Recognizing Suffering

I recently read this article by Eric Cassell for a course in medical school. What follows are some reflections on the article (here is another link if the other doesn’t work).

Cassell’s essay on suffering broadened my thoughts on what constitutes suffering. Previously I had thought of suffering in a very visceral sense, mostly related to pain. I did consider emotional pain as well as physical pain to be suffering. This would include grief, the pain of an injury or illness or the loss of a relationship. Cassell’s simple definition of suffering made me realize how limited my view was. He states, “I believe suffering to be the distress brought about by the actual or perceived impending threat to the integrity or continued existence of the whole person.” While this definition is brief, a thorough examination leaves a lot of unpacking to do. And while it includes my previous thoughts on suffering it clearly involves much more.

The key phrase for me in the definition is “whole person.” The idea of the self as more than a physical body allows for suffering to be perceived in a variety of ways. Cassell’s expansion on self-identity clarifies this idea further. He talks about the idea of a person’s past, present and future identity. When I think of someone with a disabling injury, while thinking of their suffering I may have only considered their pain and perhaps the limitation on their activities. With Cassell’s framework I can expand this to understand that this person may be suffering from their loss of identity. The things they were able to do in the past, they may no longer be able to do in the present or the future. Beyond the day to day limitations on daily activity it could also present as a serious threat to a person’s sense of self. An elderly person who gardens for example, may have to accept that due to new limitations they can no longer identify themselves as a gardener. If they are able to find a restricted way to garden they at least have to modify what kind of gardener they understand themselves to be.

Considering suffering that is the result of their own actions may reveal why shame and guilt are such powerful emotions. Perhaps someone has made decisions that threaten their existence or sense of self. Not only are they mourning the suffering caused but they are also mourning the fact that they brought the suffering on themselves.

What I appreciate about this more inclusive definition of suffering is how it helps me be more compassionate. I could see myself brushing off certain things someone may tell me as not that big of a deal, but considered in the “whole person” concept of suffering it becomes a big deal and reveals perhaps why this person thinks it is important to talk to me about it. The idea of a “perceived” threat to self helps us to be more compassionate for psychiatric patients whose threat is not reality. Or for parents with a sick child who jump to the worst conclusions possible. Their perception of the threat to their child may not be reality for a pediatrician, but it is a possible reality in their minds. This allows us to not only be understanding but the take the next step and educate in a compassionate way that acknowledges and addresses their fears.

At times in my clinical experience I have been nervous or shy around someone who was clearly suffering. Thinking about all the different types of suffering allows us to be more creative in alleviating suffering. Instead of being frustrated by not being able to completely relieve pain, we can make effort to alleviate other forms of suffering the pain is causing such as loss of function or stress on relationships. When approaching a patient I think I can ask myself a few simple questions. How is this patient suffering? Is there any possible perceived or actual threat to this person’s self-identity? If I am unable to relieve one kind of suffering, am I able to relieve a less obvious form of suffering in this person? I think addressing these questions in all my patients will make me a more complete and compassionate healer.

Creighton Joins Alegent Health: What Does it Mean for Medical Students?

There was big news this week as Creighton University and Alegent health creighton_universityentered into a “long term strategic affiliation”. What exactly does this mean? Here’s how I understand it:

– Alegent Health will take over operations of Creighton University Medical Center as well as their physician group, Creighton Medical Associates.

– Creighton students will eventually have more opportunities to getalegent health experience at Alegent sites around Omaha. Bergan-Mercy was specifically mentioned as a possible site for exposure to maternity care.

– There will be an addition of about 130 attending physicians from the Alegent group to potentially teach students.

– The academic/educational process will be overseen only by Creighton University. How this will be affected by the hospital being owned by another entity is not entirely clear.

– We’ll most likely be switching EMRs to EPIC. I really don’t like our current EMR so this is good news to me.

– We have been told there will be very little changes to rotations for this upcoming academic year.

Overall this seems to be a very positive development for Creighton University and specifically the medical school. Our dean seemed legitimately excited about the opportunity. It should expand clinical learning opportunities as well as make sure we have enough space for all our professional health schools (medicine, dental, nursing, PT, OT, pharmacy).

My only concern is what will happen when conflicts arise between what our university thinks is best for our education and what Alegent thinks is best for it’s hospitals. This was brought up in our Q&A regarding our simulation center in the hospital. Our dean re-assured us that Alegent knows it needs to stay around. But is there any obligation for Alegent to comply? Does Creighton have any leverage in the matter after giving up ownership in the hospital? I imagine these sorts of issues have been discussed and hopefully worked out but the answers given were not very concrete.

Anyway, check out this PR video highlighting the affiliation. It’s entertaining just for the corporate-speak dropped throughout the video. Our university president actually uses the word “synergy” which I’ve only heard in the context of 30 Rock.

Learn everything you need to know about medicine in one disease

In small group the other day we were discussing lupus (aka Systemic Lupus Erythematosus) and the physician leading the group started listing off all the ways the disease can affect the body. He concluded by saying,

“Basically, if you understand lupus, you understand medicine.”

So there you go.

Which obviously reminds me of this:

Apparently in the real world, sometimes it is lupus.

P.S. What’s going to happen if you click the Wikipedia links Jan 18.