As I hobbled out of the hospital, I wondered how, just six days ago, I had spent nearly thirty-six straight hours in the operating room…and even so, I had suffered excruciating pain…Yes, I thought, and therein was the paradox: like a runner crossing the finish line only to collapse, without that duty to care for the ill pushing me forward, I became an invalid.
Kalanithi’s mission to become a healer made it possible for him to accomplish anything in the face of extraordinary pain.
The Human Response to Pain
Humans remember painful things like nothing else. From hazing rituals and other rites of passage, to childbirth and injuries or illnesses, events involving intense pain are etched into our memories. Depending on the story we tell ourselves about our suffering, they are often remembered as transformative events, experiences that turned us into who we have become.
As I sat in the emergency room waiting for someone to stitch up my leg, I wondered what I could have done differently: pick up the bottles one by one? Take my time instead of rushing? Wear pants instead of shorts? A dozen thoughts went through my mind. It’s human nature to imagine alternatives when an accident occurs. We seek the lesson in the pain when it isn’t obvious.
Some patients are shocked when I tell them there is an upside to pain, but this mindset is crucial to our survival. The downside of having no pain is far worse, as we will see in Chapter 2. In Kelly McGonigal’s book The Upside of Stress, she makes a similar argument about stress. Using stress as a positive or adaptive force that pushes you to overcome the challenge ahead is far healthier in the long run than trying to avoid stress. We feel stress because what we’re doing matters to us.
There is something similar to be said about pain. In fact, stress can exacerbate pain and vice versa, but with the right mindset you can use these feelings as a catalyst to energize yourself, when you turn your thoughts towards the task at hand.
The concept of learning from our mistakes is in many ways about learning from our pain. Mistakes are painful—physically as well as psychologically—but we learn from them and use them to better ourselves. Along this journey of trying to better understand pain, I have come to believe that pain is a rich and vital source of learning.
***
Eventually, I was brought to an exam room and asked to sit on a gurney. The familiar sterile environment was accompanied by the smell of alcohol and polished steel. Everything about it said hospital. The physician’s assistant greeted me in a no-nonsense manner.
“I’m going to numb you up, wash out the wound, and sew you up,” she said. “Okay?” I lay down on my side. As she worked, I prided myself for not complaining about the pain or showing any outward signs of discomfort. It struck me as funny how strongly conditioned we are not to show pain in modern society, despite the fact that this desire to cry out is adaptive, intended to let others know we need help.
“When was your last tetanus shot?”
“I can’t remember.” I said, embarrassed. So she gave me another one, just in case. Ouch.
Chapter 2
A Blessing in Disguise
If you want to make peace with your enemy, you have to work with your enemy. Then he becomes your partner.
—Nelson Mandela
Before the discovery of surgical anesthesia in the mid-1800s, patients were forced to endure the pain of surgery while awake. This must have been a horrifying experience. In her journals, the 19th-century English novelist and playwright Frances Burney recounted the experience of undergoing breast surgery to remove a mass:
When the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision—& I almost marvel that it rings not in my Ears still!
Before anesthesia, the merit of a surgeon came down to his speed; this was paramount due to the immense pain patients were experiencing. The need to decrease pain so that surgeons could operate more precisely led to the discovery of surgical anesthesia. Anesthesia allowed surgeons to perform longer, more complex surgical procedures while sparing patients the excruciating pain of their work.
Before the discovery of anesthesia, even the most intense pain was simply accepted as a part of life. Those who suffered turned to religion for solace. It’s no coincidence that Karl Marx called religion “the opiate of the masses.” C.S. Lewis once wrote that “all great religions were first preached, and long practiced, in a world without chloroform.”
In earlier times, pain and disease were thought to be sent from God as punishment for sins and as an opportunity to seek redemption. Throughout the Middle Ages, pain was thought to provide spiritual purification. In Europe and America as late as the 18th century, physicians were often members of the clergy.
Early in the 19th century, a shift in thinking occurred. It began a humanitarian ideology that saw pain as something that should be avoided. Some philosophers began to argue that pain and suffering were fundamentally unnecessary.
In drafting the Declaration of Independence, Thomas Jefferson wrote that we all have a right to “life, liberty, and the pursuit of happiness.” This became a part of the ideological bedrock of the United States of America. If Americans had a right to pursue happiness, presumably this included the right to avoid pain.
Nineteenth-century scientific advances were paralleled by increasingly secular attitudes toward pain. There was a growing belief that suffering could be avoided and that it was truly unnecessary. As doctors used the scientific method to relieve ailments, people grew more reliant on science and less dependent on religion as the only available salve for pain and suffering. Despite advancing in other ways, the field of medicine was still years away from developing anesthesia.
Without anesthesia, pain put a major limit on the advancement of medical science. When a surgeon attempted a surgical cure for an illness or affliction, a patient was forced to endure the torture of an operation. There was simply no way around the pain. Some physicians tried using alcohol as a sedative to dull pain. Others asked patients to bite a bullet or use other, similar techniques to distract them from the pain. None of these measures effectively prevented much suffering. At the very least, this new, humanitarian view towards pain and the concomitant belief in the power of science to solve problems drove the search for a safe and effective anesthetic.
In 1846, William T. G. Morton, an American dentist, tried using ether, a gas, to put a patient under before performing a tooth extraction. When his patient awoke after the bloody procedure, he reported having experienced no pain. Morton went on to give the first successful demonstration of general anesthesia at Massachusetts General Hospital1, putting a patient under with ether while surgeon John Collins Warren removed a tumor.
Warren wrote about the landmark surgery:
The patient being prepared for the operation, the apparatus was applied to his mouth by Dr. Morton for about three minutes, at the end of which time he sank into a state of insensibility. I immediately made an incision about three inches long through the skin of the neck and began a dissection among important nerves and blood vessels
