written by reader The Gain from Pain Mainly Explained (part one)

Guest Columnist Dr. KSS begins a series on pain

By DrKSSMDPhD, July 15, 2014

[Ed. Note: Dr. KSS writes about medicine and biotech stocks for the Irregulars. He has agreed to our trading rules and he chooses his own topics. His words and opinions are his own. Enjoy!]

Lying in bed beneath an exam lamp, my 16-year-old patient’s facial serenity belied how fervently he was kneading misbaha beads with all his fingers. Outside in the Abu Dhabi morning, it was 125 degrees. I suppressed a chill: the air-conditioning was potent. The young fellow had hepatitis B.

I was about to do a liver biopsy on him, and was looking forward to it as it would be a chance to use a needle type and technique quite different from anything available stateside. Generally at this stage in the set-up, I have nurses telling suitable jokes to patients to distract, make them feel less vulnerable. I didn’t know any jokes I was sure would survive cultural transposition into Arabic, however. I had gently prised up his shirt, and was thwacking away over his liver margins, using techniques of finger percussion to choose a biopsy site.

The boy made a declaration, vaguely plaintive. “‘Please doctor,'” the translator said, quoting him. “‘I do not want to feel pain.'”

For Buddhist monks, om is the universal syllable. And for medical patients everywhere, no phrase, no sentiment, is more universal than what he’d just said. I do not want to feel pain. From a patient’s perspective, almost nothing can be more urgent, more in need of emphasis, than iterating clearly to your caretakers that you do not want to hurt, that you insist on it. But rarely had this most primal and basic desire of all patients in all places been so clearly articulated.

I reassured him, of course. “Inshallah,” he said. He’d be flooded with local anesthetic, and it would be given plenty of time to work, and I’d test him carefully before doing anything to be sure he felt nothing. And that, deep to its capsule, the sac it lives in, the liver has no nerve endings to feel pain. Even so, Guido Ceronetti, one of Italy’s most insightful dramatists and philosophers, astutely captured every patient’s dread in his ingenious volume of essays on medicine The Silence of the Body, in which he depicts patients having rising fear in proportion to a doctor’s interest in their organs, which at the doctor’s insistence are “about to ...

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