Physical Pain vs. Spiritual Pain

I just visited with one of my amazing patients yesterday.  I was struck by her honesty and candor.  When I was there I asked if she was in any pain.  She was not.  In hospice, the goal is for the patients to be as pain free as possible.  
I had just spent 90 minutes at an in-service dealing with physical vs. spiritual pain.  The premise was that if a patient has unresolved spiritual pain, it can manifest in physical symptoms, or it can be misunderstood by the patient and/or caregivers as physical pain.  Often the result is medication.  
What my dear friend and I got to is that she is frightened.  She knows that she is in hospice, and that her time is limited.  What she was wondering about was if her new declined state would be the new status quo or if she was in a downward spiral.  I spent some very treasured time just listening to her concerns and letting her cry while we held hands.  Then we talked about what it might mean if this was the "new her" or if things were going to decline. 
It was an important moment for me.  I realized that upon initially asking her if she was in pain, both of us were thinking of the physical pain that she is asked about countless times each day.  What she needed to come to grips with and let out was the spiritual pain of the uncertainty that she was feeling.  That took some time and talking to uncover.  So often, the care-givers are rushed due to their mountainous work load, and they don't have the time to just sit and talk.  
My wish for everyone, patient and care-giver, is that there is someone in their lives who can just come and sit.  Sometimes, the patient is in need of a good listener and hand-holder, and sometimes that is the need of the care-giver. 
A dear, dear friend of mine just lost her father to cancer.  She ran herself ragged between her family in one town, and her parent's home in a town 4 hours away.  She didn't know how long any of them had.  She shared with me, the hours that she laid in bed with her father.  They just talked, or looked at photos, or even watched bad daytime tv together.  She told me that the memories from that time are among her most precious. I don't know if she remembers how many loads of laundry she did, or how many bedpans she emptied, but she has crystal clarity of the times when the two of them were just quietly together.  It gave them time to talk about her father's hopes, fears, and the mark that he left on this earth and in the heart of everyone who knew him.  What an amazing gift!

Pay attention to the spiritual care of the family.  Find the help that makes it possible to "just be" sometimes, and see what comes up for exploration or release. It is the ultimate gift!