Putting Pain to Work

I admit, a professional career devoted to people with leprosy, whose main defect is an absence of pain, has biased me on the subject. And yet numbness, too, is a form of suffering. In the case of leprosy patients it can lead to a life of acute suffering.

When I reflect on pain I prefer not to think in a detached way of a hypothetical sum of the world's suffering; instead I focus on one individual with a face and body. At such moments my mind often flashes back to the refined, upper-caste features of my friend Sadagopan, whom we called Sadan. Readers of Fearfully and Wonderfully Made know him as the forbearing subject of my early experiments with proper footwear for leprosy patients.

When Sadan first came to Vellore, his feet had shrunk to half their normal length and his fingers were shortened and paralyzed. It took us nearly two years of unflagging effort to stop the pattern of destruction in his feet. Meanwhile we began reconstructing his hands, a finger at a time, attaching the most useful tendons to the most useful digits and retraining his mind to control the new set of connections. In all, Sadan spent four years with me in rehabilitation. He personified the soft-spoken, gentle Indian spirit. Together, we wept at our failures and rejoiced at the gradual successes. I came to love Sadan as a dear friend.

At last Sadan decided he should return home to his family in Madras for a trial weekend. He had come to us with badly ulcerated hands and feet. Now his hands were more flexible, and with a specially designed rocker type shoe he could walk without damage. "I want to go back to where I was rejected before," he said proudly, referring to the cafes that had turned him away and the buses that had denied him service. "Now that I am not so deformed I want to try my way in the great city of Madras."

Before Sadan left, we reviewed all the dangers he might encounter. Since he had no warning system of pain, any sharp or hot object could harm him. Having learned to care for himself in our hospital and workshop, he felt confident. He boarded a train to Madras.

On Saturday night, after an exuberant reunion dinner with his family, Sadan went to his old room where he had not slept for four years. He lay down on the woven pallet on the floor and drifted off to sleep in great peace and contentment. At last he was home, fully accepted once again.

The next morning when Sadan awoke and examined himself, as he had been trained to do at the hospital, he recoiled in horror. Part of the back of his left index finger was mangled. He knew the culprit because he had seen many such injuries on other patients. Evidence was clear: telltale drops of blood, marks in the dust, and, of course, the decimated clump of tendon and flesh that had been so carefully reconstructed some months before. A rat had visited him during the night and gnawed his finger.

Immediately he thought, What will Dr. Brand say? All that day he agonized. He considered coming back to Vellore early, but finally decided he must keep his promise to stay the weekend. He looked in vain for a rat trap to protect him that last night at home-shops were closed for a festival. He concluded he must stay awake to guard against further injury.

(To prevent such tragedies, we later tried to maintain a rule at the hospital: all released patients must take a cat home to protect them from rats during the night.)

All Sunday night Sadan sat cross-legged on his pallet, his back against the wall, studying an accounting book by the light of a kerosene lantern. About four o'clock in the morning the subject grew dull and his eyes felt heavy and he could no longer fight off sleep. The book fell forward onto his knees and his hand slid over to one side against the hot glass of the hurricane lamp.

When Sadan awoke the next morning he saw instantly that a large patch of skin had burned off the back of his right hand. He sat trembling in bed, despair growing like a tumor inside him, and stared at his two hands-one gnawed by a rat, the other melted down to the tendons. He had learned the dangers and difficulties of leprosy, in fact had taught them to others. Now he was devastated by the sight of his two damaged hands. Again he thought, How can I face Dr. Brand, who worked so hard on these hands?

Sadan returned to Vellore that day with both hands swathed in bandages. When he met me and I began to unroll the bandages, he wept. I must confess that I wept with him. As he poured out his misery to me, he said, "I feel as if I've lost all my freedom." And then, a question that has stayed with me, "How can I be free without pain?"

As I turn from the network of pain in biology to its analogy in the Body of Christ, comprising all believers, again I am struck by the importance of such a communicative system. Pain serves as vital a role in protecting and uniting that corporate membership as it does in guarding the cells of my own body.

Deep emotional connections link human beings as certainly as dendrites link cells in our bodies, evident even in such relative trivialities as sporting events. Watch the face of a wife sitting in the stands at Wimbledon as her husband plays in the championship tennis match. Strands of concern and affection unite them so intensely that every on-court success or failure can be read on the wife's face. She winces at every missed shot and smiles at each minor triumph. What affects him affects her. Or, visit a Jewish household in Miami, San Francisco, or Chicago around election time in Israel. Many Jews know more about the campaign ten thousand miles away than about their local elections. An invisible web, a plexus of human connections, links them with a tiny nation of strangers far away.

Or, recall the effect on a nation when a great 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 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 clusters 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 should link us to members of Christ's Body all over the globe. When South Africa jails courageous black Christians, when a government systematically destroys the church in Cambodia, when Central American death squads murder Christians, when Muslims drive a person from town for the crime of converting, when more of my neighbors lose their jobs, a part of my Body suffers and I should sense the loss. Pain also comes to our attention in whispered signals of loneliness, despair, discrimination, physical suffering, self-hatred.

"How can a man who is warm understand one who is cold?" asks Alexander Solzhenitsyn as he tries to fathom the apathy toward millions of Gulag inmates. In response, he has 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. We must develop a lower threshold of pain by listening, truly listening, to those who suffer. 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 all cells: persecuted Russian believers, starving Africans, oppressed South Africans and Indochinese and Central Americans . . . the litany fills our newspapers. Do we fully attend? Do we hear their cries as unmistakably as our brains hear the complaints of a strained back or broken arm? Or do we instead turn down the volume, filtering out annoying sounds of distress?

