Embracing Cicely Saunders's concept of total pain

Editor—Dame Cicely Saunders defined the concept of total pain as the suffering that encompasses all of a person's physical, psychological, social, spiritual, and practical struggles.¹ Coyle also wrote that a diagnosis of a life threatening illness jars open a door of awareness,² the same door that, for most of our lives, comfortably allows us to keep thoughts about death in the background.

For many people the opening of this door precipitates a crisis and an acute encounter with great total pain. All of this occurs in the context of a modern society that is ill equipped to handle news of possible death.³ Consequently, after diagnosis of a life threatening or life limiting illness, a patient's close family and friends may deny that their loved one is dying or might die from his or her illness. Additionally, as death is now routinely hidden from social view and medicalised,⁴,⁵ this medicalisation, which professionalises the rituals of caring for those who are seriously ill or dying, can result in a situation in which only the physical symptoms are given priority.³

Therefore, after the diagnosis, the patient may be acutely isolated, with total pain at risk of being left untended. Certain aspects of palliative care, such as day care, have much to offer from the point of diagnosis. We urge health professionals, patients, and their families to access or refer to the help that is available from palliative care services—in particular, the day units with well developed support services. Such help must be offered irrespective of whether the diagnosis pronounces the end of life or may yet still offer hope of the resumption of more life, for once the door of mortality is opened, the good life will never be quite the same again.