I had forgotten why I was challenging how we treat people living with pain in healthcare and society. But it's hard work and I became caught up in driving kids to hockey and school, in gardening, reading, and car appointments, and in all the other first world problems we love to be distracted by.

Six months ago, a patient in the hospital reminded me. I blinked and looked around realizing I had been asleep munching on the lotus fruit provided by socialization while the real world problems went on without me. To be sure, there are many people passing through my practice that could have reminded me, But like most doctors, I can become numb to the overwhelming problems faced by people with health issues. Anyway, this man's suffering snapped me out of it.

There was an injury years earlier from a job site gone wrong resulting in pain — but not like "horribly smashed up body" sort of pain. Just pain — here, there — that didn't leave any traces as to why and wouldn't just go away. More shocking was just how utterly broken he was on the inside. Outwardly functional, but completely devastated and dead inside. The detritus of his life before injury and pain scattered around him like tornado wreckage, he was unable to look or walk away from it. He was ready to end it.

There were people trying to help. This wasn't a man on the margin of society. He wasn't some functioning wreck before the accident (don't we always try to find some "reason" why people don't cope with devastation by combing past life for clues?) Things had been tried, both physical and psychological treatments, but they had not worked very well. They didn't "take". So here he was in front of me, still stuck and in pain, barely holding on.

I wanted to know: How is this possible? Where have we failed him? How could he still be so broken after all this time?

I know there is an easy way out to say, "well, you can't save everybody," or, "people have some responsibility in their own well being." I get that. I feel no compulsion to save everybody. I'll be the first to agree that we are responsible for our own happiness. Lord knows the books on my shelf have drilled that into my head.

But is it really all on him? Has he remained stubbornly stuck? Not followed good advice? Were all the doors opened?

I'm not ready to let our system of care off the hook so easily (or maybe it's our culture.) I wasn't on the journey with the healthcare professionals that have been trying to help him so I can't know their attention and efforts, but I'm sure they have been genuine and well meaning. But I could see in the story that not all had been done; he had flown under the radar; and he had been judged. Like all complex problems there were errors of omission, errors of commission, and systemic failures.

I was angry after this encounter. Something is wrong with how we approach broken people. They find me because of their pain. But once you look through the lens of their pain you often find more than a few broken bits. Living with pain can break people and things. It is an invisible force. Even Yoda would recognize it's power, "Yes. Feel it you must. Breaks you it might. Judge you they will." We need new approaches in healthcare that prevent the breaking in the first place. That's not what is happening now.

There are many layers to this. Too many for one post, but enough for a blog. I wanted to not forget again. Writing will help me clarify my thinking and point to new people and new conversations with a rising creative class in medicine. It will help me in my work with patients, with Pain BC Society, and with the changes that need to occur within my own healthcare setting.