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Pain and Suffering, Without Belief

Maryanne Chrisant, MD
Joe DiMaggio Children's Hospital
Hollywood, FL, USA

"So, as an atheist, how do you explain and deal with pain and suffering?"

I asked my friend, Jon, for his thoughts, as part of my exploration into how we filter pain and suffering through faith and religion. I've known Jon since we were in college together, thirty-something years ago. He's a palliative care physician in New York and daily navigates his way through pain and suffering. I'd like to say we were sitting in some downtown bar, but we were both driving to our respective homes and talking via mobile.

"Like, how do I justify pain and suffering? What does it mean?" He paused. "Pain and suffering just happen. I can't do anything to stop it. Let me tell you what I do every day. I recently had a patient who had been in a vegetative state for over two years. He'd been this dynamic, brilliant, young guy in law school. If this guy had lived, he would've been another John Kennedy. Until, one day...he was just in the wrong place at the wrong time: totally freak accident. Now this guy, who couldn't see me, talk to me, or acknowledge me, was my patient. Despite that, despite all that, I knew a lot about him. I'd come to know this guy from his parents' stories about him, to the point where I really felt like I knew him. I even had a dream about him...walking and talking. Anyway, this couple's son was failing and was now truly dying, and seeing his parents relate during the last months was...I hate to say it, and if you tell my wife I'll deny it...I watched them relate to each other in a way that I've never come close to in my marriage. So when that couple lost their grown up son, I could only be present and allow them to feel the connection to their son through me."

"My profession, my role, gets more difficult as I relate more to these patients and their lives. Having children definitely changed and impacted on my relationship with suffering. The son was about the same age as my eldest daughter, which made my job more difficult. It was excruciating to watch these parents suffer so much and, yes, die with their child. A part of them died when he did. Even though his consciousness had been gone for two years and all that was left was his body, it was still so painful. There are parents who justify a child's death by saying it's just 'the next step in the journey,' but I don't think so. What kind of journey is that, anyway? If I lost one of my children the only solution for me would be death. I would not want to live." He took a breath. "So when this young guy died, I thought, 'there but for the grace of...' Of what? Of nothing. There's no good reason for pain and suffering. There's no good that comes of it. There's just suffering."

He continued. "You spend your time as a transplant doc, modifying peoples' life spans, altering the course of their disease, using extreme therapies to prolong life and hopefully the quality of life, and in pediatrics it's often because the parents want you to. I do the polar opposite: I escort people to that last moment of consciousness, help them push their boat away from the shore, then stand and wave good-bye. It's often a choice my patients make. I have this 50 yr old guy with heart failure: treatable, but impeded by poverty and depression. It was all just too much. So, he decided to stop taking his meds and die in hospice. His wife can't wrap her head around his choice but understands it and is hoping for him to die quickly. That's pretty enlightened and she loves the guy a lot. At this point, her suffering is watching him suffer."

"The thing that palliative care has taught me about pain and suffering is that people have a choice as to how they process the pain and suffering, and how they relate to their own impending death. My job is to develop a relationship with my patients that allows them to relate to pain and death in whatever way they want or need to. Palliative care is more about the relationships than it is about the medicine."

"For me, as an atheist, there's no meaning, no underlying greater good, no redemption of the soul that comes with pain, suffering and death. There's no place to go to: no heaven, no hell or otherwise. It's just a 'black void' that's existed since six billion years before I was alive. There's no before-life and no after-life. People can be good or bad, or just mediocre; in the end, we all go to the same black void."

"I treat my patients like humans. I talk with them, have fun with them, bull shit with them. Whatever they want. Whatever they need, I'm open to helping facilitate. I give a lot of morphine, if they want it, and pass no judgment. There's no excuse for pain. There should be no pain. I can't treat or cure death but I can treat pain. I give a lot of morphine."

"What we do as physicians is incredibly meaningful. We do make a difference day to day and we do have some power over life and death. Sometimes you get caught up in the weeds of it. But we have to remember that we're there for the patients. In my profession, if a suffering patient with some terminal condition wants to die, that's okay. I can't get caught up in the legality or the 'what will his family think or want,' because it's my patient's choice. I give whatever they want: morphine, dilaudid, Ativan. Whatever it takes."

"My father died of lung cancer in his seventies, about 25 years ago, now. Remember? My Dad..." I could hear him shaking his head at his recollections. "He did not go gently. He was in denial until the day he died. I regret that I kept rubbing his face in his inevitable death, in his disease. Every time he talked to me about getting better, or feeling better that day, or some new drug he wanted to try, or how he was going to redo the house, I'd pull back and tell him that he was wasting time he didn't have, and that he'd be dead in a few months. I'm sorry I failed to encourage his state of denial as that's where he wanted to be. I'm sorry I didn't talk more with him about what his next trip would be or where we'd go or what we'd do. My father's death showed me that my job is to figure out where a patient wants to be and help him get there. Even if it's, 'I'm going to stop eating tomorrow. How long will it take me to die? Will it hurt?' or 'If it weren't for the pain, I'd feel pretty good. I think I'm gonna lick this and be around for another few years.'"

"Whatever my patients want from me, they get. None of us knows what's right for people when they're faced with constant, chronic suffering and impending death, but it's my job to find out; I need to know what's right for them and give it to them. Even if it's morphine, and the permission to stop eating and go."

"I see us all as infinitely sad. We're living on borrowed happiness. Time, life, is over so soon. Too soon." He paused. "And it just keeps going on, without a plan, a reason, salvation, or a God. That's it." ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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