Chaplain Shoptalk: Payoffs of Pain

The “Prime Directive” of my seven years on the job at 3 different hospices from staff and supervisors has been, “Our number one priority is to reduce pain: physical, emotional and spiritual.” I imagine this is not shocking news to my readers who are familiar with hospice. Sounds like a no-brainer, doesn’t it? But not necessarily from the patient’s point-of-view. Whoa, huh?  

This subject came up among a few of my colleagues on Twitter these past handfuls of hours, in the context of well-meaning people like friends and family trying to make the suffering (of others, mind you, not themselves) meaningful with theological bromides like, “There’s a reason for everything.”

 “My Twitter colleagues practically gagged as they cried out to each other in mutual pain upon considering such platitudes. We all knew that for a chaplain to say anything like that would be a cardinal sin. We all lamented the destructive theological implications of such clichés. But what about when the patient says it? That’s when pain versus meaninglessness get pitted against each other, with pain often the winner. Or to put it another way, spiritual pain may distress a patient more than physical pain.

Patients often try to make sense out of their physical pain, or try to wring meaning out of the fact that the disease will only get worse. I have had patients refuse pain medication because they argued that their discomfort let them atone for some transgression. Some say it is God’s will to feel pain and therefore we must not question why we experience it. The alternative in the minds of those patients apparently is the more spiritually painful option of saying that God is powerless to prevent disease, or even worse, that God causes suffering at random or does not even exist.

To say that a disease “just happens” no matter the person’s merits, healthy lifestyle, or beliefs, can be more terrifying to the patient than some sort of explanation, no matter how unsavory or imbecilic the implications. To say that a disease is Divine punishment does not put God in an admirable light even for an adult, let alone a child. Yet when a patient says pain and disease are for a reason or are a test of faith and so on, this folk theology prevents them from having their cherished beliefs overturned.

What’s a chaplain to do? This reminds me of situations where I talk with patients who are racist or have other prejudices. (See my earlier post on that topic: https://offbeatcompassion.wordpress.com/2013/08/13/a-contest-between-prejudice-and-the-angel-of-death/ ) We cannot talk people out of their beliefs; we can only let them articulate them, creating a space for them to put those beliefs “out there” and reflect upon how they sound. Certainly once I write something, such as a post, I am almost always dissatisfied with the grammar, choice of words, and the inherent interest of the topic. Thus I revise and revise.

 So it is with speech. I know sometimes once I say something out loud to another person, I may realize it was not so smart or true after all, especially if they do not show agreement. But those people I said it to may be long gone by the time I have sorted that out for myself. So it is with our patients; we are there to enable them to go on to deeper insights that relieve suffering, but unlike published writing, we are rarely privy to the final draft of their silent revisions.

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17 thoughts on “Chaplain Shoptalk: Payoffs of Pain

  1. Ross Hobe says:

    Always quite literate and interesting, your writing here goes to an altogether more intense and memorable level.

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  2. len d says:

    very interesting topic .. something we , that are lucky to have health and “normality” in our lives never consider.. the reactions people have considering their situations is truly thought provoking .. very interesting Karen .. well done , you always make us think on other levels

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    • Thank you. Few people realize that chaplains are not there just to dispense some stock prayer like a “spiritual pill,” but are primarily visiting patients to help them plumb those multiple levels and thereby increase their self-awareness.

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  3. ‘I revise and revise’ – I find Karen’s comment applicable to myself, and hopefully to all of us as life progresses. This article also made me realize I had somehow missed Karen’s blog on prejudice, a subject close to my heart, so I shall go there now.

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    • Very good words. I have been surprised how many times I have heard people in distress and grief voice the thought that God has a reason for doing “this”. I have heard parents stay it at a time of a sudden infant death and others say it when someone has died in a crash. In that moment, framing it in this way is bringing them comfort and I am there to accompany them in their journey…even when their journey is expressed in a theology that is far from what I believe. My usual response is, “Yes, God can create a reason.” In this way I affirm the spirit of what they are truly saying, without endorsing the God it portrays.

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      • Dear “Patience with Questions”: It does seem the more meaningless the death, the more acutely one can feel the need to account for it and not just fall to pieces amongst the other pieces in a cold chaotic universe.

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  4. Dear Elizabeth, I’m glad you find it applicable to yourself. This means you do the work of being self-aware, which opens the doors to richer and richer insights.

