The Problem of Pain: When Suffering Demands an Answer

Note: The ethos behind Storyline is rooted in a Christian tradition and faith. In this special Holy Week series, we explore these themes more overtly than usual. Even as we lean into faith narratives, our focus remains on our calling in medicine. To walk alongside patients in their pain with compassion and presence.

Pain and the Search for Meaning

Why does suffering exist, and what are we to do in the face of it? This question, often called “the problem of pain,” has challenged philosophers, theologians, clinicians, caregivers, and basically everyone for all generations. In moments of acute illness or loss, patients and their loved ones understandably demand answers: Why is this happening? Is there any purpose in this pain?

Those of us in healthcare know that clear answers are often elusive. We can treat many symptoms, but we cannot always resolve the deeper problem of suffering. One hard truth we learn is that no matter how badly we want to, we cannot always fix people or eliminate all their pain. What, then, is our ethical response when suffering demands an answer we do not have?

Increasingly, we find that the most healing thing we can offer is not a clever explanation but our presence, our willingness to accompany the sufferer through the dark valley. This week, as the Christian calendar carries us through Holy Week toward Easter, we reflect on the ethics of presence amid pain. Through the lens of Maundy Thursday, Good Friday, and Holy Saturday, we consider how simply being with those who suffer can be more powerful than any words we could say.

Maundy Thursday: Stay Awake and Keep Watch

Maundy Thursday commemorates the night Jesus shared a final meal with his friends and agonized in the Garden of Gethsemane. It is an evening of companionship and betrayal, service and sorrow.

The act of foot washing reminds us of embodied care: humble, close, relational. This resonates with palliative care research emphasizing that patients experience compassion, distinct from sympathy or empathy, as an active, relational response that acknowledges their personhood in suffering (Sinclair et al., 2017). Just as Jesus ministered to his friends through touch and proximity, clinicians are called to restore dignity to those in vulnerable states by attending to both physical and spiritual needs.

Yet Maundy Thursday also reveals how difficult it is to sustain emotional presence. In Gethsemane, Jesus pleads, “My soul is overwhelmed… stay here and keep watch with me” (Matthew 26:38). The disciples, despite their devotion, fall asleep.

When we see patients in complex care, families often tell us that what mattered most was not the eloquence of a clinician’s speech but their capacity to remain, to keep vigil. Trauma-informed care models confirm this clinical instinct: consistent, non-abandoning presence has been associated with reduced retraumatization and improved emotional safety (SAMHSA, 2014). The call to “stay awake” is both spiritual and clinical, a reminder that our attentiveness itself constitutes care.

Good Friday: A Question from the Cross

Good Friday marks the crucifixion, the darkest hour of the Christian story. It confronts us with extreme physical and spiritual suffering, and with the anguished question that often accompanies pain: Why, God?

On the cross, Jesus’s cry, “My God, why have You forsaken Me?”, echoes every patient asking “Why me?” or “What now?” In medicine, clinicians routinely encounter suffering that outpaces intervention. Oncology teams, ICU staff, and palliative professionals often report significant moral distress when witnessing suffering they cannot alleviate, experiences that contribute to burnout across the field (Dzeng & Curtis, 2018).

When Job’s friends offered explanations and theology, they only deepened his pain. Research on meaning-making suggests that unsolicited explanations in clinical encounters, such as “Everything happens for a reason,” often worsen emotional outcomes rather than improve them (Park, 2010). By contrast, what patients consistently remember is not words but proximity. The choice to remain present when all answers fail.

Even brief moments of compassion have been shown to reduce patient anxiety. Research has documented that as little as 40 seconds of compassionate engagement can measurably decrease distress in patients facing serious illness (Fogarty et al., 1999, foundational). The most profound response to the question “Why?” may not be an answer at all. It may be the answer of proximity.

Holy Saturday: Keeping Vigil in the Silence

Holy Saturday is the forgotten day, a day of silence, mourning, and waiting between death and resurrection. It represents the space in which suffering has happened, but deliverance is not yet visible. In this dark pause, the call to presence becomes a quiet vigil.

