Life lessons from the pain clinic

In the wake of a bereavement, Ruth Moore describes how she felt a new kinship with the patients she cares for who live with chronic pain

“Now is the start of the chronic phase.” This comment from a friend shortly after our baby son’s funeral grabbed my attention. As an anaesthetist, I appreciate the instant drug to effect gratification of anaesthesia for half of my working week. Yet pain medicine is my niche—specifically, the chronic, awkward pain that refuses to go away.

My clinic is filled with people who suffer in ways that are inconvenient to conventional medicine. They experience disparate pains that will not be boxed neatly inside a unifying diagnosis. Pain that comes with the kind of baggage it makes any attempts to cling to tidy Cartesian dualism seem delusional. I hope that my interactions with people facing such circumstances have been empathetic before now, although only they can judge. Faced with the chronic pain of grief for a child, I feel a new kinship with them.

Pain and grief are ugly things. We do not want them around because they make us afraid. We like to be in control, and loss and pain remind us that we never were. They blow apart our modern fantasy that successful living resides entirely in comfort and happiness. When this facade is shattered, difficult existential questions arise. These struggles and the questions they force upon us are most obvious among the dying: what does life mean in light of imminent death? What constitutes a “good” death, or a good life? How much will it hurt? 

In chronic pain, the questions have a different flavour—one which more closely resembles the experience of those left behind, the bereaved ones. How do I continue to live this life I would never have chosen for myself? It really does hurt. Is it possible to make peace with a pain that has no obvious endpoint?

I have heard people in persistent pain express the desire to be able to put down their pain, or let someone else shoulder the burden, if only for a while. How I wish that were possible with grief. Both experiences are isolating. The desire to reach out to others for comfort is matched by overwhelming loneliness. At times, it feels like no one can reach me.  

There are flare ups with grief, as with chronic pain. Some are predictable—a due date, an anniversary, an occasion that should be happy but now is not. These clouds gather visibly on the horizon—at least offering the opportunity to take shelter, to try to mitigate the blow. At other times they come out of a clear blue sky. We carry the weight around with us every day. On some days we are more equal to it than on others.

Hearing other people’s stories can be helpful. But as time passes, I am aware that there is a choice to make. It can be tempting to nurse grief, or pain, in an attempt to retain a connection with what has been lost. An identity can be found there, but it is one that is defined by loss. The journey from there to disabling bitterness is a short one. Instead, can I choose to integrate the loss into the larger story of my life, and to build more layers of experience around it, which may insulate it a little in time? 

Our culture does not deal well with pain. We are privileged to live in a society where diverse worldviews and faiths can be held freely. Yet we discuss them so rarely, when all is well in our private world, that in moments of shattering loss there is a risk that the fragile illusion of unity will break. We experienced, for example, the acute discomfort of those caring for our son when confronted with our faith. As a consequence, we have no social protocol for serious illness or death, and no shared paradigm. A Kurdish friend, on visiting us shortly after our son’s death, commented on the discomfort he felt on his first encounter with such a situation in British culture. We congratulated him on having become thoroughly enculturated—it’s always awkward, no one ever knows what to say. We simply appreciated the fact that he came. 

At work I have often felt the discomfort of having little to add, no new wonder drug or procedure to guarantee a pain-free future for the person in front of me. Medical training conditions us to end each encounter with a plan—to categorise, then to manage. Over time I have learnt to sit on my hands, to acknowledge the discomfort but to keep my mouth shut and listen. I have long believed that this approach has value in its own right. As grieving parents we have encountered those who are too eager to “fix” us, albeit with the best of intentions and from a desire to make things better. In truth, there is no cure. I appreciate the people who continue to show up, and who are prepared to sit with us through the confusion and anger and sadness. 

I truly admire the people I meet in clinic, who make the choice, most days at least, to accept their altered life and to find meaning in it in spite of the pain. These people keep on shouldering their particular burden, but refuse to be defined by it. I hope I can continue to learn from them.

Ruth Moore is an anaesthetist in the UK. 

Competing interests: I have no financial interests, but in addition to my NHS appointment I am a volunteer doctor with Freedom From Torture.