Control of pain is a hallmark of hospice care and bestows some of the most satisfying and tangible results in the care of the terminally ill.  I remember hundreds of patients whose pain syndromes were easily controlled with judicious use of narcotics, rendering them comfortable and able to interact with loved ones. 

But treating pain can be very tricky.  With my team, I was taking care of a Vietnam veteran in his home.  “Larry”  had a neck cancer the size of a softball that protruded through his skin, the consequence of years of tobacco use.  Neither chemotherapy nor radiation was any longer effective for him.  His hospice nurse and I monitored his pain compulsively, raising his dose of morphine every few days when he reported inadequate pain control.  Reaching outlandish doses of opioid, I began to consider switching narcotics, as changing to a different narcotic can be quite effective.

Our team chaplain, a Vietnam veteran himself, visited the patient frequently and was taken aback one day when the patient asked him whether God can forgive all things.  Of course the chaplain (AKA “spiritual counselor” in hospice lexicon) gingerly explored this query.  It turned out that the patient felt he had done unspeakable acts in Vietnam, and his anguish with these memories became prominent with his impending demise. 

In the next few weeks, the chaplain talked to him about these issues and assured him of the possibility of redemption.  As the sessions went on, his narcotic requirement decreased dramatically, and I was able to taper him to a more usual dose of morphine, and pain became a non-issue in his last few months of life.  In hospice parlance, we would say Larry had  “spiritual” pain, that is, discomfort with a prominent emotional component.  As Larry’s case shows, the treatment for this involves more than just bludgeoning with narcotics.

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