The ? of “Suffering” by Monica Williams-Murphy, MD

Monday, 18 Jan 2016 16:48

About Dr. Monica Williams-Murphy (120 Posts)

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page


“Oh God!” she groaned, looking upward with tears flooding her cheeks, which were stretched into the shape of agony. Her chest heaved uncontrollably with grief.

“I am so very sorry,” I whispered again while leaning in and stroking her hand.

This is what death notification often looks like and feels like. We doctors should be masters of delivering some of the worst news that could ever be uttered, the worst news that could ever be heard.

Suddenly, she sat bolt upright! Clearing her throat, and staring me squarely and directly in the eyes, she asked me the most common and most important question that could ever be answered during death notification: “Doctor, did he suffer?”

I heard the question echo in the air: “Doctor, did he suffer?” “Doctor, did he suffer?” “Doctor, did he suffer?”

The air was thick, silent, and still as I deliberated the answer. I never removed my eyes from hers, because I knew that no matter what, I needed to deliver the answer with complete honesty and integrity.

Very slowly, I answered: “No, I do not believe he suffered.”

Thankfully, it was the honest truth.

Some of the greatest human fears surrounding dying are not death itself. Instead, one of the most prominent concerns is whether suffering will or will not occur, whether someone did or did not suffer. In fact, themes of the presence or absence of suffering should be a human fear that we in healthcare seek to actively manage and address. We cannot divorce emotions from medical events and medical decision making, so it becomes our role to manage them instead.

Specifically, we must learn to manage fears of suffering in two distinct end of life scenarios:

1- As the end of life approaches.

2- During death notification.

Let’s discuss each briefly:

1- As the end of life approaches, we must be able to describe whether a choice may increase or produce unnecessary suffering. This sounds awfully heavy doesn’t it? Because, in healthcare we like to talk about beneficial outcomes of medical choices (even when giving our spiel about Risks, Benefits and Alternatives to treatment options). But, for the patient and the family, the potential for suffering may be at least as important, if not more important than the benefit potential.

In fact, on more than one occasion, the minute that I explained to a patient or surrogate that the broken ribs often produced by effective CPR could cause the 90 year old grandmother to suffer should she be resuscitated… the minute I used the word “suffering”… the whole plan changed.

At other times, I spend a great deal of time using words that explain how a plan of care will reduce or mitigate suffering: “We will not allow her to suffer. I will do my best to keep her comfortable.”

2- During death notification, some of the most important words which could ever be spoken are; “He did not suffer” or “I do not believe he suffered.” The catcher here is that these words must ONLY be spoken when they are the honest truth. These words are very powerful purveyors of peace for surviving loved ones and will become part of the oral history of the deceased. These honest words are a priceless gift.

So, if you are a healthcare provider, please start actively addressing “suffering” in your care of the dying or the dead.

If you are a patient or family member, ask your healthcare provider about how a medical intervention could increase or reduce “suffering.”

We will ALL benefit from more open conversations about the topic.



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2 thoughts on “The ? of “Suffering” by Monica Williams-Murphy, MD

  1. Chaplain Larry Hansen

    In the classes I teach to hospice volunteers, and other medical providers, I like to discuss what “suffering” means. I offer three different definitions:

    1-Suffering is a response to pain. As Joan Halifax writes in her wonderful book, “Being with Dying,” “Our lives include both pain and suffering. Pain is physical discomfort, while suffering is the story around pain. The first arrow, the sensation of pain, is bad enough. But it’s the second arrow—the story we tell ourselves about our pain—that’s the real trouble.” (Joan Halifax, Being With Dying: Cultivating Compassion and Fearlessness in the Presence of Death. [Shambala Publications, Inc., 2008].)

    2-Suffering is pain minus meaning. Reflecting on Viktor Frankel’s work on meaning Dr. Ira Byock has written, “(T)he dimension of meaning is central to the human experience of suffering. Pain and privation are insufficient to explain suffering. . .Human suffering requires the felt loss of meaning and purpose in life. Pain and privation can be endured if it is for a purpose.”

    3-Suffering is pain in search of meaning. This is the most–perhaps the only–way to understand suffering in a redemptive light. In his autobiography, Peter Barton wrote, “I became more able to accept the obvious fact that my life had changed and would continue to change. “Not that I took it lying down. Life was taking back many of the pleasures it had given me, and I missed them. The miraculous loans of strength and physical ease were coming due, and the payback cost me dearly. I knew only too well what I was losing to my illness; the great challenge now lay in discovering what I was being given in return. “Finding the point became the point. That was the realm in which I still had everything to gain.” (from “Not Fade Away: a Short Life Well Lived,” by Lawrence Shames and Peter Barton, Rodale Press, 2003, page 84.)

    Obviously, in the case of trauma or sudden death, most people will equate pain with suffering, which is understandable. However, cases of chronic and/or life-threatening illness, it might be fruitful to keep in mind these three different ways of understanding the concept in order to be present to patients and families in the most-supportive and empathetic way.

    –BTW, Thanks! for the book recommendation. It’s on my list. . . .

  2. Rea

    Excellent discussion, deeply true to human psychosocial life. It is not so much death itself that we fear. It is the process of dying. Does it hurt? Will we suffer? For how long? Will our loved ones suffer, or did they? The primary messenger is the doctor presently attending the case. The survivor doesn’t just listen to the words of the doctor/messenger. He observes the doctor’s whole person: facial expressions, posture, gestures, sounds like a cough or sniffle… The doctor’s self-management is vital in delivering the truth message. His very soul is under scrutiny. Shooting the messenger will not be an option when the messenger is compassionately honest…and able to address the unthinkable=Death. — With this in mind, talk about suffering in death and dying. I know of no better words: talk about it!


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