With a start, I came to myself. Though my reverie lasted only five or ten seconds, I have never forgotten the vision brought on by minuscule, shimmering nerves. Not knowing which of the two carried the pain, I had to sacrifice both. I cut them with two snips. We quickly got the bleeding under control and closed the wound.
Back in the ward, after Rajamma awoke fully, we mapped out the area on her cheek that no longer had sensation. My knots of tension relaxed when we learned the insensitivity did not include her eye. Haltingly, Rajamma tried what previously had triggered her spasms of pain. She attempted a slight smile, her first intentional smile in years. Her husband beamed back at her. With a quizzical look, she scratched her right cheek, aware that she would never feel anything there again.
Little by little after that, Rajamma’s world fell into place. She became a gentle, sweet person once again. Her husband’s anxiety began to lessen. Back home, she welcomed chickens into the house. The children began to play indoors, to jump and chase each other even in their mother’s presence. In ever-widening circles, life returned to normal for that family.
Rogue Pain
In my career I have encountered a mere handful of patients who, like Rajamma, suffer from intractable pain with no apparent physical cause. Only a few times have I had to silence pain surgically by cutting a nerve. Those of us in medicine view such a procedure as a radical one of last resort. It carries with it grave risks: the potential of denervating the wrong areas, danger to the body parts made insensitive, and most mysteriously, the chance that even after nerves are cut the pain may persist as “phantom pain.”
In Rajamma’s case I had to counter all medical instinct by treating pain itself as the problem, not as a valuable symptom. That change in perspective highlights the cruel paradox of chronic pain: no longer a directional signal that points to something else, pain becomes a self-perpetuating malevolence. Those who suffer from chronic pain care only about how to switch it off.
Most commonly, chronic pain occurs in the back, neck, or joints, although those who suffer from cancer and a few other diseases can experience such pain anywhere. Whereas painless people—such as my leprosy patients—yearn for the warning signal of pain, chronic pain sufferers hear a blaring, pointless alarm.
A flurry of recent research has focused on chronic pain, and hundreds of pain clinics now specialize in it. The preferred methods of treatment are moving away from older surgical techniques, and a rise in opioid addiction has dampened enthusiasm for chemical solutions. Instead, the term pain management has entered the vocabulary of specialists. The director of one of America’s largest chronic pain clinics has said we may need to apply a different model to chronic pain. Perhaps, he suggests, we should treat chronic pain as we treat diseases such as diabetes, by teaching patients to live comfortably despite the disease.
The broader health care industry now offers up alternative treatments for chronic pain: foot or earlobe massage, bee-stinger acupuncture, numbing pads, biofeedback, self-hypnosis. Devices such as TNS (transcutaneous nerve stimulators) offer a more technological approach. Most of these techniques of pain management rely on overloading the brain circuits with diversionary stimuli, which in turn suppress incoming pain signals.
I prefer simpler methods to accomplish the same purpose. For example, I recommend a stiff-bristle hair brush for a person experiencing arm or leg pain. The effect of briskly stroking the skin will excite touch and pressure sensors and often relieve pain. Or when my chronic back pain intensifies I go for a barefoot walk on the rough shell-and-gravel sidewalks near my home.
Compassion Fatigue
Images of suffering fill our television screens daily, a form of chronic pain on a global scale. Jesus himself acknowledged the deep-rooted nature of human misery when he observed (in a statement that is often grossly misapplied), “The poor you will always have with you” (Mark 14:7).
Having lived in a country where suffering was a distressing reality, I know well the dilemma posed by chronic pain on a massive scale. I have stared at long rows of patients, knowing I must decline treatment for all but a handful, and knowing too that thousands more await attention in remote areas.
