Strategies of enduring and the suffering of loss: modes of comfort used by a resilient survivor.

In this case study, the narrative of a young mother who survived multiple losses and excruciating and prolonged pain in the treatment of burns is explored to develop and contrast the concepts of enduring and suffering. Joan survived an explosion that resulted in the death of her three children, disfiguring thermal injuries, the loss of her husband through divorce, and, as a consequence, the loss of her home, church, and community. Strategies of enduring--surviving the immediate impact of trauma, the long-term medical treatment and rehabilitation, and social adjustment--are described and contrasted with the experience of suffering. The article describes how Joan ultimately reformulated an acceptable sense of self and of the future. Her capacity to endure pervaded both physical and emotional dimensions of healing. Nursing care that did not assist her to endure, and therefore increased her suffering, and care that was perceived to be comforting, and therefore enhanced her ability to endure and reduced her suffering, are described.