No Words: Presence and ‘Total Pain’

This chapter extends my examination of Cicely Saunders’s repeated assertion that words are rarely needed in end-of-life care. Starting from Saunders’s interest in the power of her patients’ passivity, I argue ‘total pain’ incorporates how the dying body’s vulnerability establishes new forms of relationality and temporality so that personhood lies increasingly in relations with others and experiences frequently feel timeless. Modes of caring presence expressed through non-narrative acts like touch, watching and ‘being with’, which Saunders implies assist with ‘total pain’, can be understood as ways of holding or making space for the complexities of such experience, while accepting potential shortfalls in communication or understanding. Saunders is therefore not only an early advocate for forms of narrative medicine but also of non-instrumental acts that challenge positivist medical interventions by seeming to do nothing but nevertheless affirming value through bearing witness.