Spiritual Pain and Grief

Prairie Doc Perspective Week of July 20th, 2025
Spiritual Pain and Grief
By The Rev. Kari Sansgaard, Avera@Home Hospice Chaplain – Sioux Falls, SD

After nearly twenty years of parish ministry, I entered the world of health care, which, I learned, abounds in acronyms. My first clue was in chaplaincy training, known as “CPE” (Clinical Pastoral Education), the required education for most hospital and hospice chaplains. CNA, SoB (Shortness of Breath), PRN, HoH (Hard of Hearing), and a myriad of other acronyms are now part of my own vernacular. QoL (Quality of Life) is the ‘big’ one in hospice, sometimes called “comfort care.” When quantity of life becomes diminished, it’s all about quality.

Dame Cicely Saunders, the founder of hospice as we know it, understood human suffering as a combination of physical, psychological, social and spiritual pain. She famously said the following: YOU MATTER BECAUSE YOU ARE YOU, AND YOU MATTER TO THE END OF YOUR LIFE.

I suggest that all people are spiritual, where spirituality is defined as the source(s) of meaning and purpose that guide and encourage us. Spiritual pain, then, is part and parcel of being human. I describe it simply as anything that breaks your heart. A pet dies; a friend moves away; a family member becomes estranged; a dream is not realized; divorce, death, broken trust, and so on. 

In hospice, when death is impending, spiritual pain can lead us to ponder existential questions, such as the following:

• How has my life been meaningful?
• Is there a God or Higher Power?
• What will be my legacy?
• Have I lived my life to the fullest?
• What do I do about my regrets?
• Will I see my loved ones again?

Chaplains abide with us when we boldly ask these (and other) questions. At our best, we provide both active and reflective listening, safe space, and a supportive presence. In the crying, wrestling, confusion and fear, we remain.

In addition to supporting areas of spiritual pain, chaplains are curious about sources of meaning in our lives (our spiritual resources). In whom or what do you place our ultimate trust? What people, experiences, music, places and/or Higher Power enliven your spirit and ground you? Life review in this realm can lead to laughter, connection and peace.


SPIRITUAL CARE IS NOT AN OPTIONAL EXTRA FOR THE DYING.
-Dame Cicely Saunders

When we are grieving, spiritual pain can be exhausting. We can move through anger, sadness, numbness and peace in the course of thirty minutes. How do we ‘do’ life with the emptiness we feel? We are not made to endure this suffering alone.

Grief groups, clergy, therapists, good friends, music, books, podcasts and nature walks, are among the resources available to us. It is important, in all life chapters, to nurture our spiritual resources. When crises come, our spiritual grounding can buoy us.

As you tend to your body, mind and spirit through in this complex and beautiful life, may your QoL be well.

Pr. Kari Sansgaard, is an ELCA pastor who serves as Avera Hospice Chaplain at Daugherty House Prince of Peace and Touchmark All Saints in Sioux Falls. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.