An Open Letter to the Patient with Chronic Pain in the ER

I hope this perspective is different than you expect

To the patient who comes into the ER with pain that has been there for nine months or three years or your whole life, who has seen every specialist you were advised to see, taken every pill or shot, endured pointless surgeries on the off chance that you could be “fixed,” 

I see that though your pain hasn’t changed recently to signal a physiologic emergency, that you are here with an emergency nonetheless; one of despair and desperation. Sometimes you view me as your last and best hope. 

I have to admit that I have only meager offerings to feed that hope. That said, I think I have more to offer than some of my colleagues who become defensive assholes when faced with a problem they can’t fix. They are cruel because they believed the story that doctors are all-powerful and your suffering made a fool of them. The tools in our toolbox can repair a broken bone or a leaky heart valve, but we do not have the tools to repair that complex weaving of mind, body, and spirit where most suffering lies. 

What do I actually have to offer? I will give you as much time as I can to help you feel seen, heard, and understood. I am well aware this does nothing for your pain. On the other hand, I’ve been told by others in your shoes that it’s more than you’ve likely been granted elsewhere. 

The balm I have to soothe your pain is quite transient, but generally I can offer a little comfort here and a little troubleshooting for home. I can recheck testing that has been done, though to be honest that is mainly in service to helping you understand that I am taking you seriously. 

I will talk to you about your life. Do you always put the needs of others first? Did this pain develop because you’ve been through some shit and your body is telling you it is time for a reckoning? I have no idea if this will address what brought you here. On the other hand, the only path to healing after you’ve exhausted the traditional options involves meandering through the dark forest of your whole self. Does healing look like fundamentally changing all of the relationships in your life, including with yourself? Does healing look like accepting a life that looks very different from what you dreamed or imagined? I honestly don’t know, but the risk-to-reward ratio is much more favorable than what’s been tried so far since there has been no reward. 

You’ve come to the ER for long-term pain. What can I offer you? I can stop looking for the abyss within you and turn my chair, so we are both looking out at the abyss together.