Opinion: I’m a neurosurgeon. I’ve learned pain and suffering are very different things

John (not his real name) was in his mid-60s, a VA patient with chronic back pain. After three surgeries by three different surgeons over about five years, he was no better off; his lumbar spine was littered with arthritis and titanium implants. He had made the rounds again, to physical therapists, chiropractors, and pain providers, and now he was in my office. The last thing he needed was more surgery. The more gently I explained, the angrier he became. He left looking like a man betrayed by the system. He wanted me to “do something” and to “fix it.” I could do neither. After 30 years in practice, you would think that I would have perfected the “I can’t help you” speech. I haven’t, and God forbid I fall into the trap of a canned speech to a suffering patient whom I cannot make better. I often question myself after such an encounter. Did I help this patient even though I could not fix the problem? Or did I just add another layer of suffering? In a 1982 essay in The New England Journal of Medicine, “The Nature of Suffering and the Goals of Medicine,” the physician Eric Cassell noted that medicine is obliged to relieve suffering yet gives it little attention. “Suffering occurs when an impending destruction of the person is perceived; it continues until the threat of disintegration has passed or until the integrity of the person can be restored in some other manner,” he wrote. Pain becomes suffering, he noted, when people “feel out of control, when the pain is overwhelming, when the source of the pain is unknown, when the meaning of the pain is dire, or when the pain is chronic.” Physicians who concentrate only on curing bodily disease, he warned, may “do things that cause the patient as a person to suffer.” The anatomy and physiology of the brain is consistent with Cassel’s position: Pain and suffering are processed by different pathways. Some people feel intense pain without experiencing suffering, while others continue to suffer greatly even when physical pain is not present. The distinction between pain and suffering is particularly important now because assisted dying is spreading fast. It is now legal in 13 states and the District of Columbia. New York’s law took effect on Aug. 5, and Illinois’ on Sept. 12. Beneath the policy fight sits an assumption that suffering is a malfunction to be eliminated. Someone needs to “fix it.” Oregon’s 2025 data illustrate that suffering, and not necessarily pain, motivates patients to seek aid in dying. Among the 400 people who died under the law, the most common concerns were loss of autonomy (89%) and being less able to enjoy life’s activities (89%). Inadequate pain control, or concern about it, was reported by 37%. These patients are suffering, but their suffering goes far beyond physical pain. If personhood is ignored, people suffer. Cassell proposed that suffering can be relieved, even when pain continues, by making the source of the pain known, changing its meaning, and showing that it can be controlled and that an end is in sight. Then he made a bold claim: “Transcendence is probably the most powerful way in which one is restored to wholeness after an injury to personhood. … The sufferer is not isolated by pain but is brought closer to a transpersonal source of meaning and to the human community that shares those meanings.” Such an experience, he added, “need not involve religion in any formal sense; however, in its transpersonal dimension, it is deeply spiritual.” If unrelieved suffering drives people toward assisted dying, and transcendence is the most powerful way to relieve it, how does someone connect with the transcendent? Religious faith by its nature connects the believer with something greater and, in the three monotheistic traditions, with a transcendent someone. Cassell’s paper challenges physicians to relieve both pain and suffering. Pain pathways are well described by science and an abundance of medical and surgical options exist to relieve pain. Suffering can be described in physiological terms but only to a point; beyond that, scientific analysis comes up lacking. Suffering is intensely personal and defies reductionistic “scientism.” Any attempt to address it must take place within a relationship that goes beyond medications, therapies, and surgeries. I could not understand the meaning of John’s pain unless I had a relationship with him. Did I take the time to develop that relationship? Did I offer to keep seeing him even though I could not “fix it”? If I’m honest with myself, the answer to both questions is no. While there remain many good things about the delivery of health care, a chasm has opened between patients and those who care for them. What was once a covenantal relationship has become transactional. A person in need once placed his trust in someone who promised to serve his good. Now expertise and service are doled out in exchange for relative value units. More time is spent looking at a computer screen than at the face of the patient. At the root of this lies a single issue: the depersonalization of medicine. The patient is too often reduced to a bystander, a medical problem to be solved. They become the occurrence of a disease rather than a person in need of help. Medications, therapies, and surgeries are our weapons in the battle against disease. When the battle is lost (and at some point it will be), we move on to the next skirmish, and the patient is left isolated and abandoned. While it is apparent that patients suffer as the result of the depersonalization of medicine, the physician is diminished too. If I neglect the person in front of me, my skills may persist, but I am reduced from an instrument of healing to a technician Relief of pain does not require me to be in relation with the person in front of me. All I need to do is write a prescription for a painkiller. But if I desire to relieve suffering, I must be willing to enter that sacred space, approaching with reverence the one who cries out to be heard. The former is easy; the latter is rich. So where do we go from here? Often, the response is to encourage health care providers to accompany their patients, but what does that even mean? The word companion comes from the Latin com (with) and panis (bread): A companion is one who shares bread with you. You cannot accompany someone from afar. It demands a close, intimate relationship. To accompany means to love. We must love our patients. The objections are predictable: That crosses a professional boundary; we need to maintain objectivity; we will burn out. But love, in the classic sense, is to will the good of the other for the sake of the other. It is not a sentiment. It is a decision. If I will the good of my patients for the sake of my needs (money, prestige), then I am not loving them. That is objectifying them. If I cannot love my patients, I need to quit. Inevitably, we will encounter patients that we cannot fix. We do not have a solution to their pain and suffering. So then what? When we cannot relieve suffering, we are called to co-suffer. The late Msgr. Lorenzo Albacete, priest, physicist, and theologian, wrote that “to co-suffer — to be a companion with the sufferer — is to walk alongside them to transcendence.” This is precisely what Cassell was advocating: The best way to relieve suffering is a link to the transcendent. While transcendence is often associated with religious faith, connecting with the transcendent is possible for anyone. In classic philosophy, the transcendentals are the good, the true, and the beautiful. What makes them transcendent is that they point toward something beyond our daily existence, moving to what is more inward than my inward self and higher than my highest self. Participating in the transcendent can bring meaning to suffering. Truth: Suffering strips away illusions about status and what matters, restoring a dignity when nothing can be fixed. Goodness: Suffering can become an occasion for love, an opportunity to show courage, patience, and forgiveness. Beauty: Beauty shows that suffering is not the whole of reality and offers true consolation. Both Cassel and Albacete connect suffering with the transcendent, but Albacete also warned: “Suffering is a cry that characterizes the human person, and we do violence to the human person if we try to extinguish that cry.” The cruelest response to suffering is to attempt to explain it away. We can only ask “why” together with the one who suffers. I never saw John again. Earlier this year, I saw an elderly man with osteoporosis suffering from a compression fracture. Stabilizing it was followed by another fracture, then another. His pain is unabated, and he is becoming more and more bent forward. He knows I cannot “fix it,” yet he returns every month to be heard. At the end of each visit, he thanks me for listening even though I offer no solutions. I cannot fix him, but I can accompany him, co-suffer with him, and ask “why” together. Stephen Doran, M.D., is a neurosurgeon in Omaha, Neb., a permanent deacon and bioethicist for the Archdiocese of Omaha, and the author of “To Die Well: A Catholic Neurosurgeon’s Guide to the End of Life.”