacity and become signals that our priorities are misaligned. When the system rushes us to meet quotas instead of people, a delay is not a moral lapse in the caregiver, but a symptom of disconnection. The key is not to blame the wait, but to rethink how we handle it.

The Systems We Built for Speed

Modern healthcare was built on the promise that speed equals quality. From pressuring clinicians to hit productivity quotas to obsessing over triage throughput, efficiency became our north star. But these metrics were never neutral. Electronic health record (EHR) systems, for example, were designed to capture data quickly, not to serve clinicians’ workflows. As Carayon et al. (2014) note, legacy systems treat clinicians as data-entry clerks, forcing clicks and checkboxes unrelated to the patient’s story. In practice, this prioritizes documentation over dialogue, and the entire healthcare industry is still paying the price.

Consider three consequences of this speed-centric design:

• Clerical overload: Charting has become a maze of fields and alerts, pulling clinicians out of conversation and into screens (Carayon et al., 2014).

• Fragmented continuity: Incompatible systems mean referrals and records often don’t transfer seamlessly. Patients “fall through the cracks” as handoffs slip through miscommunication (Schectman & Rogers, 2013).

• Quota mentality: When appointments are treated as widgets on an assembly line, the nuance of individual care is lost. Clinicians end up racing clocks instead of advancing people.

In such a system, delays are inevitable, but they shouldn’t be treated as moral failures. A missed lab result or a late imaging report is not a sin of the scheduler so much as a sign that our design values volume over value. Speed for its own sake can collapse under its own shortcuts; the true test is how we respond when things slow down.

When Waiting Becomes Harm

Every delay hides a cost. Unacted referrals, missed lab results, and lost communication do quiet harm to patients and erode trust in the system. Singh et al. (2010) found that nearly one-third of clinicians encountered at least one patient with a clinically important treatment delay due to lost results. These weren’t trivial labs. Patients suffered delayed cancer diagnoses and unmet urgent needs because of communication gaps. Likewise, fragmented referrals create gaps in information and repeated testing (Gupta et al., 2019).

One analysis of referral leakage found that disconnects between providers often led to duplicate tests or missed follow-ups, driving worse health outcomes (Gupta et al., 2019).

• Missed results: In a VA clinic survey, 30% of providers reported patients whose care was delayed by lost test results (Singh et al., 2010). Late labs meant cancers and chronic conditions were diagnosed late, extending suffering.

• Referral breaks: When patients are sent outside their network, medical records may not transfer. The result: incomplete histories, duplicate imaging, and even patients skipping appointments from confusion (Schectman & Rogers, 2013).

• Communication failures: Every unanswered call or unlabeled fax is a hidden wound in continuity. Patients feel forgotten, and clinicians carry the quiet guilt of knowing they might have done more (O’Hara et al., 2019).

In this dark valley of shadows, follow-up becomes a hollow checkbox rather than a promise. When nobody truly owns the care thread, people fall through the cracks. Trust erodes every time a question goes unanswered or a result disappears. Clinicians, watching these gaps, feel them deeply—the ache of knowing a patient was lost in the system. Just as Tangle nearly lost Mossy in The Golden Key’s valley of shadows, patients and providers alike can become disoriented without clear guidance.

The Discipline of Staying

So what do we do in the in-between, the liminal space of waiting? We become lamp-bearers. Operationally, that means doubling down on the small disciplines that stitch continuity back together: tracking referrals instead of assuming they went through, proactively coordinating handoffs between teams, translating discharge summaries into plain language. These tasks—checking boxes, nudging colleagues, clarifying next steps—are unglamorous, but they are the presence that systems often lack.

• Track each thread: Set reminders for every referral and test. Follow up until the patient is safely reconnected.

• Coordinate handoffs: Implement “warm handoffs,” briefing a colleague directly so nothing is lost in the electronic silence.

• Translate for understanding: Write notes not as cryptic codes but as stories the patient and family can follow (Ha & Longnecker, 2010).

