Elizabeth Peterson, DMin, RN, is Professor and Department Chair of Nursing, at Bethel University, St. Paul, Minnesota. She teaches Psychiatric- Mental Health Nursing, Nursing Care of the Elderly, Foundations of Health

Ministry, and Curriculum and Instruction in Nursing Education.

DOI:10.1097/CNJ.0b013e31822b6f5e

Suffering When

Takes a Toll We may silently struggle with questions

about who God is and how he can be trusted when painful

things happen.

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tunately, cumulative encounters with suffering can take a toll on nurses. This commitment to help suffering people can easily become overwhelming as nurses face pain they cannot alleviate, needs they cannot meet, and suffering they cannot explain or understand. Stephen Wright (2002) recognizes the personal challenge of dealing with suffering in nursing practice, saying, “With each nursing moment we may be challenged to face our own sense of mortality, the meaning and purpose of suffering, and to draw upon the deepest resources to support ourselves in the often difficult world of nursing” (p. 709). He suggests dealing with suffering requires that nurses have a means for dealing with some of

the complicated and often personal issues surrounding suffering, adding, “Questions about who and what we are, how we deal with distress and suffering, why things happen to us, and so on, can be hard to answer, especially if as nurses we have uncertainties about the answers to such questions ourselves” (p. 709).

Sometimes dealing with suffering can be even more difficult for nurses who are Christians because the occurrence of suffer- ing causes us to ask hard questions that can challenge our beliefs about the goodness and power of God. Even as we try to alleviate suffering, we may silently struggle with questions about who God is and how he can be trusted when such painful things happen.

In struggling with questions about suffer- ing, we are in good company. Epicurus, the famous Greek philosopher (341–270 B.C.), is attributed with this oft-quoted observation:

Is God willing to prevent evil, but not able? Then he is not omnipotent. Is he able, but not willing? Then he is malevolent. Is he both able and willing? Then whence cometh evil? Is he neither able nor willing? Then why call him God? (Barnes, 2010, p. 92)

Apart from personally knowing God, this is how the secular world frequently views suffering.

As Christians we turn to Scripture to try and understand difficult issues, including suffering. Unfortunately, as most experts agree, the Bible does not provide definitive answers about why suffering occurs. Yet, Scripture has a great deal to say about suffering. Grappling with what the Bible says is part of the process of personal spiritual as well as professional growth in preparation for dealing with suffering in others.

AbstrAct: Observing and trying to cope with suffering is an integral part of nursing practice. Yet, there are times when this can take a toll on nurses, even leading to struggles with faith as nurses try to understand how a God who is good and all powerful can allow people to suffer. This article looks at a biblical understanding of suffering and discusses ways nurses can cope with caring for suffering people.

KEY WOrDs: nursing, self-care, suffering,

A few years ago while working for a home care agency, I was asked to make a mental health assessment on a family whose 17-year-old son was paralyzed

as a result of a motor vehicle accident. When I arrived, I discovered the father of the family, who was in his early 40s, was paralyzed as the result of a stroke 2 years earlier. Because of the father’s disability, the mother, who had been a homemaker since her children were born, had to return to work. The family was already challenged because of this situation, and the son’s accident and need for ongoing care was overwhelm- ing to both parents. As we talked, I learned this family had a deep faith. The family was dealing with all of these circumstances as best they could, but one of the hardest issues for them was why God had allowed all of this to happen. When I left their home, I realized that I was struggling with the same question. I found myself wonder- ing why one family should have to deal with so much, and I wondered why God would have let it happen. I even started to wonder if I could trust God in my own life.

SUFFERING: PART OF NURSING According to nurse author Lorraine Wright (2005),

“Nurses form relationships with individuals, families, and communities to promote health and alleviate or diminish suffering. Indeed…the very heart or essence of nursing is the encounter with suffering” (p. xviii). Probably most individuals enter the nursing profession because of their desire to help suffering people. Unfor-

By Elizabeth Peterson

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that should have been ours…The Servant of the Lord has taken on himself those very sufferings of his people. Not only does he know what it is like—he actually experiences our sufferings with us. (p. 81)

