Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Co-bearers of suffering


Sometimes a patient’s pain can’t be eliminated. However, we can still walk with them as a co-bearer of suffering. 

The midnight hallway was suffused with the usual ambient green light, radiating from the telemetry monitors standing guard at the nurses’ station. The familiar evening haze was broken by a single thick band of iridescence emanating from the last room on the left. Inside, a muscled man of 50 paced, anxiously twirling his neat mustache. He was in pain. We’d tried everything in our arsenal, and it had barely touched the relentless, jaw-grinding pain. Tonight, again, I was called to the bedside. What on earth could I do? 


The difficulty of relieving patients’ discomfort is the Sisyphean burden of every resident. In the face of suffering, every physician is forced to grapple with both its meaning and approach to relieving it. 


This quandary occupies the mind and pen of the great British author Graham Greene in his classic novel “The Heart of the Matter.” Greene, known for his masterful portraits of the interior life, finds a worthy muse in our protagonist, Major Henry Scobie. Scobie is a man of conscience, a senior police officer, completely devoted to his duty as protector even at the risk of his own life and limb. 


He’s a pillar of his community and a husband making every effort to alleviate his wife’s despair after the death of their young daughter. However, throughout the story, the seemingly moral paragon commits a series of professionally unethical and personally immoral acts. He takes bribes, smuggles illegal goods, carries on an extended extramarital affair, and even cooperates in the taking of life. Why would such a duty-bound protector fall into this?  


Surprisingly, this is far from a tale of progressive moral compromise. As Scobie tells us, each choice made is made with clear eyes, logically adhering to his goal of protecting others from suffering, even at the cost of his own soul. 


The trouble is that it doesn’t work; as the story unfolds, we see that Scobie’s attempts to avoid pain at all costs yield only deeper suffering for the people he means to save. He achingly confesses, “I can’t bear to see suffering, and I cause it all the time. I want to get out, out.”  


Many of us have felt this same bitter sentiment as we struggle to comfort the sick and dying entrusted to our care. In the recent past, we treated pain as “the fifth vital sign,” developed exponentially stronger analgesics, and yet find ourselves with seemingly more suffering and despair than before. We may even, in our most frustrated moments, join in Major Scobie’s lament. 


The relief of pain will always be temporary or incomplete, and any clinical approach must accept that relief as subordinate to other goods and principles. We must accept our limits as imperfect healers and, when our magic bullets fail, simply walk with our patients as co-bearers of their suffering.









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.