We tend to view global suffering indirectly, via news reports and magazine articles, and thus pain forces a choice upon us. We can choose to extend our aid and food and abundance to help ease human misery, or we can numb the chronic pain by averting our gaze from the problems. The Bible makes clear that we in the Body have a responsibility to the suffering of those in the margins. Overseas relief aid administered by Christian agencies has mushroomed in recent years, a sign that we are attending to the short-term, crisis pains of the world. Christians have helped spearhead emergency responses to crises in Asia, Central America, and Africa, contributing billions of dollars to support such efforts. We who are strong help the weak.
Nonetheless, in handling chronic, long-term pain, the church still seems in its infancy. The head of one large Christian relief agency confessed,
I must restrain myself from global ambulance-chasing. When a major disaster occurs that captures media attention, our donors respond with incredible generosity. Agencies like mine collect millions of dollars, and move in with a kind of overkill. When the crisis is “hot news,” we have no difficulty raising funds. Six months later, the desperate problems are still there, but the camera crews have gone elsewhere, and no one cares about the long-term suffering.
Although intense suffering may prompt a sudden outpouring of aid, donors soon tire of hearing about depressing conditions. Instead of increasing sensitivity, as a human body does in response to injury, we decrease it. Our focus turns from “How do I deal with the cause of the pain?” to “How can I silence it?” No longer a stimulus for action, the pain becomes a dull, ineffective throb. It has worn us down.
The field of health services illustrates the dilemma of relief work. People readily donate money for hospitals, drugs, and medical supplies. Yet, according to the World Health Organization, the great majority of health problems—as much as 80 percent of all diseases—derive from polluted water supplies. Development programs for sanitation and hygiene simply don’t have the drawing power of more dramatic appeals.
Of course, chronic pain also occurs close to home, not just in places like Ethiopia and the Sahel. During tough economic times the United States and Europe also hear plaintive cries from people who cannot provide for their own basic necessities. That sound, too, can become a dull throb, easier to tune out than attend to.
A few years ago, as an economic slump and the impact of budget cuts in social programs began to affect people in urban areas, churches found themselves facing overwhelming human need. The poor began turning to the church, not a government office, for aid. Alarmed about the sudden increase of homeless people in his city, the mayor of New York made a creative proposal to church leaders. Thirty-six thousand people wander New York streets without shelter, he said; if each of the city’s 3,500 churches and synagogues would care for ten of them, they would solve the problem of homelessness. The mayor brought to urgent attention a chronic pain that plagued a large city.
Churches responded defensively. One Protestant leader seemed offended that he had first read of the proposal in the newspaper. “It is a very complex situation and the remedy will be complex,” said another. “There are many problems of implementation.” Most asked for time to evaluate the proposal. They claimed their houses of worship were ill-equipped to shelter the homeless. Only seven congregations responded affirmatively.
Although the mayor’s proposal indeed had a complex dimension, its simple appeal to charity stands in direct line with the message of the Old Testament prophets, Jesus, and the apostles. “Share your bread with the hungry and bring the homeless poor into your house,” said Isaiah (58:7 ESV). In the early church, members routinely brought vegetables, fruit, milk, and honey to distribute to widows, prisoners, and the sick. Following their path, modern churches have taken the lead in operating soup kitchens and homeless s
helters, so effectively that the US government sponsored “charitable choice” legislation to aid their efforts.
In no way do I mean to imply that chronic pain will gradually fade away. No one who has worked in a country such as India could easily come to that conclusion. I think of the crush of refugees fleeing war and violence; and of a lonely woman, abandoned by her husband, left alone to raise children with insufficient resources; and of released prisoners struggling to reenter society; and of monumental problems of health in the developing world. Neither governments nor the church will relieve all that suffering. More important are the attitudes and energy with which we respond to these chronic pains. Do we grow numb and insensitive? Do we react with a quick burst of enthusiastic support that wanes over time?
People with chronic pain, such as quadriplegics or the parents of disabled children, describe a common pattern: friends and church members initially respond with sympathy and compassion, but over time they lose interest. Most people find an ordeal with no end in sight unsettling and can even come to resent the one who is suffering.