What does it mean to humans who are suffering that God experienced pain, abandonment, rejection, shame, humiliation, loneliness, and countless other horrors? Certainly, it does not remove the pain of suffering, but it does provide a presence and with that, a hope. Human suffering is not a solitary experience because the God of the universe has experienced and under- stands the depth of human suffering. When God, who has experienced greater pain and suffering than any human could ever know, promises to be present in the suffering of humans, there is a basis for real hope. This hope comes from knowing that the infinitely powerful God loves and walks with his children, and will lead them through their pain and suffering. Author, poet, and hymn-writer Marjorie Clarkson (1984) explains,

Hope does not mean that we will avoid or be able to ignore suffering, of course. Indeed, hope born of faith becomes matured and purified through difficulty. The surprise that we experience in hope, then, is not that, unexpect- edly, things turn out better than expected. For even when they do not, we can still have a keen hope. The basis of our hope has to do with the One who is stronger than life and suffering. Faith opens us up to God’s sustaining, healing presence. A person in difficulty can trust because of a belief that something else is possible. To trust is to allow for hope. (p. 63)

Good Can Come Out of Suffering. This is rarely the perspective of someone anticipating or experiencing suffering, but it often becomes the response of someone after suffering. Clarkson (1984) again offers insight:

The suffering that is part of our life is not a cruel, senseless waste. For

There are at least four important compo- nents to a biblical understanding of suffering that offer a beginning perspec- tive: suffering is real and inevitable; God himself experienced suffering; good can come out of suffering; and only in eternity will complete under- standing of suffering occur.

BIBlIcAl PERSPEcTIvES ON SUFFERING

Suffering is Real and Inevitable. Some contemporary Christian teachers suggest that suffering is somehow foreign to a life of faith and that having enough or the right kind of faith prevents us from experiencing suffer- ing. Yet, it probably is not necessary to read beyond the book of Genesis to see that after the “Fall” when Adam and Eve disobeyed God and sin entered the world (Genesis 3), suffering became real and inevitable. Over and over again Scripture addresses suffering and makes clear that suffering takes place in both followers of God and nonfollowers, sometimes as a result of wrong doing, and often in situations of apparent innocence. In fact, suffering was a part of the experience of most people whose stories are included in the Bible. Not only do biblical accounts recognize the existence of suffering, they also describe the experience of suffering. Because the experience of suffering is frequently so personal and painful that words are inadequate, the Bible can be helpful putting into words what suffering is like. The stories and teachings of the Bible give individuals permission and ways to describe the reality of suffering. “I cry out to you, O God, but you do not answer; I stand up, but you merely look at me….The churning inside me never stops; days of suffering confront me” ( Job 30:20, 27, NIV).

Not only do the Scriptures give permission to talk about the reality of suffering, the Bible teaches suffering is inevitable. The Apostle Paul makes it very clear, “For it has been granted to you on behalf of Christ not only to believe on him, but also to suffer for him” (Philippians 1:29, NIV). Some- times it seems the Scriptures are more vocal about the inevitability of suffering

than many contemporary churches and teachers. Walter Brueggemann (1984) reflected on this tendency to avoid talking about suffering by suggesting that in most churches we prefer to read psalms of praise and victory rather than of lament. Brueggemann goes so far as to call it a denial of the real world:

Such a denial and cover-up, which I take it to be, is an odd inclination for passionate Bible users, given the large number of psalms that are songs of lament, protest, and complaint about the incoherence that is experienced in the world. At least it is clear that a church that goes on singing “happy songs” in the face of raw reality is doing something very different from what the Bible itself does. …Serious use of the lament psalms has been minimal because we have believed that faith does not mean to acknowledge and embrace negativity. We have thought that acknowledg- ment of negativity was somehow an act of unfaith, as though the very speech about it conceded too much about God’s “loss of control.” (p. 54)

When we acknowledge the reality and inevitability of suffering, we avoid creating unnecessary dissonance, since, in fact, the Scriptures teach that suffering will happen and should not be a cause for surprise.

