November 2006
by Vicki Rackner MD
A parent, child or partner in pain can bring even the strongest, most capable adult to his knees. You want to do the right thing. Yet, when someone you love is in pain, it's easy to collapse into a helpless state of fear.
Billy said, "It was one thing enduring my kids' runny noses and not knowing how to get them to blow them or sneeze so they'd be comfortable. It was something else entirely standing next to my dad in bed and watching him struggle unsuccessfully to turn over into a more comfortable position. I bent over slid my arms underneath him and lifted him up as reverently and as gently as I could but his loud cry of pain was unnerving!"
Should Billy offer his father pain medication? Phone the doctor? Call 911? Choosing a course of action that best serves a loved one in pain can be a huge challenge.
While there are no right answers, understanding the way on which your loved one responds to pain...and how you respond to pain…offer valuable information that can guide your next steps.
Just as each of us has a style of dressing, so, too, each of us has a style of addressing pain signals. I noticed five patterns of "addressing styles" which I call the "pain personalities": The Strong Stoic, The Worried Well, The Ostrich, The Victim and The Ideal Patient. I believe that this style is shaped in childhood and is largely unalterable. However, the way in which the pain style is understood and managed can literally make the difference between life and death. As an aside, if you have a conflict with your loved one about pain, it's usually because you have different pain personalities.
The Strong Stoic Gerda, who comes from sturdy Scandinavian stock, says, "You needed to be near death's door before Mother called the doctor. Sure, money was tight. I think the real reason we didn't go to doctor was pride. Although Mother never said it, we knew that being healthy and being tough were sources of pride. Illness and pain were shameful conditions that were hidden."
If your parent is a Strong Stoics, expect that you will not hear about pain until the situation is quite serious. Be on the lookout for behaviors that suggest that something is out of balance – sleep changes, giving up a regular activity or a voice on the phone that does not sound right. Emphasize the courage and the strength of character to seek medical advice and focus on the return to health. Make certain that all health care providers, particularly ER doctors, know if your parent is a Strong Stoic. Say. "My mother rarely utters a complaint. When she says she's in pain, I take it very seriously."
The Worried Well Another group, previously called hypochondriacs (and with new vistas of health information opening on the Internet, they are called cyberchondriacs), we call the "Worried Well." These are intelligent people who hear about a new illness on the news, and recognize that they have several of the symptoms -- and maybe they have this diagnosis! They know just enough to be dangerous. One out of four visits to primary care doctors deals with the latest concerns of the Worried Well. If the Strong Stoics come to the doctor too late, the Worried Well come too early.
The Worried Well do best with regularly scheduled office visits. If your mother or father is a member of this club, you know how easy it is to tune out during the long litany of new complaints. However, just as a broken watch is right twice a day, illness can really strike!
The Ostrich We all need a healthy dose of denial to read the newspaper and get on with our days. However, denial can go overboard and threaten health. In fact, many disease processes like alcoholism and eating disorders are built on a foundation of deception and denial. The Ostrich hides his head in the sand during times of pain to construct a reality on which everything's okay. Ann said, "After Thanksgiving dinner Dad was popping antacids for 'heartburn'. Mom was worried when she noticed that Dad's grey skin was beaded with sweat. Dad said that he was fine and he even got mad at Mom when she called 911."
If your parent is an Ostrich, your most effective strategy is to understand your parent's reality, then offer an alternative point of view that has the weight of a doctor's authority behind it. "Yes, Dad, you may well just have heartburn. But your doctor insists that we make sure it's not a heart attack."
The Victim Tom grew up in a family that unintentionally rewarded illness. He says, "Staying home from school when I was sick used to be more fun than family vacations! I had my mom's undivided attention, and all the TV and ice cream I wanted." These childhood lessons about the goodies for being a victim of illness can carry through to adulthood. Kelly said, "Mom is always talking about her sleep problems. One day I came to her house to find her napping. I heard loud snoring, then saw her hold her breath. She looked just like the patient on the TV show about sleep apnea. Maybe Mom had sleep apnea and there was hope that she would overcome her sleep problems! She never even spoke to her doctor about my idea. I'm not sure that Mom really wants to part with any of her problems."
If your parent is a victim, tough love is an effective approach.. "Mom, I hear your words say you want to get better but your actions tell another story. You've complained bitterly about your sleep problems. Based on what I saw, I think you might have sleep apnea. When will you be talking with your doctor about this? Would you like me to join you for the appointment, so I can tell the doctor what I witnessed as you slept?"
The Ideal Patient The Ideal Patients pay attention to their bodies, note the whispering messages before the body shouts out with pain and honors a well-developed trust in their intuition. They know when it's time to make a doctor appointment. James said, "Mom had a new pain in her breast that worried her. She saw her doctor, who could not feel a lump. He said, 'You probably just bumped it. Your next mammogram is in four months. Let's hold off until then.' Mom trusted her instincts and requested an immediate mammogram which showed a small pre-cancerous growth. She may have saved her own life by listening to her intuition even though her doctor recommended a different course."
The Ideal Patients simply need your support and encouragement to listen to their intuition, even if the doctor says otherwise. Say to your parent, "Yes, your doctor went to medical school but you're the expert on your own body."
When someone you love is in pain, it hurts. Let your actions be guided, in part, by an understanding of the pain personality of both yourself and your loved one.
Copyright © Vicki Rackner MD, 2006
When Someone You Love is in Pain