Monday, October 12, 2009

Pain Beyond Words, and an Impulse Just to Endure -

Having gone through five significant operations, including one to remove my entire diseased colon and another to cut out my cancerous prostate, I think I can safely state that pain falls into two broad categories: the kind you can articulate, and pain that is beyond words.

If you can tell an E.M.T., a nurse or a doctor where it hurts and how much, that is generally a good sign. But what interests me even more is the pain that can't be articulated. Fortunately, I've experienced this only twice.

The first time came in 1984, when I had my colon taken out. I had been taken back to my room after surgery, one-quarter awake and feeling as if I had just tumbled over Niagara Falls in a barrel. The orderlies and nurses wheeled the gurney against my hospital bed, then started to move me. That was when I became half-awake.

Even though they were tugging me just a few inches, my body pulsed with the worst pain that I had felt in my life. And when it seemed to me that the half-dozen or so tubes snaking from my body were about to be ripped out because they were tangled at the foot of my bed, I tried to shout. But all that came out, I think, was, "Uh-uh-uh." Mercifully, once I slumped onto my bed, I heaved a sigh and went to sleep.

When I had my prostate out in 2008, I almost fainted when a new resident tried to remove one of my drains. Instead of giving it a firm yank, she waggled it inside my body as if she were whipping up cotton candy. I became dizzy, broke into a cold sweat and nearly threw up. She finally left and got help.

I wouldn't have chosen to be in those two situations, but each one granted me insight into myself and into the nature of pain.

In each case, I was humbled by pain that to me seemed to transcend the basic medical scale of 1 (mildest) to 10 (most severe). And pain is a path to humility. When it hurts just to wriggle up in bed, elbows digging into the mattress for support, you generally don't think of yourself as sitting atop the food chain.

And pain is a teacher. More than ever, I understand how abhorrent it is to inflict pain. I have learned to distinguish between mere discomfort and pain that can't be tolerated. And tough-guy popular culture — oh, great, ultimate fighting on Spike TV — doesn't impress me at all.

I have no patience these days with the Nietzschean cliché, "That which does not kill us makes us stronger." I've found that the deepest pain holds no meaning. It is not purifying. It is not ennobling. It does not make you a better human being. It just is.

All the worst pain does is reduce us to our most primal animal. We want it to stop. We want to survive. It short-circuits any sense of self, diminishes us to a bundle of biological reflexes.

Right after the radical open surgery to remove my prostate, I felt like one big post-op throb of pain. The morphine drip was my new best pal. It didn't take long, though, for discrete fiefs of ache and twinge to make themselves known: catheter burn (complemented by the occasional bladder spasm), sore and swollen testicles and the subtle attack of hospital-bed back.

But oddly enough, those sensations were almost pleasant — distractions from my wounded gut. The abdominal incision was raw and tender, but that didn't stop me from fingering it, searching for different notes of discomfort on the xylophone of the 25 metal staples that held me together.

I've been surprised by the degree of pain you can become used to. Before I had my colon out, my stomach hurt constantly from ulcerative colitis, and I bled a lot from my rectum. It wasn't until I was recovering that I realized how sick I had been.

One side effect of all these operations is that common day-in-and-day-out bumps and bruises don't get much of a rise out of me. Stubbed toes and headaches, spider bites and bee stings? Whatever. The bracing prickle of alcohol sloshed onto a cut or a scrape actually feels pretty good to me. And after all the siphoning, and replenishing, of my blood over the years, I don't flinch at needles.

We don't like to talk about pain — are somehow shamed by it and try to shrug it off. We're told to play through pain or, even, to pray through it. We revere our stoic American archetypes, like the Wild West gunslinger riddled by half a dozen slugs of lead who swears, "Aw heck, Doc, it's only a scratch."

One of the stupidest things I've ever done was not take my pain medication after that surgery in 1984. I was raised in a tight-lipped rural culture in which even aspirin was suspect, and I was taught that real men embraced their pain as if it were their destiny. It was supposed to be better to sweat through pain-induced insomnia at 3 in the morning than give in to the terrible temptation to take a pill that would let you sleep.

Well, enough with that. Pain is a crucial part of our medical tales. It needs to be articulated, then confronted — even if, sometimes, the pain is beyond words.

Dana Jennings is a reporter at The New York Times. His postings on coping with prostate cancer appear each week at

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