Modern healthcare often undervalues stillness. Yet research on end-of-life care reveals that families consistently rate the presence of caregivers as more impactful than interventions themselves (Teno et al., 2004, foundational). The “No One Dies Alone” model affirms this principle: volunteers simply sit in silence, offering human dignity through companionship (UC Davis Health, 2022). What appears to be doing nothing is, in reality, doing everything that matters most.

Theologically, Holy Saturday invites us to hope in what we cannot see. In medical terms, this aligns with the liminal space many caregivers occupy, suspended between doing and being, knowing and waiting. Dykstra (2005) frames this as “a service of vulnerability,” in which caregivers share the uncertainties of the sufferer. This is the opposite of passivity; it is a discipline. And it maps onto what families tell us again and again: the person who stayed is the person they remember.

Holding vigil with no guarantee of outcome takes courage, spiritual, clinical, and personal. Research supports what faith tells us: non-abandonment is itself a form of care. Whether in NICUs, hospices, or trauma centers, sustained presence has been associated with reduced trauma, increased satisfaction with care, and stronger therapeutic alliance (Back et al., 2016). Holy Saturday teaches us that the waiting, the not-knowing, the simple act of staying can be sacred medicine.

The Presence That Heals

Across Holy Week, we witness a model not of theological perfectionism, but of ethical, embodied solidarity. Maundy Thursday teaches us to serve humbly. Good Friday teaches us to remain through grief. Holy Saturday teaches us to hope in silence. And Easter, this Sunday, teaches us that staying through the darkness is not the end of the story.

Together, these days offer clinicians and caregivers, whether religious or not, a framework for presence-centered care.

This is what we hold at Storyline. A steady clinical companion is an expert who sees the person’s story, what the chart shows and what daily life feels like, translates what is happening, and remains with patients and families through the complexity of care, especially between visits.

When suffering demands an answer, the most healing response may be: I do not know. But I will not leave you.

This is what patients remember. This is what transforms our presence, however small, into something sacred.

The problem of pain may never be fully solved in this life. But the ethics of presence offer a way forward: to accompany, to witness, to remain. In a healthcare landscape increasingly dominated by metrics and protocols, this ancient wisdom reminds us that healing often happens not through what we do, but through who we are willing to be.

References

Back, A. L., Steinhauser, K. E., Kamal, A. H., & Jackson, V. A. (2016). Building resilience for palliative care clinicians: An approach to burnout prevention based on individual skills and workplace factors. Journal of Pain and Symptom Management, 52(2), 284-291. https://doi.org/10.1016/j.jpainsymman.2016.02.002

Dykstra, C. (2005). Growing in the life of faith: Education and Christian practices (2nd ed.). Westminster John Knox Press.

Dzeng, E., & Curtis, J. R. (2018). Understanding ethical climate, moral distress, and burnout: A novel tool and a conceptual framework. BMJ Quality & Safety, 27(10), 766-770. https://doi.org/10.1136/bmjqs-2018-007905

Fogarty, L. A., Curbow, B. A., Wingard, J. R., McDonnell, K., & Somerfield, M. R. (1999). Can 40 seconds of compassion reduce patient anxiety? Journal of Clinical Oncology, 17(1), 371-379. https://doi.org/10.1200/JCO.1999.17.1.371

Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning-making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257-301. https://doi.org/10.1037/a0018301

Sinclair, S., Beamer, K., Hack, T. F., McClement, S., Raffin Bouchal, S., Chochinov, H. M., & Hagen, N. A. (2017). Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliative Medicine, 31(5), 437-447. https://doi.org/10.1177/0269216316663499

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). U.S. Department of Health and Human Services.

Teno, J. M., Clarridge, B. R., Casey, V., Welch, L. C., Wetle, T., Shield, R., & Mor, V. (2004). Family perspectives on end-of-life care at the last place of care. JAMA, 291(1), 88-93. https://doi.org/10.1001/jama.291.1.88

UC Davis Health. (2022). No One Dies Alone (NODA) program. https://health.ucdavis.edu/chaplaincy/no-one-dies-alone