Or recall the effect on a nation when a beloved leader dies. I experienced the unifying effect of pain most profoundly in 1963 when I came to the United States to address the student chapel at Stanford University. As it happened, the chapel service occurred just two days after the assassination of President John F. Kennedy. I spoke on pain that day, for I could read nothing but pain on the faces of hundreds of students jammed into that building. I described for them scenes from around the world, where I knew groups of people would be gathering together in prayer and mourning to share the pain of a grieving nation. I have never felt such unity of spirit in a worship service.
Something like those sympathetic connections joins us to members of Christ’s Body all over the globe. When an oppressive government jails courageous Christians, when Islamic radicals behead those of a different religion, or even when my neighbors lose their jobs, a part of my Body suffers and I sense the loss. The pain of others can also come to our attention in less dramatic ways: the whispered signals of loneliness, depression, opioid addiction, discrimination, physical suffering, self-hatred.
“How can a man who is warm understand one who is cold?” asked Alexander Solzhenitsyn as he tried to fathom the apathy toward millions of Gulag inmates. In response, he devoted his life to perform the work of a nerve cell, alerting us to pain we may have overlooked. In a Body composed of millions of cells, the comfortable ones must consciously attend to the messages of pain, cultivating a lower threshold of pain. The word compassion itself comes from Latin words cum and pati, together meaning “to suffer with.”
Today our world has shrunk, and as a Body we live in awareness of many cells. A litany of suffering fills our media outlets. Do I fully attend? Do I hear their cries as unmistakably as my brain hears the complaints of a strained back or broken arm? Or do I instead filter out the annoying sounds of distress?
Closer, within my own local branch of Christ’s Body—how do I respond? Tragically, those who are struggling with divorce, alcoholism, gender or sexual identity, introversion, rebelliousness, unemployment, or marginalization often report that the church is the last group to show them compassion. Like a person who takes aspirin at the first sign of a headache, we want to silence them, without addressing the underlying causes.
Someone once asked John Wesley’s mother, “Which one of your eleven children do you love the most?” She gave a wise answer to match the folly of the question: “I love the one who’s sick until she’s well, and the one who’s away until he comes home.” That, I believe, is God’s attitude toward our suffering planet. Jesus always stood on the side of those who were suffering; he came for the sick and not the well, the sinners and not the righteous.
God gave this succinct summary of the life of King Josiah: “He defended the cause of the poor and needy, and so all went well.” And then this poignant postscript: “Is that not what it means to know me?” (Jeremiah 22:16).
Another Kind of Unity
Skeptics see divisiveness as the church’s greatest failure. In response, leaders exhort denominations and interfaith groups to join hands in a national or worldwide campaign. From my experience with the body’s nervous system, I would propose another kind of unity, one based on pain.
I can read the health of a physical body by how well it listens to pain— after all, most of the diagnostic tools we use (fever, pulse, blood cell count) measure the body’s healing response. Analogously, the spiritual Body’s health depends on whether the strong parts attend to the weak.
I have performed many amputations, most of them the result of a hand or foot no longer reporting pain. There are members of the corporate Body, too, whose pain we never sense, for we have denervated or cut whatever link would carry an awareness of them to us. They suffer silently, unnoticed by the rest of the Body.
I think of my Palestinian friends, for example. In places like Bethlehem, children have grown up knowing nothing but occupation and war. They play not in parks but in crumbling buildings pockmarked by rifle fire and explosives. Palestinian Christians feel abandoned by the church in the West, which focuses so much attention on Israel and assumes all non-Israelis in the Middle East to be Arab and Muslim. Beleaguered Christians in places like Lebanon and Syria plead for understanding from their brothers and sisters in the West, but we act as though the neuronal connections have been cut, the synapses blocked. Few hear their pain and respond with Christian love and compassion.
I think of the LGBTQ population scattered throughout our churches and colleges. Surveys show that a significant percentage of students in Christian colleges struggle with same-sex attraction. Yet some college administrations simply pretend those issues do not exist. Those students are left to flounder, cut off from the balance and diversity of the larger Body and from the acceptance and understanding that they need.
I think of the elderly, often put away out of sight behind institutional walls that muffle the sounds of loneliness. Or of battered children who grow up troubled, unwelcomed into foster homes. Or of refugees who feel cut off from participation in the larger Body. Or of prisoners sealed off behind electric fences. Or of foreign students who live in enclaves of cheap lodging, or of the homeless who lack any lodging at all.
Modern society tends to isolate these problems by appointing professional social workers to deal with them. No matter how well-intentioned, institutionalized charity can isolate hurting members from close personal contact with healthy ones. Both groups lose out: the charity recipients who are cut off from person-to-person compassion and the charity donors who offer care solely as a material transaction.
In the human body, when an area loses sensory contact with the rest of the body, even when its nourishment system remains intact, that part begins to wither and atrophy. In the vast majority of cases—ninety-five of every hundred insensitive hands I have examined—permanent injury or deformation results. Likewise, loss of feeling in the spiritual Body leads to atrophy and deterioration. So much of the sorrow in the world is due to members who simply do not care when another part suffers.
