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Medicine and the Arts

Commentary on an Excerpt From In the Country of Hearts

Journeys in the Art of Medicine

McEntyre, Marilyn PhD

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doi: 10.1097/01.ACM.0000482103.90482.50
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I know several people who wake into chronic pain every morning. I think of them when I wake with an annoying headache or find that my slightly arthritic foot isn’t bearing my weight happily. Acute pain I have had, and can imagine. Chronic pain borders on the unimaginable. Each of these friends—one with multiple sclerosis, one with advanced arthritis, and one who has recently had her 10th back surgery following extensive damage suffered in an automobile accident—has developed coping strategies. They plan, and their daily plans are modest. They organize the objects around them according to accessibility, weight, and frequency of use. Even as they remain determinedly independent, they foster the kinds of friendships where frank conversation about their physical needs happens easily: When they need help, they ask; when they don’t, they say so. And when the help isn’t quite what they need, they often say that, too. They laugh and weep with equal candor. And most of their time is spent reaching past their pain into a world whose needs may be the more apparent to them because they know need. One is a pastor and political activist. One teaches college courses from her wheelchair. One finds ways to change the lives of at-risk immigrants and people in various kinds of recovery who seem to cross her path with remarkable regularity. They have learned things from living with their pain that can’t be reduced (or elevated) to some ideal of saintly patience or stoicism. Like an older woman who was asked once what gifts she had to offer her community, they have “been through things,” and that is what they bring, without fanfare, when the tribe gathers.

John Stone’s empathetic observations about the difference between acute and chronic pain in this short excerpt from In the Country of Hearts are the kind that require an imagination willing to dwell on the details and locate the metaphors that enable a precision that fuels real compassion. The wild beast at the foot of the bed embodies several dimensions of pain: It is other, not self. It lurks, even when it is not attacking. Its “wildness” lies in its unpredictability; it could strike any time, or lie for a period of uneasy peace in the shadows, napping. It is no respecter of human boundaries, or of human authority. It moves according to its own law, which is impersonal and implacable.

The electricity in the forearm offers a geography of pain where riverbeds are dug into the body by a current that gradually erodes one’s defenses. The current breaches those defenses as rivers do their banks when they can no longer accommodate floodwaters. From arm to wrists to fingers, the current claims all available tributaries and the body becomes a site where natural forces supersede the brain’s benevolent dictatorship.

The words one finds to name the pain have to be rediscovered and retrieved each time, the alphabet reorganized for new “raids on the inarticulate,” as T.S. Eliot put it. It slices or scorches or floods or unfurls. It fills or empties. It charges or deadens. It sharpens focus or obliterates all categories.

It is glib and unhelpful to romanticize those who live with the kind of pain Stone writes about in this generously imaginative passage. While they may, in fact, be heroic, most of them don’t want that badge, preferring to retain their membership in the large association of ordinary folks who grumble a little, find amusement where they can, and manage what they must or, as my grandmother put it, “make do.” The people I know who live with a beast at the foot of their beds have developed skill sets that make them canny, pragmatic, and, at the risk of falling into cliché, wise, if wisdom is knowing when to submit prudently and when to risk pain for the sake of deep and costly pleasure. I learn from them. As Stone rightly reminds us, those among us who suffer bear something to which the rest of us would do well to bear witness. They manifest a plasticity of will and intention and a range of endurance that can lead us, whose turn for great pain has not yet come, to a more complex vision of hope and a humbler reckoning of our own economies of energy.

Even when they complain, when they withdraw into exhaustion or grow thorns of irritability, or perhaps especially then, they help us chart the waters we are all navigating, sailing a little closer to the edge, which the ancient cartographers marked with the cryptic warning, “Here be dragons.”

Marilyn McEntyre, PhD

M. McEntyre is adjunct professor of medical humanities, UC Berkeley–UCSF Joint Medical Program, University of California, Berkeley, California; [email protected]

© 2016 by the Association of American Medical Colleges