I retain a clear memory from my childhood of the monthly charity of my Aunt Eunice in England. She kept a little book from the Aged Pilgrims’ Friend Society and visited women from that list every month without fail. I accompanied her as she brought money or food or clothing or Christmas packages to those elderly women. In her own quiet, unglamorous way, Aunt Eunice taught me how to turn impersonal, chronic pain into a personal experience of sharing. She insisted on visiting the women, not mailing them packages, and she kept up her simple ministrations faithfully for years.
A physical body’s health can be measured in large part by its response to pain. Pain management requires a delicate balance between proper sensitivity, to determine its cause and mobilize a response, and enough inner strength to keep the pain from dominating the whole person. For the Body of Christ, the balance is every bit as delicate and as imperative.
Friction and Lubrication
Not all chronic pain in the physical body is debilitating. Less intense forms affect as many as one hundred million people in the United States alone. Persistent pain, often located in the knees, hips, or lower back, affects more Americans than diabetes, heart disease, and cancer combined. Joint replacements, stem cell therapy, and vertebrae fusions have become commonplace, offering a more recent solution to one particular kind of chronic pain.
When parts work together closely, they generate friction. I was reminded of this danger when a concert pianist in England consulted me. “I can no longer perform,” she told me. “I can’t concentrate on the flow of music or the rhythm. Instead, I can only think of the pain that shoots through my hand whenever the thumb moves at a certain angle.” She had recently canceled a series of concerts because of that grating pain, even though she retained all her skills of musical interpretation, muscle action, sense of touch, and timing.
The trouble emanated from a small arthritic area between the two wrist bones at the base of her thumb, and I suggested she continue to play in a way that moved that joint minimally. “But how can I think about Chopin when I have to worry about the angle of my thumb?” she protested. Each time she started to play, her attention riveted on the painful friction of that one roughened little joint.
Treating patients such as this pianist prompted me to study the type of lubrication in our joints, and I gained a new appreciation for how healthy joints work so smoothly without pain. At the Cavendish Laboratory in Cambridge, England, a team of chemists and engineers were seeking a material suitable for use in artificial joints. They found that a joint such as the knee has only one-fifth the friction of highly polished metal—about the same friction as ice on ice. How is this possible? they wondered.
Further research revealed that joint cartilage is filled with tiny channels bathed in synovial fluid. As a joint moves, the part of the cartilage bearing the strain compresses, causing jets of fluid to squirt out from these canaliculi. The fluid forms a sort of pressure lubrication that lifts the two surfaces apart. When the joint continues to move, a different part of the surface bears the stress; fluid in the new area squirts out while the area just relieved of pressure sucks its fluid in. Thus, in active movement the joint surfaces do not really touch, rather they float on jets of fluid. The Cavendish engineers were astonished, for boundary lubrication and pressure lubrication were recent inventions—they had thought.
Considering how often joints and bearings require attention in a machine, my joints amaze me with their ability to last for decades without squeaking or grinding. Even so, despite their remarkable powers of lubrication, the body’s joints can deteriorate as their gliding surfaces begin to wear thin. As I age, my joints have begun to ache and throb, a natural response to years of wear.
Rheumatoid arthritis, an autoimmune disorder, poses a far more serious problem. Suddenly the body’s immune system turns cannibalistic, mistakenly attacking the joints as if they were foreign substances. The synovium thickens and inflames, and a civil war breaks out. The defense mechanism itself becomes the disease.
I see clear parallels in the spiritual Body. Its “joints” are those areas of potential friction where people work together in some stressful activity. A form of spiritual rheumatoid arthritis sometimes attacks individuals who are doing good and important work. Members become hypersensitive, taking offense at imagined criticism or even a disagreement over politics or theology. Their own dignity and position become more important than the harmony of the group.
Some may assume Christians are less susceptible to friction because of the ideals and goals they hold in common. In fact, Christian work can increase friction as the pressure to “be spiritual” exacerbates working tensions. At the Christian Medical College in India we had a psychiatrist who counseled many missionary clients. Highly motivated, working in lonely places, often with just one colleague, missionaries fall prey to acute personal tensions. Friction may result from something as trivial as an ill-timed joke, a tendency to snore, or the way a roommate picks her teeth.
