I started this blog because I knew that everything in the world came back to palliation. That is to say, everything in the world comes back to pain. Pain is suffering, and suffering is what each one of us is given in some form or another on this earth. It doesn’t have to make sense to us; it likely makes all the sense in the world to a higher entity. But although it doesn’t make sense to us, it doesn’t mean that suffering is senseless, without any value.
It is hard to find the value in pain, especially if it becomes chronic, a state of mind. Pain can break the most resolute of people. It can turn optimism to despair, hope to rage. If pain is not resolved - and with some forms of pain this is a formidable task - it can drive one to madness. Especially in patients or people who were doing well before, pain and its new normal can feel like an inescapable hell.
Reading about Luigi Mangione is heartbreaking. His senseless act of violence which got the world’s attention was apparently borne of intractable pain. It is actually understandable that his chronic pain, in someone so young, possibly pushed to have surgery before knowing the full scope of what he needed to realize to heal, morphed into rage. It is also understandable that many patients and families fighting the crooked insurers within a lopsided healthcare system feel the same frustration, anger, even rage. Brian Thompson, while not deserving assassination, clearly wasn’t doing right by the average individuals his healthcare company was supposed to serve. The assassination was a terrible gunshot which opened up a collective wound, and forces us to ask the hard questions: why are we playing games with our health? Why is money so dominant in our healthcare system? When are we going to start helping palliate our patients - not pretend to cure them but help them heal from their personal hells?
I believe so much in symptom management. I believe that pain is more than just physical. Pain is mental, existential, emotional. Pain, and especially chronic pain, becomes a state of mind. When beautiful souls as so many of us are become saddled with intractable suffering, it can drive us at minimum to distraction, and at most to insanity. May we pray that the outcome of this sad case be a further opening up of the discussion of why compassionate care matters, of why palliation of the whole being matters, and of why our healthcare should be what we want, not what money dictates.
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