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  5. Laurie Dinerstein-Kurs says:

    Karen – you phrased it perfectly!
    There is no question that some comments made by patients can seem somewhat bizarre, to say the least. Particularly when their view is radically different from ours (as the chaplain), not of a mainstream variety or just even a well known position held by many, i.e., – that G-d doesn’t give us more than we can handle or this must be Divine punishment, etc. Of course their remark: “I want to suffer, it is my due”… is a hard nut to crack when it is obvious they are in spiritual turmoil.
    How to relate to these comments, how to respond to the patient and learning what it is the patient is really contemplating, are the finer details of a good pastoral visit.
    How in-depth one can direct the conversation really depends on how much time both the patient and/or the chaplain have – and how open to dialogue either or both actually are, can really impact and determine the course and direction of the visit.
    Comfort of the mind and peace in the spirit – both impact healing – no matter what the view.

    Laurie

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    • Shows to what extent good pastoral care is art as well as science. As you say, how ready the patient really is to cast off defenses is key to how far the conversation can penetrate depths scarcely known to themselves. Thank you so much for your high praise.

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  6. Nancy Lloyd says:

    While visiting brother-in-law who had a major stroke 5 years ago and quite a few “events” since. I find I must force myself not to say “How are you?” Imbecilic, indeed. He gets worse, then “better” by way of extensive physical therapy, then worse over and over. He’s not fine but not near death and not well either. Help, chaplains! give us more insigth and better words.
    Nancy Lloyd

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    • One way I circumvent the absurdity of the “How are you” question is to say, “How are you doing at the moment?” (or “this morning” and the like.) That covers both the “good” and the “bad” days. I am so sorry to hear of this agonizing “middle ground” that your brother-in-law must tread. Just be present to him without trying to say anything special, and without trying to “fix” his distress. The paradox is that by not fixing or resolving or helping, such restraint on our part is itself the means to resolution and help.

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    • Laurie Dinerstein-Kurs says:

      Ah, what to say to someone who is NOT doing well……
      This is quite the challenge. Much depends on in what capacity this visit is being executed. Is it a friend, a relative, a chaplain??? Is this visit in the home, in the hospital, in rehab??? The answer is often determined by these influences.
      For the healthy person who is searching for the right words, the perfect opening to offer someone who is NOT doing well……much depends on the relationship – on the projected outcome – on the pt’s age – on the pt’s personality – the visitors personality – the time of day – the length of time the pt. has already been ill or incapacitated – anything and everything said prior to this visit, by anyone and everyone. And a zillion other possibilities abound. No wonder there is such a sense of apprehension and concern to say just the right thing. Oftentimes, there is an equal sense of trepidation of behalf of the patient – in how to accept stupid remarks, hurtful comments, silly observations and heartless suggestions without appearing annoyed, disturbed, shocked or offended.
      So, not unlike paying a visit to a recent mourner….sometimes less is best. Sometimes just showing caring is sufficient. Sometimes merely letting them know that you are saddened by the turn of events validates their feelings of sadness.

      So, in my humble opinion – there is no one greeting or comment that will fit every visit. Common sense should guide one – and walk gently on their feelings. A sincere offer of being available to help in some concrete way is often very welcomed – and eases ther conversation into something positive. From offering to walk the dog, to watering the plants, to just being available for conversation. Saying it is totally unkind if you have no real intention of following through.
      What to say can be as simple as “I am glad to see you”, to “I treasure our friendship – can I help you with the laundry?

      Laurie

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      • Laurie, you so adroitly describe the conspiracy shared by both visitor and patient of each “protecting” each other from feelings and needs of each at the moment. Thus both waste energy putting on a cheerful face. Nancy, the best gift we can give the sick is to let them know that they can drop the cheerful front and share how they feel without worrying about how you will take it. Indeed, “less is more” in terms of “what to say.” The simpler the better. An opener can be, “I’m here for you. ” Then just wait and see what your loved one says, and let him guide you as to where the conversation might go next.

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  7. […] Chaplain Shoptalk: Payoffs of Pain (offbeatcompassion.wordpress.com) […]

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  8. […] the discussion through commenting below. I furthermore invite you to look at my related article: https://offbeatcompassion.wordpress.com/2013/10/07/chaplain-shoptalk-payoffs-of-pain/ **************************** Note: I recently wrote a guest post about why I wrote Encountering The […]

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