The gift nobody wants

'Life is difficult'. I wanted to throw the book across the room.

I had just begun reading M. Scott Peck's classic 'The Road Less Travelled' during university, after being prompted to by a friend. Of course I knew a lot of the truths and lessons contained within the book from the ethos of my Christian upbringing. However this particular piece of unpolished statement of fact struck against my quiet, peaceful suburban outlook. I knew about pain, of course I did. I had seen its effects on family members and patients, but those were individual cases which I somehow managed to stoically contain. This larger existential statement of fact left me very uncomfortable and vulnerable.

Growing up with a World War II veteran English grandfather, I had been an early adopter of the seeming virtues of 'a stiff upper lip' and 'taking it on the chin'. An acknowledgement that pain and hardship would come my way, but that the best response was a defensive one: stiffened resolve and an unflinching exterior. These served relatively well as guiding principles, until pain would no longer allow me to tune it out in a number of arising circumstances, and finally made me sit down and listen to it.

It is impossible to work in healthcare and not encounter the pain of another, and our own pained response to the suffering of those around us. If pain remains an indistinct cacophony of noise, it can become unbearable and crushing. However, if we allow ourselves to engage with it and listen to what it is trying to tell us, we could be wiser and safer for it. 'The Gift of Pain' is a 1997 book written by Dr Paul Brand and Phil Yancey. Dr Brand was an orthopaedic surgeon who contributed enormously to the field of hand surgery and the modern understanding of leprosy. He goes on to describe the invaluable need for pain as a warning system to help us minimise damage and preserve healthy tissue. This is particularly in the case of leprosy patients, who due to the damage caused to their peripheral nervous system by the causative leprosy mycobacteriae, are unable to effectively feel when they injure themselves. Because of this, they might continue to overuse fingers or feet despite trauma, and this can result is further serious disability.

Pain however is a complex phenomenon, and can be the result not only of physical injury, but also emotional and psychological trauma too. This is why chronic pain clinics at tertiary referral hospitals are often multidisciplinary. They consist of anaesthetists, surgeons, psychiatrists, psychologists and social workers. Our experience of pain as human beings is multi-faceted, and any attempt to ameliorate these extreme examples of pain without a multi-modal response is likely to miss the full picture. Pain is designed to be protective, and show us our limits. However when acute pain is mismanaged or ignored, a more entrenched and intractable form of chronic pain can develop, and this can remain a challenge to the individual and treating healthcare worker respectively.

Having said that, however, I am aware of individuals who have shared a difficult journey with tragedy, suffering and pain in their lives. These had been uninvited events, and there was often a prolonged period of not wanting to experience the circumstances to their full extent. However, in coming to terms with the reality of what their life was now about, they allowed the pain to be transformative. In acknowledging that pain has a limiting effect, they respected this, and allowed their attention to focus on good days, gratitude, and the lessons that were being taught, as well as letting go of what they were unable to control. In allowing the latter to take place, they spared themselves the double trauma of their actual pain, and the existential pain at why they couldn't seem to escape it.

Not many of us seek out pain in it's manifold manifestations, but part of being human is that we will experience pain in our lives. It might be the acute pain of a fractured ankle, or the more complicated pain of the loss of a loved one. In either scenario, we have the option to ignore it and shore up consequences and further damage to and for ourselves, or we can chose to acknowledge the pain and it's purpose and wisely engage it.

In a life that is difficult, which will it be?