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Another Voice: Life does not need to end in pain and distress

The Rev. Derek Davis

Traveling about Erie County as a chaplain for Hospice Buffalo, I am ever impressed by the generosity, warmth and hospitality I receive from people of all faith backgrounds as they welcome me into their homes. They share the most intimate details of their lives, not only the joy and comfort their faith gives them, but their doubts, fears and pain as well.

I am an ordained minister with seven years chaplaincy experience. In addition, I have worked 30 years as a practical nurse, primarily in the psychiatric field. I know how to help people deal with their spiritual and psychological suffering. When it comes to physical pain, that area of expertise is addressed by our hospice doctors and nurses, and they do it exceptionally well. So I am flabbergasted when I enter a home and find a patient nearing the end of life who continues to suffer physical pain because they or their caregivers are not using prescribed medications. This failure is not because the family or the patient wants to suffer. The failure is due to misunderstanding and fear – primarily the fear of the medication morphine.

Spiritually, there are two ways of knowing – with the head and with the heart. With the head, we know that patients in hospice care are prescribed morphine for two reasons – pain and shortness of breath. Patients and their families know this because their primary doctors, as well as the hospice doctors and nurses, tell them. So why do people resist giving morphine? They know in their heads it is appropriate, but not in their hearts. This is the realm of philosophy, of the soul; this is the realm of the chaplain.

How is knowing with your head different than knowing with your heart? Education is the knowledge of the head. It is learned formally in school as well as from family, friends, work and study. It is the practical “stuff” we absorb to function in society. Feeling is the knowledge of the heart.

Contrary to what most folks think, thoughts come first, followed by the feeling associated with the thought. (Try this for yourself: think of something or someone pleasant and feel the feeling.) Feelings can’t be wrong – they just are. Thoughts, on the other hand, can be wrong and are proven to be so. Nonetheless, one still has the associated feeling. This is what happens with patients and families. They “know” in their heads that morphine is appropriate, but the feeling associated with it is sadness. The feeling associated with morphine is the knowledge that life, as we’ve experienced it, is very nearly over.

The vast majority of us do not want it to end. But life does not need to end in pain and distress. The hospice team is present to support the patient and family with both kinds of pain – the head/physical pain, with prescribed medications, including morphine; and the heart/emotional pain, with empathetic, reflective listening and presence.

The Rev. Derek Davis, Ph.D., has just retired as chaplain at the Center for Hospice & Palliative Care.