The apostle Paul set out clearly how members of Christ’s Body should respond to those who suffer:
Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God. For just as we share abundantly in the sufferings of Christ, so also our comfort abounds through Christ. . . . And our hope for you is firm, because we know that just as you share in our sufferings, so also you share in our comfort. (2 Corinthians 1:3-5, 7)
Many accounts of Christians who have suffered, beginning with the book of Job and the Psalms and continuing through the writings of the saints, speak of a “dark night of the soul” when God seems strangely absent. When we need God most, God seems most inaccessible. At this moment of apparent abandonment, the Body can rise to perhaps its highest calling: we become in fact Christ’s Body, the enfleshment of his reality in the world.
When God seems unreal, we can demonstrate that reality to others by expressing Christ’s love and character. Some may see this as God’s failure to respond to our deepest needs: “My God, why have you forsaken me?” I see it as a calling for the rest of the Body to unify and to embody the love of God. I say this carefully: we can show love when God seems not to.
Pedro’s Palm
One of my favorite patients at Carville, a man named Pedro, taught me about developing greater sensitivity to pain. For fifteen years he had lived without the sensation of pain in his left hand, yet somehow the hand had suffered no damage. Of all the patients we monitored, only Pedro showed no signs of scarring or loss of fingertips.
While mapping sensation on Pedro’s hand, one of my associates made a surprising discovery. One tiny spot on the edge of his palm still had normal sensitivity so that he could feel the lightest touch of a pin, even a stiff hair. Elsewhere, the hand felt nothing. A thermograph showed that the sensitive spot was a
t least six degrees hotter than the rest of Pedro’s hand (bolstering our theory, still being formulated, that warm areas of the body resist nerve damage from leprosy).
Pedro’s hand became for us an object of great curiosity, and he graciously obliged without protest as we conducted tests and observed his activities. We noticed that he approached things with the edge of his palm, much as a dog approaches an object with a searching nose. For instance, he picked up a cup of coffee only after testing its temperature with his sensitive spot.
Pedro eventually tired of our fascination with his hand. To satisfy our curiosity, he told us, “You know, I was born with a birthmark on my hand. The doctors said it was something called a hemangioma and froze it with dry ice. But they never fully got rid of it because I can still feel it pulsing.”
Somewhat embarrassed that we had not considered that possibility, we verified that the blood vessels in his hand were indeed abnormal. A tangle of tiny arteries supplied an extra amount of blood and directed some of it straight back to the veins without sending it through all the fine capillaries. As a result, the blood flowed very swiftly through that part of his hand, keeping its temperature close to that of his heart, too warm for the leprosy bacilli to flourish.
A single warm spot, the size of a nickel, which Pedro had previously viewed as a defect, gave him a great advantage after he contracted leprosy. That one remaining patch of sensitivity protected his entire hand.
In a church that has grown large and institutional, I pray for similar small patches of sensitivity. I look for modern prophets who, whether in speech, sermon, or art form, will call attention to the needy by eloquently voicing their pain. A healthy Body values these pain-sensitive members, just as Pedro valued his tiny spot of sensitivity.
“Since my people are crushed, I am crushed,” cried Jeremiah (Jeremiah 8:21). And elsewhere,
Oh my anguish, my anguish!
I writhe in pain.
Oh, the agony of my heart!
My heart pounds within me,
I cannot keep silent. (Jeremiah 4:19)
Micah, too, wrote of his grief at his nation’s condition:
Because of this I will weep and wail;
I will go about barefoot and naked.
I will howl like a jackal
and moan like an owl. (Micah 1:8)
These prophets stand in great contrast to insensitive Jonah, who cared more about his comfort than about an entire city’s destruction. The prophets of Israel sought to warn an entire nation of its social and spiritual numbness. I sense a need for modern Jeremiahs and Micahs—too often dismissed as young radicals—who can direct our attention to those in need of compassion and comfort.
By ignoring pain, we risk forfeiting the wonderful benefits of belonging to the Body. For a living organism is only as strong as its weakest part.
Chapter Eighteen
CHRONIC PAIN
ON SEVERAL OCCASIONS I have met a pain that defies understanding. Although it serves no apparent purpose, it so tyrannizes a life that the patient can think of little else.
Rajamma crept into my office with the demeanor of a hunted animal. As if scouting for an enemy, she peered warily around the room before lowering herself into a chair. She had many enemies: a sudden noise, anything that might startle her, even a gust of wind. Her cheeks were sunken, and she was thin to the point of emaciation. Marks scarred her face in a peculiar pattern, which I recognized as treatments by the traditional medicine man. She had scratched and burned her facial skin so that it had taken on a tough, leathery texture.
At this point I had been working in India only a year or two. During my training in London, whenever I encountered a case requiring a specialist I promptly referred the patient to someone more qualified and experienced. In South India I had no such luxury.
