Learn to be in the moment with your heart open.
The author writes: “Sometimes, I ask patients if a healthcare provider has ever talked with them about their emotional suffering. To date, not a single patient has answered yes.”
I recently spoke to a hundred nurses on the topic of seeing and ameliorating patient suffering. Before I began my presentation, I asked the audience who among them, while in nursing school, had learned or talked about patient suffering. No one raised a hand.
Although I had long known the topic of emotional suffering is generally ignored in healthcare or, at best, left to chaplains and palliative care clinicians, I was surprised and disappointed to see not much had changed since the 1990s when I was in nursing school.
It was in graduate school where I first learned about the true nature of suffering from reading Eric Cassell’s classic book The Nature of Suffering and the Goals of Medicine, first published by Oxford Press in 1991. His rendering on the concept of individual suffering helped ignite a shift in how medicine is taught and practiced that continues to this day.
A few years into my nursing career, I heard Cassell speak about suffering to a large gathering of cardiology providers. He explained that his medical education had been based on the mind-body split. Medical students were trained to become physicians who do things to sick bodies. They might address physical suffering, such as pain, without ever considering the patient’s emotional anguish.
Affliction of the person
Cassell said he realized early in his career that, everywhere he went, there was emotional suffering—suffering that was not acknowledged or addressed. He concluded that suffering was an affliction of the person, not the body. He learned to be in the moment with his heart (or soul) open so the patient would flow into him. Then he could “see” the suffering.
In graduate school, I had planned to research end-of-life issues until an enlightened professor suggested I look at quality of life instead. Until people actually die, she explained, quality of life is paramount. Besides, it can be difficult to impossible to predict when a patient will die. Immediately, I shifted my focus to chronic illness and advance directives, both of which address suffering in the context of end-of-life care.
In the early 2000s, I worked as an evening shift supervisor with adult psychiatric patients in a large hospital. When I had time, I chose someone I did not know to talk with in their room. My goal was to discover the source of their suffering and not leave the room until I had realistic hope for that patient. I discovered that the main distress of patients was not their diagnosis as much as their emotional and spiritual suffering.
All but one
In recent years, while working with adults suffering from addiction, I began asking patients if they had endured trauma or abuse as young children. Then I asked if they saw any connection between their early trauma and eventual addiction. All but one answered yes to both questions.
The one exception was a woman in her 30s. When I asked about childhood trauma, she said no, she had not suffered trauma or abuse as a child. I was silent for a moment. Having listened to her personal history, I was certain she had been abused at a young age. Yet I did not want to contradict her—it was her personal story to interpret.
Before I could think of what to say, she added, “Well, my daddy pulled me up the stairs by my hair when I was 16.” Then she began to cry, saying that no one had ever asked her about her suffering.
Many of the patients I talked with said they were in active addiction by the time they were adolescents. All expressed that using alcohol or drugs helped numb the effects of the childhood emotional suffering they were still unable to comprehend or process.
See with your heart
Today, I work in a large healthcare system where I talk with patients every day. My clinical assessment begins with conscious attention to my heart being open. Then I relate to the patient as one human being to another. Through our shared humanity, the patient often reveals how his or her personal suffering has impacted quality of life. Loss of dignity, loneliness, hopelessness, and powerlessness are common themes.
Sometimes, I ask patients if a healthcare provider has ever talked with them about their emotional suffering. To date, not a single patient has answered yes.
I continue to wait for the medical profession to understand what Antoine de Saint-Exupéry meant when he wrote in The Little Prince, “It is only with the heart that one can see rightly; what is essential is invisible to the eye.” RNL
Donna Helen Crisp, JD, MSN, RN, PMHCNS-BC, a resident of Raleigh, North Carolina, USA, is a nurse ethicist and the author of Anatomy of Medical Errors: The Patient in Room 2, published by Sigma Theta Tau International Honor Society of Nursing (Sigma).