Pain, Thresholds, and Holy Listening: Reframing Our Approach to Patients in Pain
Anna Wright, MD, MACS, Medical Director, Community Hospice and Palliative Care, Jacksonville, Florida
Patients with chronic pain can prove challenging for health care providers. The encounters are often emotionally charged and can be adversarial with patients feeling the provider is not listening and providers feeling manipulated and challenged. How might we change this dynamic? What would be a more fitting approach to the patient in pain? Through illustrative patient stories, this paper will explore the Celtic practice of thresholds, coupled with the spiritual direction practice of holy listening as a different way of being with pain patients.
Dr. William May raised two questions which can be applied to patients suffering with pain. The first question, “What are we going to do about it?” is the usual focus for patients and health care providers. The second question, “How are we going to behave towards it?” is often the more important question. (1) As clinicians, we often bring a laser focus to making the diagnosis and “fixing” the problem. Too often, do no harm becomes do something, and this thinking is embraced by patients and clinicians and is fueled by our immediate-gratification-driven world. For many patients with pain, fixing is often not an option, leading to increasing frustration and dissatisfaction for patients and providers. A more fitting approach for patients and clinicians to pain might be, “How are we going to behave towards it?”
What if we approach our patients with pain differently? What if we change how we behave towards pain and our patients with pain? In Celtic Christianity, thresholds were important places for ancient Irish monks. The Celtic threshold is a place of entering, an opening, and a space between as we move from one place to another or a place of transition. Celts believe thresholds are “thin places” where the veil between heaven and earth is thin. Thresholds frame places where we can meet patients in pain and deepen the value of their words by holy listening. By being with patients and listening empathetically, we make a connection where patients feel heard, validated and valued. Thresholds call us to places of grace, healing and hope, but crossing this threshold with patients in pain may be uncomfortable as it requires us to be vulnerable and to relinquish control over time and topic. (2)
If we are open to crossing the threshold into the thin space of the patient and God, we will discover a new way of patient care that can transform (3) us and our patients. We may not be able to alleviate the pain but we can cross the threshold and be in that pit of misery with our patients as empathetic listeners. When patients give their pain a voice, healing begins.
1 William May, The Patient’s Ordeal (Bloomington, IN: Indiana University Press, 1991), 3-4.
2 Christine V. Paintner, The Soul’s Slow Ripening: 12 Celtic Practices for Seeking the Sacred (Notre Dame, IN: Sorin Books, 2018), 1-3
3 Esther de Waal, To Pause at the Threshold: Reflections on Living on the Border (Harrisburg, PA: Morehouse, 2004), location 87.
Dr. William May raised two questions which can be applied to patients suffering with pain. The first question, “What are we going to do about it?” is the usual focus for patients and health care providers. The second question, “How are we going to behave towards it?” is often the more important question. (1) As clinicians, we often bring a laser focus to making the diagnosis and “fixing” the problem. Too often, do no harm becomes do something, and this thinking is embraced by patients and clinicians and is fueled by our immediate-gratification-driven world. For many patients with pain, fixing is often not an option, leading to increasing frustration and dissatisfaction for patients and providers. A more fitting approach for patients and clinicians to pain might be, “How are we going to behave towards it?”
What if we approach our patients with pain differently? What if we change how we behave towards pain and our patients with pain? In Celtic Christianity, thresholds were important places for ancient Irish monks. The Celtic threshold is a place of entering, an opening, and a space between as we move from one place to another or a place of transition. Celts believe thresholds are “thin places” where the veil between heaven and earth is thin. Thresholds frame places where we can meet patients in pain and deepen the value of their words by holy listening. By being with patients and listening empathetically, we make a connection where patients feel heard, validated and valued. Thresholds call us to places of grace, healing and hope, but crossing this threshold with patients in pain may be uncomfortable as it requires us to be vulnerable and to relinquish control over time and topic. (2)
If we are open to crossing the threshold into the thin space of the patient and God, we will discover a new way of patient care that can transform (3) us and our patients. We may not be able to alleviate the pain but we can cross the threshold and be in that pit of misery with our patients as empathetic listeners. When patients give their pain a voice, healing begins.
1 William May, The Patient’s Ordeal (Bloomington, IN: Indiana University Press, 1991), 3-4.
2 Christine V. Paintner, The Soul’s Slow Ripening: 12 Celtic Practices for Seeking the Sacred (Notre Dame, IN: Sorin Books, 2018), 1-3
3 Esther de Waal, To Pause at the Threshold: Reflections on Living on the Border (Harrisburg, PA: Morehouse, 2004), location 87.