Rajamma suffered from tic douloureux, neuralgia of the face in its most severe form. The pain attacks spasmodically, an overwhelming shot of agony to one side of the face. It causes a grimace, thus the name “tic,” suggesting a twitch of the facial muscles. The condition may develop after an infection, such as a septic molar tooth, or it may have no identifiable cause. Even though Rajamma could not identify any tooth problems, local dentists had extracted all the teeth on one side of her face in hopes of eliminating the source of pain. As she told me her story, speaking slowly, she kept her mouth open and moved her lips carefully to limit the movement of her cheeks.
Her husband explained that the family tiptoed around and would not laugh or even tell a joke for fear of triggering one of her attacks. I asked about her near-starvation weight. “I dare not chew,” she said, “so I live on fluids, not too hot, not too cold.”
Rajamma lived in a tiny, earthen hut with her husband and four children. “My children never play in or near the house anymore,” she said with regret. Though chickens usually have the run of village houses, she kept hers penned so that none would fly up or startle her by cackling.
Despite all these precautions Rajamma lived at the mercy of excruciating pain, which hit her many times a day, incapacitating her. In desperation she had the village “doctors” heat a metal tube in the fire and burn blisters onto her face in an attempt to quell the pain. Her mental health had deteriorated badly and, though her husband tried to sympathize, I could tell the family was approaching a state of crisis.
I made every effort to locate a physical cause for the pain, and failed. Twice I tried to deaden the trigger area, which seemed to lie just in front of her right cheek bone. The first time, the sight of the needle near her face touched off one of her most savage attacks. My second attempt, under anesthesia, did not succeed.
Reluctantly, I concluded that I had only one sure way to stop Rajamma’s agony: I must open her skull and divide the nerves supplying that section of her face. I put off this decision because I had not been trained for neurosurgery and indeed had never observed such a procedure. But I saw no other recourse. Fortunately, in an anatomy course in Wales years before, I had dissected the cranial nerves and knew just where to find the Gasserian ganglion within the bony coverings of the brain. A nerve block to that ganglion represented her only hope.
I explained the procedure to Rajamma and her husband, emphasizing the dangers. I might fail because of my inexperience. Perhaps worse, I might cut more of the nerves than should be cut. In that event her eyeball, as well as her cheek, might become insensitive, which could eventuate in blindness. I painted a bleak picture of possible consequences, yet nothing I said to the couple caused the slightest flicker of hesitation. The impact of Rajamma’s suffering on her family was so great that even if I told them she would lose an eye in the operation, they would have readily consented.
Over the next week I studied all the books I could find and planned a strategy with our anesthesiologist. Since I wanted to communicate with the patient during surgery, we chose an anesthetic that would keep her alert enough to respond to questions. The day for surgery arrived.
The Family Awaits
We arranged Rajamma in a sitting position in order to minimize pressure on the veins in her head, and after the anesthetic had taken hold I began to cut. The Gasserian ganglion lies at the junction of the fifth cranial nerve, in a venous sinus surrounded by bone. Inside this cavity, veins and nerves crisscross in a skein of tangled threads, making it impossible to keep the site free of blood. I chipped away the overlying bone and entered the cavity, picking through the layers of tissue one by one. At last I could see the base of the cavity. A plexus of nerve tissue, an inch across and half an inch deep, lay glimmering under my light like a crescent moon. From that mass, fine white nerve fibers fanned out, like tributaries of a river, toward the face.
In most of the body, a tough sheath enwraps each nerve, allowing it to tolerate a certain amount of stretching. Nerves in the bony skull, not designed to be touched or pulled, lack this protective sheath, and the slightest tremor of my hand would tear a nerve irreparably.
I took special care to identify a motor nerve, any
damage to which would partially paralyze her jaw. But the other fibers all looked the same and lay bundled so close together that I could not be sure which was which. I electrically stimulated one delicate fiber and asked Rajamma what she felt. “You are touching my eye,” she said. My heart beat faster, and beads of sweat popped out on my forehead as I dropped that slender nerve back into place.
I stared into the spreading pool of blood, pale and watery from the anemia caused by Rajamma’s malnutrition. (At that time we had no blood bank to enrich her blood before surgery.) Finally, I separated two tiny, white nerve fibers and lifted them away from the blood. These two seemed the most likely carriers of the pain impulses that were making her life a misery. The time had come for me to cut them.
As I lifted the two nerves with my probe, an awful sensation broke over me like a wave. I was transfixed by the import of what I was about to attempt. Surgeons are trained to maintain a certain distance from patients so that personal feelings will not impair our judgment—for this reason we are warned not to operate on our own family members. At that moment I had a vision of Rajamma’s family gathered around me in a circle, staring, waiting to see what I would do with her life.
Was one of these two the faulty nerve? So little is known about the physiology of nerves that I could not possibly spot a visual defect. As I gazed at those trembling strands of soft white matter, each the thickness of a cotton sewing thread, I found it hard to believe they held such power. Yet these nerves, containing hundreds of axons serving thousands of nerve endings, were domineering an entire family. Meanwhile, nerves just like them were steadying my hands and letting me know exactly how much force to apply to my instruments.
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