God Knows and Understands the Experience of Suffering. God’s nature is a loving, Trinitarian relationship consisting of the Father, Son, and Holy Spirit. It is in the context of this Trinitarian relationship that God experienced suffering when Jesus Christ died on the cross, and it is out of that relationship that God reaches out to his creation. Not only did God experience suffering, but he was com- pletely innocent in the process. The Trinitarian God suffered the agonies of the crucifixion. Brueggemann (1984) comments:

Isaiah 53 states Christ not only can sympathize, but he has carried our griefs and sorrows. This means more than he took the punishment

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make them hope for the remainder, and, hoping for that, they “in patience do wait for that.” And it is because of this, that St. Paul can say with such confidence that, he “reckons that the sufferings of this present time are not worthy to be compared with the glory which shall be revealed in us.” Though he lives in the present it is clear that the Christian, according to St. Paul, is meant to live for the future. (Lloyd-Jones, 1994, p. 113)

Scripture makes it clear that the ultimate hope for suffering is found in eternity. This means that the outcome of understanding the biblical perspec- tive on suffering is the realization that the mystery of suffering will not be completely understood and cannot completely be explained until eternity in heaven. At the same time, though, suffering can provide the means for spiritual growth in the here and now. Suffering helps to clarify purpose in life, provides a perspective on the future, and gives a deeper understanding of God’s nature and plans. The Apostle Paul, again, provides insight into this life-changing link between suffering and transformation as he assures believers that, “Our light momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal” (2 Corinthians 4:17-18, NIV).

DEAlING wITh SUFFERING As nurses, when we awake in the

middle of the night reliving the suffering of a patient or his or her family and try to make sense out of it, how can a biblical perspective on suffering help? Before answering that question we first need to recognize that for a biblical perspective to help us at the point of our struggles with suffering it needs to impact our thinking, emotions, and our spirits. To be impacted by a biblical perspective on suffering we need to proceed intentionally.

To be intentional we first need to acknowledge the reality of our struggle with the suffering we have seen.

the Christian, it has profound meaning. By it, God is refining us and working for us an eternal weight of glory—the glory of being like Jesus Christ and living with him forever. Through the very pain by which Satan seeks to destroy us, God is changing our sinful humanity into Christ’s image, triumphing over Satan in us. (p. 65)

Heilie Lee (1996) suggests that we learn to experience God’s love through suffering, saying:

When we have identified, entered, and embraced the suffering of Christ, we will be more able to experience the love of God in a full way. We will be more and more like him day by day. The preaching of the gospel will be real and effective because we really understand the love of God; the love that Christ had when he suffered and died on the cross for us.” (p. 22)

This echoes what the New Testament authors say about suffering. The Apostle Paul describes the growth that can take place as a result of suffering. “We also rejoice in our sufferings, because we know that suffering produces persever- ance; perseverance, character; and character, hope” (Romans 5:3, NIV). He later shares his deep desire to experience suffering in order to come to know Christ more fully, but also recognizes this would cause both hardship and profound spiritual growth, “I want to know Christ and

the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death” (Philippians 3:10, NIV).

Only in Eternity Will We Fully Understand Suffering. One criticism of Christianity is that it takes a “pie in the sky by and by” approach to life. If this means we don’t face the reality of suffering or don’t try to alleviate it, then the criticism is probably fair. But the Bible makes it clear that this life is not all there is. The faith and hope we have is not limited to our earthly experience, and, in fact, it won’t be fulfilled on earth. JonTal Murphree suggests, “All life on earth is only a fleeting moment in the span of eternity. The sufferings here are little more than a passing dream in light of the reality of eternal joy” (1981, p. 124).

Martyn Lloyd-Jones (1899–1981), minister of Westminster Abby in London and one of the foremost ministers of his day, speaks in even stronger language about the future hope of Christians as he discusses Romans 8:

Christians according to St. Paul are “heirs.” They have not yet inherited fully, they are waiting, they are expecting. There is “glory which is waiting to be revealed,” and they look forward to it. They are “waiting for the adoption, to wit, the redemption of the body.” They have not gathered in the great harvest, but they have received the “first-fruits.” They have not yet seen fully their great inheritance, but they have seen and known sufficient to

When we acknowledge the reality and

inevitability of suffering, we avoid creating

unnecessary dissonance.

