Unfortunately so common: physical pains going hand-in-hand with deep emotional and spiritual suffering
In the Middle East, the number one killing disease in women is breast cancer which comprises between 30-40% of all female cancers. Due to lack of awareness and socio-cultural reasons, women refrain from going to be examined and treated until the disease reaches the stage when cure is not an option but rather palliation. In the majority of cases, breast cancer at its advanced stage is associated with severe physical pains due to metastases to bones and other organs. Unfortunately to date, opioids (natural or synthetic), which are the most effective drugs to overcome these debilitating pains, are not available for these kinds of situations, mainly because of cultural prejudices and stigmatisation.
While visiting a cancer center, I came across a 38 year old woman who had reached the terminal phase of breast cancer. The woman was lying very quietly in her bed, while her serene face revealed efforts to control her immense inner pains and suffering. While asking her the reasoning for her late presentation to obtain medical treatment she responded: "If my neighbours would have known that I have cancer, my daughters would not have had a chance to marry". Fully realising the state of distress that she was in, I shared with her my empathy and continued to ask: "Tell me more about your concerns". The woman added very softly: "You know what, I do accept my fate, but what worries me most is the problem of who will take care of my three daughters".
This woman exemplifies a typical case where physical pains go along with deep emotional and spiritual suffering. We, the caregivers, can nowadays offer good and efficient pain killers, and thereby alleviate physical suffering. Our patient will never be freed of her inner feelings of fear, anxiety and distress, but at least she could leave our world with less physical suffering.
Michael Silbermann, Middle East Cancer Consortium, Haifa, Israel