The Pain Chronicles Read online

  I lay beside Kurt, covered by a frayed magenta beach towel. It’s hard to recall how I felt about my body at that time, but it involved a dim sense of unease that led me to conceal it. I remind myself of this sometimes now: I didn’t enjoy my body that much even before I got pain, so pain didn’t ruin as much as it should have. I wonder now, if I had known that that afternoon was, in one sense, the beginning of pain and that henceforth my opportunities to take pleasure in my body would be numbered, would I have thrown aside the towel?

  I wanted to swim straight across the pond, as I had as a child. Then, my father had always followed me in a rowboat, which I was glad about because I was afraid of eels. Cynthia climbed out of the water and stretched out on the beach.

  “Would you swim to the other shore with me?” I asked Kurt. My heart beat as if I had propositioned him.

  Kurt looked up with a lazy, skeptical glance. He gazed at the pond and wrinkled his nose. “It’s too far,” he said.

  “Go with her,” Cynthia said.

  “Now?” he said.

  We swam and swam, arms curving over heads, pausing to look up as the families on the far shore came into clearer view. Closer, breath, closer. The straps of my white suit tangled, and the top slipped down. I wondered whether my breasts, pointing down pale in the dark water, looked like eels’ faces to the eels waiting below. Finally we flopped on the wooden dock, clean and hot and cold and wet, alone together—a pond away from where we began.

  “We really went the distance, didn’t we?” Kurt said later as we climbed back to the shore and collapsed, shivering, onto the warm sand at Cynthia’s feet.

  I looked up at Cynthia and saw something register. In a novel, this would be a tragic turning point: the older woman realizes that her young friend wants her former lover, and even though the woman doesn’t want him anymore, even though the woman might have in fact—as Cynthia had—left the man years ago, there’s always a price for desire: someone has to drown. Our story is so different, though, I thought, because Cynthia is different—I felt her generosity, her easy love, as she rubbed suntan lotion into my back. “You and Kurt are such matched swimmers,” she said reflectively. And then: “You should go inside, sweetie. You’re starting to burn.”

  Sunset fell as Kurt played guitar on the deck. The light changed on the water, and the shrubs sloping toward the sea darkened and merged into the hill. We drank and listened, and as I listened, pain set in.

  It began in my neck and poured through my right shoulder, down into my arm and hand. It felt as if my right side were sunburned, but inside out, reddening and beginning to pucker and blister beneath the skin.

  I usually drink wine, but I poured a glass of gin. It tasted as anesthetic as it looked, clear and cooling. But the pain seemed to be drinking, too, and as it drank, it grew bold and began to mock and turn on me.

  “I think I am not feeling well,” I announced, puzzled, and went downstairs to bed.

  My right side refused to fall asleep. It throbbed, reminding me of a horror movie I saw once, in which a transplanted limb is still possessed by the angry spirit of its original owner. I slipped into Kurt’s room to look in the long mirror. I turned at different angles, but my right and left shoulders looked the same.

  The pain continued, lively through the night. I heard Kurt and Cynthia whispering in the hall, and the closing of doors, and then I went up to the living room and wrapped myself in a blanket on the couch and drank more gin.

  I woke from a dream of terrible pain—of reaching for something you shouldn’t and arriving to find yourself stranded in a place you never wished to be.

  “Hey,” Kurt said, puzzled, as he came up the stairs.

  I sat up on the couch, cradling my arm, blinking, confused, waiting for the usual feeling of emerging from a nightmare. But the pain lingered, veiling the ordinary world.

  “You look—What? Are you okay?”

  “Yes—yes. I liked swimming across the pond with you,” I said with unplanned passion. Why was I revealing feelings for him? Why was I concealing the pain?

  He offered a mug of tea. I reached for it with my bad arm, as if to illustrate that nothing was wrong.

  “Perhaps we could go again today,” I said. But the cup was oddly heavy in my hand; I could barely bring it to my trembling lips.

  POENA

  Romantic and physical pain have nothing to do with each other, I firmly believed at that time, just as there is no likeness between a broken heart and a heart attack. A broken heart is a metaphor; a myocardial infarction is a cardiovascular event. Indeed, even as a metaphor, a broken heart seems antiquated now that we know emotion stems from the brain.

  “How do you know the nature of your ailment?” my favorite grandmother—a Christian Scientist—used to inquire when I had a headache. “How do you know that it isn’t a spiritual problem?”

  “Because I know,” I would say. “Because I’m not confused.”

