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Total Pain – It’s Complicated
30 April 2018

HCA Hospice Care’s holistic approach in addressing complex pain

An interview with Tan Ching Yee, Head of Psychosocial Services, HCA Hospice Care

Dame Cicely Saunders, the founder of the modern hospice movement, coined the concept of total pain in 1964. Having worked extensively in various hospices in UK caring for dying patients, she discovered that the pain experienced by the patients was more than physical pain. They showed signs of mental distress and were experiencing social problems, emotional difficulties and spiritual pain.

“It is paramount to understand the underlying reason behind each patient’s ‘pain’. The concept of ‘total pain’ includes physical, psychological, social and spiritual pain,” explains Ms Tan Ching Yee, Head of Psychosocial Services (PSS) Team at HCA.

“Pain that is non-physical in nature can be a result of issues that have accumulated and left unresolved over the years.” At HCA, the PSS team, comprising social workers, counsellors and therapists, work closely with nurses and doctors to understand patients’ pain.

“It is paramount to understand the underlying reason behind each patient’s ‘pain’”

Total pain takes into account, the physical, psychological, social and spiritual impacts on a person

Forgiveness As Pain Relief

Relating an encounter with a patient, Ching Yee shares, “He had stage four lung cancer and was experiencing breathlessness and pain throughout his body. The prescribed pain medications did not seem to be able to settle his pain.”

“During our first session, he clenched his fist tightly on his chest. I sat with him for an hour, acknowledging that it can be difficult and painful. He had tears in his eyes but did not utter a word.”

“In subsequent sessions, he managed to share with me his thoughts on his illness. This gave me a clearer picture of this ‘pain’ that he was facing. He viewed cancer as his punishment for all the bad things he had done, the key being his infidelity to his wife. He was worried about the possibility of meeting his late parents when he dies (in the after-life), fearing their ‘reprimand’.”

“It is paramount to understand the underlying reason behind each patient’s ‘pain’.” – Ms Tan Ching Yee, HCA Hospice Care’s Head of Psychosocial Services team.

Progressively, Ching Yee worked together with the patient on how best to ‘face’ his parents in light of his impending passing. He eventually decided that he needed to seek his parent’s forgiveness.

“This decision helped him express his desire to seek his wife’s forgiveness. Initially resistant, she finally relented on the basis that he was dying and she still loved him despite his wrongdoings.”

On the day of reconciliation, facilitated by Ching Yee, minimal words were exchanged. The patient and his wife simply embraced and spent time grieving over the lost decades spent in resentment.

Soon after, the patient passed away peacefully, surrounded by his wife and children.

Improving Quality Of Life vs. Managing Physical Pain

“When we help a person who has non-physical pain issues, we need to understand the meaning and relationship that this person has with the pain,” adds Ms Tan. “There needs to be proper pacing and space provided for patients to discover and subsequently, express their feelings.”

“This is what it means to understand ‘total pain’ and then to manage from there. Ultimately, our goal is to improve the quality of life for each patient in the last stretch of his or her journey, not just physical pain management.”