When I experience friction with colleagues or fellow church members, I have to ask myself whether it stems from my own pride or righteous indignation. Could my irritation be causing more harm than whatever I am irritated about? Sometimes the grace of God comes in the form of little squirts of synovial fluid that helps older Christians to get along with the young, who have different notions of proper behavior and appearance—and that also helps the young to understand what it must be like to live with brittle, worn-down cartilage.
The human body goes to remarkable lengths to prevent friction, and the Body of Christ should learn from it the need to lubricate possible friction areas as we cooperate in mutual activity. It takes little grace to get along with people who see eye to eye with me. Grace is put to the test when I work together with people who have different styles and see the world differently—who “rub me the wrong way.”
Chapter Nineteen
BRAIN
The Enchanted Loom
WHAT FORCE RACES THROUGH THE BODY to connect its many parts? Could it possibly be electricity? To former generations, the very concept of electricity was as mysterious, and terrifying, as nuclear energy is to ours. Benjamin Franklin risked his life by launching a kite into the teeth of that fiery power. What relevance could the feared juice of the heavens have to nerve cells buried in the body’s soft tissue?
Before Luigi Galvani, an Italian who lived thirty years after Franklin, scientists and doctors had accepted the ideas of the Greek physician Galen, who described the body’s communication system as a flow of pneuma, or spirit, through a network of hollow tubes. Then one humid day, Galvani brought a few frogs home for dinner and hung them on his porch.
Following one of those farfetched hunches that have formed the history of science, he beheaded the frogs, skinned them, and ran a wire from a lightning rod to the frogs’ exposed spinal cords. He recorded what happened next as a summer thunderstorm swept across Bologna: “As the lightning broke out, at
the same moment all the muscles fell into violent and multiple contractions, so that, just as does the splendor and flash of the lightning, so too did the muscular motions and contractions . . . precede the thunders and, as it were, warn of them.”
Galvani did not bother to describe the expressions on the faces of his guests, who watched headless frogs jerk and twitch as though kicking across a pond. He stuck to the science, concluding that electricity, not pneuma, had surged through the nerves of the frogs and stimulated movement in dead animals. Entranced, Galvani performed many other experiments. One bright day he hung several beheaded frogs on copper hooks just above the iron railing of his porch. Whenever one of the frog legs drifted toward the railing and made contact, it jerked violently. Reflexes during a lightning storm are one thing, but dead frogs high-kicking on a sunny day—that’s the kind of discovery to set the scientific community on its ears. And so it did.
Galvani’s rival, Alessandro Volta, decided that the electric current had nothing to do with the frogs and everything to do with two dissimilar metals joined by an organic conductor. He went on to invent the battery, and we have him to thank for flashlights, laptop computers, and cars that start on below-zero mornings. Galvani insisted the reaction came from “animal electricity,” and we have him to thank for EKG monitors, biofeedback machines, and electric shock treatment.
Wires Within Us
The neuron plays the key role in carrying out orders from the head. Inside each of us, twelve billion neurons, so fine that a hair-width bundle of them contains one hundred thousand separate “wires,” lie poised for action. Medical specialists view them as the most significant and interesting cells in the entire body.
The neuron begins with a maze of minute, lacy extensions called dendrites, which, like the root-hairs of a tree, ascend to a single shaft. These dendrites wrap around every square millimeter of skin, every muscle, every blood vessel, and every bone, interweaving so intricately that even through a microscope it is nearly impossible to discern where one ends and another begins. I liken the sight to standing on the edge of a forest on a winter day. Before me marches a line of several hundred trees, each thrusting dark lengths of snow-laced branches up and out. If all those trees were somehow compressed into a few square yards, with their branchlets filling in the spaces without touching each other, the resulting image would resemble a nerve bunch in the body.
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