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.