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chAllENGING YET ENRIchING Dealing with suffering may be one

of the greatest challenges of nursing practice. It is challenging, not only because of the suffering experienced by others, but potentially it may challenge our sense of well-being and under- standing of life itself. On the flip side, suffering also has the potential to be one of the most enriching aspects of our practice, for ourselves and for those receiving our care. However, that potential can only be reached as we enter into our suffering as well as that of others. The anguish and dissonance that can result from suffering is to be guarded and protected, not avoided or prevented. Facing the pain of suffering can result in richness and growth found in no other way. Not only can we grow, but we may help others grow as well. Writing about the impact nurses can have on helping patients who suffer, Lorraine Wright concludes:

Under the blows of mortal experience, those who suffer from serious illness, loss, or disability need comfort, hope, and, above all, the knowledge and reassurance that they are still cherished. This kind of practice is indeed spiritual and one that offers a great opportunity and blessing for all health professionals. (2005, p. 215)

Barnes, H. B. (2010). Understanding religion and science: Introducing the debate. London, UK: Continuum International.

Brueggemann, W. (1984). The message of the Psalms. Minneapolis, MN: Augsburg.

Clarkson, M. (1984). Destined for glory: The meaning of suffering. Grand Rapids, MI: Eerdmans.

Katongole, E., & Rice, C. (2008). Reconciling all things: A Christian vision for justice, peace, and healing. Downers Grove, IL: InterVarsity.

Lee, H. (1996). The merits of suffering. Grand Rapids, MI: Eerdmans.

Lloyd-Jones, M. (1994). Why does God allow suffering? Wheaton, IL: Crossway.

Murphree, J. (1981). A loving God and a suffering world. Downers Grove, IL: InterVarsity.

Wicks, R. (2006). Overcoming secondary stress in medical and nursing practice. New York, NY: Oxford.

Wright, L. M. (2005). Spirituality, suffering, and illness: Ideas for healing. Philadelphia, PA: F. A. Davis.

Wright, S. (2002). Examining the impact of spirituality on nurses and healthcare provision. Professional Nurse, 17(12), 709–711.

Sometimes as nurses we feel we must be able to handle anything, and when we struggle with something like suffering, we are demonstrating personal and professional weakness. The reality is we do struggle with the painful situations we see daily in nursing practice: a child run over by a school bus, a woman miscarrying a much wanted child, a college student becoming incapacitated with mental illness, a young father learning he has cancer, an elderly person dying alone, or a family who has lost their health insurance and are being refused care. To acknowledge our struggle with difficult situations is to acknowledge our humanness. When we face circumstances that are beyond our ability to change or to understand, lamenting, as described earlier by Brueggemann, might be a fitting response. Katongole and Rice describe lament. “Lament is not despair. It is not whining.…Lament is a cry directed to God” (2008, p. 78). Lament is the recognition that if God is not there, there will be no hope, no good, and no meaning in the situation. Sometimes we need to allow ourselves to recognize the reality of the suffering around us and express our anguish to God, and sometimes a part of that process is to acknowledge our own suffering and anguish. By doing so we can experience comfort and hope in knowing God understands our anguish—he too has experienced suffering. As we cry out to God, we can find freedom from a false sense of responsibility or guilt over our inability to ease or eliminate the suffering of

our patients, and recognize that in some circumstances only God can intervene.

Second, we need to seek support from others in the Christian community. We need people with whom we can discuss experiences with suffering to gain new perspectives and understanding. Some support can only come from fellow nurses who understand the challenges of nursing practice. However, equally important is support from people who do not know the intricacies of nursing practice and who approach suffering from a totally different perspective. We need people with whom we can bare our souls, and we need to have people who we know are praying for us. There are few things in life that we can truly handle by ourselves; without a doubt suffering is not on that list.

Third, we need to take time for personal renewal and growth. Dealing with suffering can be emotionally, physically, and spiritually exhausting. Robert Wicks (2006) remarks, “Health care is one of the few professions where it is socially acceptable to ignore your family, your non-work life, yourself ” (p. 113). He suggests that self-care involves anything from taking a quiet walk, to having friends or family over for dinner, to having a hobby, to journaling, to asking oneself profound questions such as “what really gives value to my life” (p. 113). Taking time for activities such as reading the Bible and other helpful books, praying, attending church, participating in small groups, or other religious practices helps give meaning to life and restore one’s inner self.

“Though he lives in the present it is clear that

the Christian, according to St. Paul, is meant

to live for the future.” Martyn Lloyd-Jones.

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