We encountered a terminally ill patient, who had resigned as hospital nurse soon after she had fallen ill. As a former health professional, she was acting the good patient and performing her part as a member of the family. The patient was suffering social pain, so much so that she seemed to be unable to express what was really on her mind. One day, the ex-nurse gave us her precious nurse pin. It was when it occurred to us that what the patient had said and behaved was an expression of spiritual pain. Then, we started exploring the meaning of what she had said and done and tried to get at the structure of her spiritual pain referring to Murata's three structures of the spiritual pain of terminally ill patients: “time existence,” “relational existence” and “autogenic existence.” Eventually, we found that her behavior to respond to the wish of her family and to keep a good relationship with her physicians, which she herself regarded as social pain, was to sweep away uneasiness about and fear of being left alone, that is, the spiritual pain associated with “relational existence.” We also found that the spiritual pain associated with “time existence” intermingled with her wish to continue to be a nurse as expressed in the handing over of her nurse's pin.
Pain ; Patients ; Nurses ; seconds ; SOCIAL

Objective : Parkinson’s disease (PD) is a disease treated by polytherapy. This time, the authors report the role of pharmacists in one of the few Parkinson’s disease facilities in Japan (https://sunwels.jp/pdhouse/; abbreviated as PD House), which was born from the voices of PD patients. Methods : The backgrounds of 52 patients admitted to the PD House and prescriptions for them were analyzed to mainly clarify: the percentages of patients aged 75 or over and those using 7 or more prescribed drugs; and frequently used drugs to be carefully administered to the elderly. The approaches provided by pharmacists through interprofessional collaboration were also analyzed. Results : The percentages of patients aged 75 or over and those receiving benefits for individuals requiring care were 71.2 and 92.3%, respectively. Those using 7 or more prescribed drugs accounted for 75.0%. In multidisciplinary collaboration, pharmacists were involved in not only pharmacotherapy but also nutritional evaluation of patients with severe nutritional disorders, proposal of appropriate nutritional therapy, understanding of swallowing function, and appropriate medication teaching. Conclusion : The actual situation of PD patients, where they used multiple drugs, and their backgrounds suggest that interprofessional collaboration is indispensable for PD treatment, and the roles of pharmacists were shown to be important.