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.

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