Empathy does not replace morphine

June 2, 2009

A psychoanalyst describes her intimate psychosocial care with a dying patient. But her musings on caring for the terminally ill leave out one crucial thing--pain relief.

There is a heartfelt article in the health section of today's New York Times by a psychoanalyst ministering to a dying patient. The lead sentence reads: "'Talk, just talk,' she says, her voice a whisper, her body contorting as she braces for the next onslaught of pain."

A few lines into the piece, the author identifies herself as a "specialist in treating the medically ill." She also tells the readers that she'll be with the patient "in any way she needs me to be."

"For her, I will travel an hour on public transportation, wipe her brow, dab her drool, fetch blankets, hold her hand, even sing a lullaby if that's what she wants."

Reading this begs the question, as the "medical specialist" watches the "furrows of pain creasing her [the patient's] forehead," why she doesn't attend, in some way, to what is obviously undertreated pain. The hand-holding and lullabies are fine, but not addressing acute symptoms of pain borders on malpractice. The PhD who wrote this should be aware that it is not acceptable for patients to be writhing in pain. At the very least, it sends a dangerous message to caregivers.

The truth about cancer pain hurts. Even though we have the ability to relieve more than 90% of cancer-induced pain, this physically and emotionally debilitating symptom is still vastly undertreated, causing unnecessary suffering among our cancer patients. 

According to studies, more than 70% of patients with cancer have moderate to severe pain during their illness, and many report fearing pain more than death. Moreover, studies also show that at least 50% of cancer patients are grossly undertreated for pain.

This issue needs more national attention. We do not yet have the ability to cure many cancers, but we have the tools in our armamentarium to relieve the pain and suffering in our patient population. Ignoring pain is bad medicine.