Religions call their holiest people saints. In secular speak, a saint is a person who is pure, honest beyond reproach and mostly devotes one’s life to the benefit of others. In our more common vernacular, we, call those who sacrifice themselves for the good of others heroes.

I have decided that my grandfather was either a saint or a hero. I have only come to that opinion recently, long after he has passed.

My grandmother had multiple sclerosis. She was in constant pain. Sometimes it was severe enough that she would scream and wish to die. Grandma could not move from one position in a chair to another without assistance. From the time I remember, she sat frozen with her knees at a right angle to her hips. Her 90-pound frame – which looked like a skeleton – had to be carried from the living room chair to the toilet to the kitchen table to the bed. In bed she had to lie on her side, because her legs had developed permanent contractures, preventing her from resting in any other position.

During the 18 years of my childhood and youth, my grandfather rarely left my grandmother’s side except to work in the fields. I never recall my grandfather speaking negatively to her or expressing anger at her dependence. Nor did he ever ask anyone else in the family to help care for her.

Today we would call my grandfather a “caregiver,” but that sounds too clinical. That level of generosity requires a higher level of attribution. Saint or hero – take your pick.

People with acute pain receive flowers, calls and visits, but when the pain becomes chronic, those connections soon fade leaving the person with pain isolated. Family and friends drift away because their own schedules make demands or because they don’t know how to make a meaningful contribution. The caregiver often shares this isolation. It is the daily responsibility that separates the caregiver from those who care about the ill person. Those who care may be sincere, but they are not in the foxhole.

The caregiver is most often an adult child, parent or spouse. They face innumerable challenges. They deprive themselves of a normal schedule. They forgo pleasures and other responsibilities to be there for the one in need, out of duty, love or both.

The role of caregiver for a person with chronic pain is not a sprint but a marathon. People who have chronic pain may live for years, and so goes the role of the caregiver. Responsibilities are never-ending. The duties include nursing, banking, cooking, housecleaning, bill paying and all other activities required to exist in society.

Every day in my practice as I saw patients with chronic pain, I would also see caregivers. I was always in awe of their spirit and generosity. They, along with my grandfather, are heroes in our society if not saints. I am not sure I can tell the difference.