He was in agonizing pain and pleaded to a doctor for pain relief, adding that he had not slept for several days. Not only was pain relief denied to him, but he was also insulted by a doctor with the words, “What do you want me to do? Sing a lullaby and rock you to sleep?”
Even after a year, the patient says that he cannot help being angry with that doctor and cannot help feeling like wanting to stab him with a knife.
We as health care professionals can add insult to injury by our behavior. We can be cruel not only by denying pain relief but also by refusing to feel and empathize.
Why do health care professionals behave like that? Is it just callousness or is it a sense of helplessness from not knowing what to do when faced with pain and suffering?
Venu (not his real name) had come to us for pain management. He was diagnosed with have transitional cell carcinoma of the urinary bladder and underwent radical surgery and bileteral uretero sigmoidostomy in 2009. That was the medical story, the past. All that was no longer relevant. Only the pain was.
At 60 years of age, Venu was the bread winner of the family. He had four children, three daughters and one son, all of whom were married and living elsewhere with their own families.
His job was harvesting coconuts; manually climbing up to the top of each coconut tree and cutting down bunches of coconuts and the leaves. It was hard work, climbing up and climbing down all day, but he was a hard worker. Like many men from similar background, after the hard work during the day, he would spend some time in his evenings with his friends, drinking, smoking, and chatting.
His wife spoke about him with great affection. “He was a responsible family man,” she said. “Though he would drink every day, unlike other men, he always took care of the family needs. We had a good life. He did not deserve this (cancer),” she cried.
Venu came to us with several issues, including pain, incontinence, and sleeplessness, but for pain more than for anything else. When I first saw him, he looked very tired, anxious, and dejected. Initially he was reluctant to share his feelings. But later, he spoke about his family, his work, his interests in life, and his treatment so far.
And as the treatment progressed and his pain became bearable, he opened his heart more. One day, he told me about an unforgettable experience that he had while he was under treatment at a government hospital.
He said, “When I was under treatment at that hospital, I was in severe pain. I used to howl in pain, it was so unbearable. It was like my whole body was on fire. How would you feel if someone lighted a fire under you and made you lie on it? It was like that. And because of this pain, I could not sleep. Oh, it was unbelievable.
There would be some relief when I was given injections. But that happened only once in a while. One day when the pain was much more agonizing than the usual, I asked the doctor to do something to relieve the pain. I was desperate. It was days since I had slept, I told him.
But the doctor’s reply was: ‘What do you want me to do? Sing a lullaby and rock you to sleep?’ I felt as if someone had slapped me in the face. That remark hurt me deeply. I felt angry, hurt, and insulted. I almost felt like stabbing him with a knife, and that became an overpowering feeling.
That day I realized that anyone may earn a medical degree, but to become a ‘real doctor’ he needed to be sensitive to not only to the patient’s physical problems but also his feelings.”
“All this happened a year ago, but I still cannot forgive that fellow,” Venu concluded.
I found it hard to believe that a doctor or any health care professional for that matter could or would behave like that. I am a medical social worker; I know all about therapeutic distancing. But I felt angry and then also hurt, as if someone had done me a personal injury.
We, as health care professionals are “trained” to care for the patients. We get trained for two, three, five and more years to become professionals and of course, we get our highly esteemed degrees. It seems that somewhere along the way, our sensitivity, warmth, and compassion die out.
We are no longer human, but become the lifeless prefixes to our names or the cold degrees that we earned.
A week after his discharge, Venu came to us for review. His pain was under control with medication and his sleep had improved. He confessed that when he first came to us he had come with no hope at all; he had decided that this would be his last visit to any hospital for treatment.
He said he was done with going to hospitals, taking medications that did not help and being treated like “an outcast.” He said the way he was treated here made a lot of difference. He felt people believed him when he mentioned the severity of his pain; he felt cared for and respected.
This was an important lesson for me too. Many times we say things we don’t really mean, we say things callously, we do not really think how or if it would hurt and pain others. If it is to a friend, we may at least say we are sorry. But when we hurt a patient, we do not even do that.
Why do we behave like that? Why did that doctor behave so cruelly? Was it just callousness and abuse of the power that he had on that helpless man? Or did it come out of a sense of helplessness because he had not been taught the fundamentals of pain management and simply did not know what to do? Or even if he did know what to do, was it because he did not have access to essential medicines such as morphine?
The focus of this year’s World Hospice and Palliative Care Day is: Living and Dying in Pain, It doesn’t have to happen. Over the coming months, we will be sharing narratives of pain, suffering and relief to highlight this issue.
This article was originally published as part of the series: Narratives in Pain, Suffering and Relief in the Journal of Pain & Palliative Care Pharmacotherapy. It is republished with permission. To view the original article please visit the journal online.