On being stoic

This is my very first blog and musing!  I hope if you read this you are indulgent with me and add some comments at the end so I can use them to reflect and learn!

This first blog is a story that starts with a trip to the dentist.  I have been having trouble with a tooth for a while.  My brother-in-law is my dentist: ‘I think we need to take it out, Anne’ he says.  Now, let’s just put this in context, it’s a big tooth, a daddy one.  I’ve never had a tooth out before; only those that I wobbled out as a youngster. ‘OK’, say I, meekly (my heart started to pound – OMG thinks I).

The next part isn’t pretty.  I sat in the chair while he wrested the tooth out.  I didn’t like it, not one bit.  When he was done he came and looked at me, properly looked, and then gave me an unexpected hug.  My feelings must have shown in my face. 

‘I’ve been a good patient, haven’t I?’ I asked.

I have no idea why that was the most important thing to ask at that time. What on earth did I mean ‘good patient’ and why did I ask?

I started to think about how health was viewed by me and in my family and what was deemed to be important.  I’m a northern girl, brought up in a hard community of working class families.  Ill health was not part of any discussions I can recall as a child.  My thoughts took me back to my granddad.  He is dead now but I loved him very much.  He was a little hardy man who I know loved me unreservedly.  Later on in his life he had chronic obstructive pulmonary disease.  He walked his little dog, Trixie, nearly every single day of the last decade of his life.  As his condition got worse he just adjusted the length of the walk and went more slowly.  More importantly, I never once heard him complain about his breathing.  If he was puffed we would just stop for a few minutes.  I suspect what he was demonstrating was ‘being stoic’.

 Grandad and Trixie 1979

So what is being ‘stoic’ and does it/should it matter to those providing care?

I decided to have a look at nursing literature and explore whether behaviours such as stoicism were considered, when we are looking after patients.  There wasn’t extensive literature but I found one very interesting paper by Spiers (2006).  Spiers (2006) links stoicism to a determination to endure and also comments that endurance allows the patient to remain in control; patients can present ‘themselves as a stoic person who was able and willing to tolerate pain’ (p. 296).

This presents a dilemma for nurses, the need for patients to remain in control and yet support them in dealing with issues where they may be close to their edge of tolerance.   I would argue that in these circumstances nurses need sophisticated communication and assessment skills that allow patients to express stoicism at the same time as dealing with complex symptoms such as pain.  These are difficult skills to teach and learn.  Spiers (2006) cites some interesting examples of the interactions between nurses and patents.

So it appears that not all patients are the same, no surprise there then, and that nurses need to have complex communication skills to deal with patients like me who have a desire to remain stoic and in control.  I’m not sure these are conversations we have often enough as the ‘do you have any pain today, Mrs. Cooper’ may not work for me and I hope in future if I need nursing care I have a nurse who can think beyond a pain assessment scale.

Thank goodness my brother-in-law (aka Dentist) had good enough skills to assess that I was feeling a bit grim – a hug that day went a long, long way!

Spiers, J., (2006) ‘Expressing and responding to pain and stoicism in home-care nurse-patient interactions’ Scandinavian Journal of Caring 20 pp 293-301 Abstract available online http://www.ncbi.nlm.nih.gov/pubmed/16922983