Presence in the Midst of Pain
A nurse’s mission is to alleviate suffering, and when my patient is in pain, that is my only goal: to make their pain go away. Now.
In theory, your hospice team can respond to and alleviate pain 98% of the time with the medications available. It takes time for the medication to begin working though, and sometimes it may take hours to figure out the proper dosage. Waiting while your loved one is in pain is excruciating. Here are some tools to ground yourself in that difficult moment and practice the art of presence.
Oral pain medication like morphine begins to work in about 20-30 minutes and will reach its peak effect after one hour. Just knowing that your loved one will experience some relief in 20 minutes may help.
Inhale, count to 4.
Exhale, count to 6.
In the meantime, mindful presence is key.
Take some breaths and ground yourself into the moment. Feel your feet connect with the earth. On the next inhale, count to 4, and on the exhale, count to 6. Pull up a chair next to the bedside, all the while tuning into your breath. Where do you feel your breath the most? Your stomach? Your nostrils? Your chest? Just notice and let your breath anchor you into this present moment with your loved one. When you begin to feel anxiety or fear creep up, take a breath counting to 4, and exhale counting to 6. Connect again with your feet on the earth.
This breathing technique is proven to help you calm down and feel more present.
In a pamphlet written for healthcare professionals, USCD health researchers explain: “Breathing regulates the autonomic nervous system. Deep breaths with elongated exhales through the mouth engender calm by activating the parasympathetic branch of the nervous system.”
When you feel a little more grounded, tell your loved one you will stay with them as they are waiting for the pain medicine to work. Remind them they will feel some relief in about 20-30 minutes. Maybe stroke their arm if they respond positively to touch. Some patients hate to be touched when they are in pain; for others, it is a wonderful diversion.
If your loved one can only tolerate the pain by closing their eyes and going inward, continue your breathing techniques and remain quietly in the chair next to them. You can knit or read quietly. Pay attention to your own breath when you begin to feel anxious.
If your loved one seems receptive to a diversion, consider anything that may distract them from their pain:
a cute small child, a furry animal friend, television, cat videos, art, knitting, scrolling through photos on a computer, a delicious ice cream sundae. You can read to them quietly from their favorite book or play some music that is soothing to them. Pay attention to the room, the temperature, the lighting. Is the patient warm or cold? Modify the environment in any way that will make them more comfortable. A blanket fresh out of the dryer may take the edge off. Because opioids dry out the mouth, your loved one may need water — or ice chips, a popsicle, or a sweet candy.
Dame Cicely Saunders, the founder of the hospice movement, states, “suffering is intolerable when nobody cares.” Over the years I have learned that my hospice patients often just want someone to be with them, to sit silently nearby and bear witness to their suffering. This is no easy task, but with your breath as your anchor, you can soften into this uncomfortable space.
Your engaged and thoughtful presence is alleviating their emotional or spiritual suffering while waiting for their physical pain to subside. You are compassion in action.