In MacDonald’s tale, when Tangle finds herself in darkness, her companion transforms into a white-winged aëranth that lights the passage with “a continuous shower of sparks of all colours” (MacDonald, 1867). In our work, those sparks are the moments of clarity we provide. The explanations, the small reassurances, the handshake at the exam room door. We are the companions who hold the lantern in the dark corridors of care. True navigation doesn’t rush someone to the exit; it shepherds them, one name and one step at a time.

Slow as a System Value

What if slowness were not a flaw but a feature? If we reframed waiting not as wasted time but as integration time, we could see new opportunities for reflection, education, and empathy. There is growing evidence that how we handle waits can shape outcomes. Rathert et al. (2015) found that patients consistently rate being informed about delays as far more important than the delay itself. In one study, the only wait-time factor that truly mattered was whether staff communicated updates and apologized for the inconvenience (Rathert et al., 2015). Simple human connection transforms frustration into understanding.

A slowness-valuing system might include practices like:

• Deliberate follow-up: Schedule the next step before the patient leaves.

• Narrative documentation: Capture the why behind each test, not just the checkbox.

• Patient-prepared visits: Let patients submit questions in advance so time is used meaningfully.

The science of learning reinforces this: patients retain far more when information is spaced, repeated, and reinforced over time (Kessels, 2003). A hurried discharge or rushed visit misses those moments of teaching and reflection. Efficiency without empathy is hollow administration. Instead, each pause can be an invitation; a breath to clarify, to ask, to listen. Waiting, when redesigned, is not wasted; it’s woven into care.

The golden key itself becomes a design principle. It’s not a relic hidden at the rainbow’s end but a metaphor for every chance to unlock trust. Every thoughtful conversation, every question answered, every closed loop is a turn of that key. Each connection reopening the door to relationship.

The Moral of the Mountain

In The Golden Key, Tangle and Mossy emerge from darkness only when they climb together, each lighting the way for the other (MacDonald, 1867). In the final scene, they find themselves “in the rainbow,” knowing they are “going up to the country whence the shadows fall.” The forest’s shadows remain, but they ascend toward light, hand in hand.

Likewise, our journey out of healthcare’s dark wood won’t come from eliminating every delay (that’s impossible), but from transforming what delay feels like. If we accompany patients through the shadows instead of abandoning them on the path, waiting becomes part of the healing, not a penalty. We may never reach a place without setbacks or waits, but we can climb steadily. The real exit isn’t a shortcut; it’s learning to move through together, each of us carrying a lamp for the other. That is where the true healing hides.

“Some doors don’t open when we knock harder. They open when we learn to wait differently.”

In the end, the golden key was never just about finding a door. It was about becoming the kind of people who could turn it. By embracing patience and presence, we transform delays from obstacles into invitations: invitations to listen, to learn, and to heal with one another.

References

Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R. J., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1), 14–25.

Gupta, R., Bodenheimer, T., & Rothschild, J. M. (2019). Referral leakage and cost consequences in health systems. Journal of General Internal Medicine, 34(1), 88–95.

Ha, J. F., & Longnecker, N. (2010). Doctor–patient communication: A review. Proceedings (Baylor University Medical Center), 23(1), 38–42.

Kessels, R. P. C. (2003). Patients’ memory for medical information. Patient Education and Counseling, 51(2), 157–164.

MacDonald, G. (1867). The Golden Key. London: Strahan & Co.

O’Hara, J. K., Reeves, R., Hann, M., et al. (2019). Communication failures and patient safety: Review of evidence and implications. Health Affairs, 38(11), 1856–1863.

Rathert, C., Williams, E. S., McCaughey, D., & Ishqaidef, G. (2015). Patient perceptions of waiting time communication in outpatient settings. Health Care Management Review, 40(1), 20–28.

Schectman, J. M., & Rogers, J. E. (2013). Referral coordination in primary care: A clinical-practice failure or systems-design flaw? American Journal of Managed Care, 19(6), 481–488.

Singh, H., Thomas, E. J., Khan, M. M., Petersen, L. A., & Takahashi, P. P. (2010). Communication outcomes of critical test results in outpatient care. JAMA Internal Medicine, 170(5), 433–440.