And closer, within the confines of our own local membership of Christ's Body-how do we respond? Tragically, the divorced, the alcoholics, the introverted, the rebellious, the unemployed often report that the church is the last body to show them compassion. Like a person who takes aspirin at the first sign of headache, we want to silence them, to "cure" them without addressing the underlying causes.

Someone once asked John Wesley's mother, "Which one of your eleven children do you love the most?" Her answer was as wise as the question foolish: "I love the one who's sick until he's well, and the one who's away until he comes home." That, I believe, is God's attitude toward our suffering planet. He feels the pain of the suffering; do we?

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 profound postscript: "Is that not what it means to know me?" (Jer. 22:16).

I hear many cries for unity in the church today; a watching world sees divisiveness as our greatest failure. Calls go out exhorting one denomination to merge with another, or for many denominations to join hands in a national or worldwide campaign. Out of my experience with the nervous system in the human body I would propose another kind of unity: one based on pain.

I can read the health of a physical body by noting how well it "listens" to pain-most of the diagnostic tools we use, after all (fever, pulse, blood cell count), measure the body's healing response. Analogously, the corporate Body's health depends on how the stronger parts attend to the weaker.

Some cries of pain in the Body come to us loudly and persistently. We cannot help but acknowledge them. I am more concerned with the distant outposts of pain, the extremities of limb in His Body that we have somehow silenced. I have performed many amputations in my life, most of them because the hand or foot has gone silent and no longer reports pain. There are members of Christ's 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, but silently, unnoticed by the rest of the Body.

I think of my Lebanese friends, for example. In Beirut, children have grown up knowing nothing but war. They carry submachine guns as nonchalantly as American children carry water pistols. They play, not in parks, but in crumbling skyscrapers gutted by bombs. Christians in Lebanon, especially the Armenians, feel utterly 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. Spokesmen for Christians in Lebanon eloquently plead for compassion or some token of understanding by their brothers and sisters in the West, but we act as though the neural connections have been cut, the synapses blocked. Few hear their pain and respond with Christian love.

Or I think of the homosexual population scattered throughout our churches and colleges. Some surveys show that as many as 20 percent of males in Christian colleges struggle with homosexual tendencies. The reality is so abhorrent to Christian leaders, though, that the church may simply pretend they do not exist. They are left to flounder, cut off from the balance and diversity of the larger Body and the compassion that might help them.

Or I think of the elderly, often put away out of sight behind institutional walls that hold in all sounds of loneliness and mourning. Or of battered children who grow up troubled, unwelcomed into foster homes. Or of races who feel cut off from participation in the Body. Or of prisoners sealed off behind huge fences. Or of foreign students who live tucked away in cheap lodging, isolated and afraid. Even those within the church judged for some minor doctrinal disagreement can feel cut off, severed.

In modern society we tend to isolate these problems by forming organizations and appointing social workers to deal with them. If we are not careful, a form of institutionalized charity will grow up that effectively isolates hurting members from close personal contact with healthy ones. In such an event, both groups atrophy: the charity recipients who are cut off from human touch and compassion and the charity donors who think of love as a kind of 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-95 of 100 insensitive hands I have examined-severe injury or deformation results. The body poorly protects what it does not feel. In the spiritual Body, also, loss of feeling inevitably leads to atrophy and inner deterioration. So much of the sorrow in the world is due to the selfishness of one living organism that simply does not care when another suffers. In Christ's Body we suffer because we do not suffer enough.

I must also mention one further service that members of Christ's Body perform by embracing others' suffering. I say this carefully: we can show love when God seems not to.

The great accounts of Christians who have suffered, beginning with the Book of Job and the Psalms and continuing through the writings of and about the saints, speak of a "dark night of the soul" when God seems strangely absent. When we need Him most, He is 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 His reality to others by modeling His 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 push through loneliness and isolation and to embody physically the love of God.

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 have received from God. For just as the sufferings of Christ flow over into our lives, so also through Christ our comfort overflows. If we are distressed, it is for your comfort and salvation; if we are comforted, it is for your comfort, which produces in you patient endurance of the same suffering we suffer. 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 Cor. 1:3-7).

As I reflect on the need to develop greater sensitivity to pain, I think of one of my favorite patients at Carville, a man named Pedro. For fifteen years he had lived without pain sensation 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 fingertip. My associate went over Pedro's hand with great care and came up with a surprise. 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 on the hand he could feel nothing. We also found on a thermograph that the sensitive spot was at least six degrees hotter than the rest of Pedro's hand (which supported 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 our tests and observed his activities. We noticed that he approached things with the edge of his hand, much as a dog approaches an object with a searching nose. He picked up a cup of coffee only after testing its temperature with his feeling spot.

Finally Pedro tired of our endless fascination with his hand. He said, "You know, I was born with a birthmark on my hand. The doctors said it was 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 option, we verified that indeed the arteries in his hand were abnormal. A tangle of arteries brought an extra amount of blood and short-circuited 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 the heart, too warm for the leprosy bacilli to flourish.

That single warm spot, the size of a nickel, which Pedro had previously viewed as a defect, had become a wonderful advantage to him when 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. We must look to prophets, whether in speech, sermon, or art form, who will call attention to the needy by eloquently voicing their pain.

"Since my people are crushed, I am crushed," cried 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" (4:19). Prophets like Jeremiah and Micah stand in great contrast to an insensitive one like Jonah, who cared more about his comfort than about an entire city's destruction.

The prophets of Israel tried to warn an entire nation of social and spiritual numbness. We need to encourage modern Jeremiahs and Micahs and to value our compassionate, pain-sensitive members as much as Pedro valued his tiny spot of sensitivity. By shutting off sensitivity to pain, we risk forfeiting the wonderful privileges of being part of a Body. A living organism is only as strong as its weakest part.