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Recapitulating Pain, Suffering, and Death

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Vincent Valentine, MD
University of Alabama Birmingham
Birmingham, AL, USA

Pain is universal. We all experience it, physically, emotionally, directly and indirectly. As healthcare providers, we witness pain through illness and death. We see patients suffer from medication side effects, cope with attachments to machines and eventually die; however, we do not personally know what it is like to live with illness, or for that matter, die. Art and literature help explore pain beyond science's depth to provide a broader view of a patient's diagnosis and suffering. Although substantial improvements have been made through innovation, modern science allows healthcare providers to be emotionally detached with depersonalized terminology and breviloquent bedside manner. For example, we hear of the ECMO patient in the ICU, rather than the wife with IPF eating, breathing, walking, sleeping and going to the bathroom in the confines of a 100 square foot room for more than three weeks awaiting lung transplantation. Kafka infers in "Country Doctor" and writes, "To write a prescription is easy, but to come to an understanding with people is hard." This is present today in regards to opioids for pain relief and managing patients of the ISHLT. We must communicate the topics of pain and suffering, while being descriptive and articulate, and understand that the perception of pain is elusive.

Elaine Scarry's The Body in Pain summarizes suffering and the fear of death. She describes pain with a metaphor by stating, "When one hears about someone with physical pain, the events happening within the interior of that person's body- may seem to have the remote character of some deep subterranean fact belonging to an invisible geography that however portentous has no reality, because it has not yet manifest itself on the visible surface of the earth." Scarry's seismographical event is happening beneath the earth so we cannot see it, like a patient's sickness hidden beneath the skin. She links the geographical metaphor to the way we "speak about the heavens; alternatively, it seems as distant as the interstellar events referred to by scientists who speak to us of a not yet detectable mystery of an intergalactic scream." She connects illness and pain to the afterlife, offering a chance for "scientists"- that's us- to communicate on a more personal level (She prefers less mystery when it comes to being diagnosed). Through literature, we see valuable testimonies about cultural and ideological notions that include illness, pain, suffering, and death. This gives us a more inclusive portrayal of the essential and peripheral details encompassing medicine and suffering with the life and death of patients. Scarry rewords Descartes', "I think therefore I am" by claiming, "To have pain is to have certainty- the bedrock of reality." With this vulnerable portrayal, the person who is in pain is fully aware of suffering, whereas those external are in constant doubt and question.

In the way healthcare providers cure illness, they must also alleviate suffering whether it is detected or understood. The great composer Gustav Mahler reveals the personal expression of his inner world characterized by a sense of loneliness and alienation. His music focuses on the isolated individual attempting to cope with romantic rejection as he struggles between hope and despair, the questions of death and redemption as well as the grieving process. This symphonic construction and unification reflect the inner and outer patterns of Mahler's life, while juxtaposing wildly conflicting views. His symphony No.5 is a superb example of an expressionist art movement with progressive emotional states of the grieving process. After the loss of his daughter Maria and his own diagnosis of heart disease involving serious valvular abnormalities, Mahler composed Das Lied von der Erde to help him cope with grief, fear and anxiety. ■

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

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