Articles: Pain and Suffering
What is "suffering"?
 Although
the phrase "pain and suffering" places suffering
in a secondary position, suffering is a broader concept
than pain since it encompasses many aspects of life after
injury. Certainly pain can cause suffering, but suffering
may exist independent of pain. Since medical records will
rarely comment that the patient is "suffering",
a basic understanding of causes and symptoms of suffering
as well as the ability to interpret medical documentation
help identify suffering.
Causes of suffering
Personal/bodily
injury or medical malpractice can profoundly disrupt the
life of an individual and his or her family. There are many
causes of suffering. These are just a few:
Being in unfamiliar
surroundings: Exposure to new sights, sounds, smells,
people contribute to stress
Loss of independence:
The inability to care for one’s own needs, on either
a temporary or permanent basis
Role disruptions:
The alteration in one’s usual roles and responsibilities
Separation from loved
ones or peers: The disruption in normal relationships
imposed by isolation in the hospital, nursing home or at
home
Sensory overload:
Constant exposure to lights, noise and being touched
Disruption in routines:
Alteration in lifestyle due to the need for medical treatment
or by injuries
Inadequate understanding
of one’s health situation: Not receiving or
being able to comprehend what is happening or going to happen
or the prognosis
Loss of one’s
ability to protect one’s body from the view of others.
Loss of control:
Surrendering control of one’s body and life to others.
Boredom: Lack
of variety in one’s daily routine.
Fearful anticipation
of surgery or procedures: Stress caused by
worrying about upcoming unpleasant events.
Disfigurement/change
in body image: Alteration in appearance caused
by trauma, surgery, burns and other causes.
Loss of recreation:
Inability to participate in hobbies or other relaxing activities.
For children, disruption in play activities can be profound.
Lost opportunities:
The inability to participate in chances to improve one’s
life.
Loss of control over
bodily functions: Incontinence of bladder and bowel,
inability to eat, breathe on one’s own, get out of
bed, or wash oneself contribute to a feeling of helplessness.
Disruption in communication:
The presence of a ventilator, tracheostomy, stroke or head
injury impairs communication
Restraints:
Restricted movement prevents adjusting position or touching
one’s body, for example to scratch the face.
Symptoms of suffering
Suffering may be manifested through emotional and psychological
reactions. The patient may express anxiety, fear or become
agitated. Barsky (1995, p. 1061) notes that "patients
often become angry in response to the suffering and disability
caused by disease, adverse life events or the psychological
threats inherent in being a patient." He notes that
illness often causes anger because it presents the threats
of disfigurement, pain, lost opportunity, abandonment, and
even death. Some patients are particularly enraged by the
helplessness, lack of control and enforced passivity that
disease (or injury) confers. The patient may feel helpless,
hopeless, powerless, lonely and isolated. Depression and
withdrawal from others may occur. Posttraumatic stress disorder
may result after a traumatic event, such as the development
of quadriplegia or being burned as result of nursing negligence.
Two qualities are common to patients affected by posttraumatic
stress disorder: depersonalization (the stripping away of
one’s individuality) and entrapment (the sense that
escape routes are non-existent or dangerous) (Clark, 1997).
Physical symptoms of suffering
may appear in the form of a rapid breathing rate, ulcers
in the stomach, insomnia, irritable bowel syndrome (cramping
and diarrhea), headaches, asthma attacks, depression, withdrawal
and so on.
It is important to neither
overemphasize nor underestimate the suffering that accompanies
injury. Medical records should be used to substantiate the
presence of suffering. Documentation of medications administered
to alleviate symptoms that cause suffering, analysis of
the charting of healthcare professionals, and understanding
of medical equipment and procedures are useful in defining
the face of suffering.
References
Barsky, A. (1995). Approach
to the angry patient, in Goroll (Editor), Primary Care
Medicine, third edition, Philadelphia: Lippincott-Raven
Publishers.
Clark, C. (1997, August). Posttraumatic
stress disorder: how to support healing. American Journal
of Nursing, 97 (8), 27.
See Medical Legal Aspects
of Pain and Suffering for extensive information on this
subject.
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