  The feeling of Kurt and the feeling of pain had a certain similar emotional hue. And because they began at the same time, the narrative of pain and the narrative of the romance began to entwine and become a single story in my mind.

  Three years later I lay in Kurt’s bed for the first time, shivery and sleepless with the hope and fear that accompanies great change—and with pain, the same ghostly pain that had arisen for no reason that weekend three years before and then disappeared beneath the surface of my body.

  That day, I had taken the train to Providence to visit Kurt, something I had never done without Cynthia. Cynthia—who had recently married and liked the idea of her two friends pairing—had actually arranged for the date. I had asked if we could go swimming that afternoon, in memory of the afternoon in Nantucket. We swam past scores of anxious parents bent on keeping their children from slipping under the white rope separating them from deeper waters, and then we lay on the dock on the far shore. It was so sunny, it was as if we were still swimming in the sun-air. We lay resting on the wooden slats, gauging each other’s desire to lie there forever against the knowledge that the longer you wait, the harder it is to swim back. He was ready and then I was ready, but he closed his eyes again. I had just slipped into sleep when I felt his foot on my back, and I understood that we would sleep together that night.

  I am not given to large romantic hopes—to imagining that a given boyfriend could be the last boyfriend—and I’ve never understood how that feeling seems to come so easily to most people. But that night, as I lay beside him in the dark, a sense of possibility began to dawn. The night I lost my virginity, I had stayed awake with the sense of irrevocable transformation, but since then, sex had all been erasable, like scribbling on one of those childhood magic slates that you can shake blank so the game can go on and on. Could this be different?

  But I also had pain again. The old, eerie pain, familiar and strange. In the years since that day on Nantucket, I had felt a brush of this pain from time to time—a pointless ache in my neck and shoulders, which I dimly attributed to structural weakness in my body. I have a large head—poorly supported by a long neck and narrow shoulders—which I carry in a forward position, giving the impression at times that it is in danger of toppling off. I knew I should work on my posture, but it was on the list of boring beauty routines, such as working on my nails or my tan, that I had no real intention of undertaking. And the occasional achiness had become as normal as the sight of my unpolished nails and sunless skin.

  Only once in that period had the pain been something odder and more urgent. I was at a roof-deck garden party on the Upper East Side of Manhattan when a forgotten friend handed me a gigantic baby—a baby I hadn’t even known existed. I stood there alone momentarily, gaping at the baby, when pain sidled up and put a hand around my neck. I thrust the baby back into his mother’s arms immediately, smarting, but the touch of pain tingled as dusk gathered and the air began to chill. I continued my conversations. I thought of it as a brush of mortality, a reminder that these parties could not go on forever.


  Light began to fill Kurt’s bedroom, and pain filled the house of my body like smoke. I thought of a deer I had seen once as a child on a hiking trip in a summer nature camp. Its leg had disappeared beneath a tangle of roots. As our troop came near, the animal began to thrash, making a huge rustling noise, twisting its neck in desperation. Our leader made us stand back as he went up to examine it. When he came back, he said the deer’s leg was fractured and there was nothing to do. “It’s nature’s way,” he said. Some of the children began to cry. How could that be nature’s way? What was nature thinking? The deer would die in pain.

  I finally fell asleep, but woke from a dream about the deer. I had this dream every few years, but this time my body was merging with the deer, its leg turning into my arm, disappearing into the earth, like Persephone struggling to loose herself from her captor. When I woke, the image disappeared and the dream pain remained.

  “Why aren’t you sleeping?” Kurt said, stirring beside me. “I can feel you not sleeping.”

  “No, nothing,” I murmured. If he became my true love, I would look back on this night and realize that it had been the happiest night of my life because it had led to lasting happiness. But I had pain. Happiness and pain. The two nested familiarly together in my mind.

  Yet—why? Was pain the price of happiness—or a punishment for having it? Pain, from the Latin poena, “punishment for an offense,” and surviving in the English phrase on pain of death; the Greek poine, from the verb “to pay, atone, compensate”; and old French, peine, “punishment, or suffering thought to be endured by souls in hell.”

  But what was there to pay for? I had committed no offense. But there it was: I wanted Kurt, and I got pain. I slept with Kurt, and the pain returned. Those two facts nestled against each other, and (in the terms with which we will one day describe everything) with the miraculous neuroplasticity of the brain, began to develop neural connections. The sex mixed with the pain: the weight of his hands, pressing, imprinting, hurting my body, irrevocable as love.

  It wasn’t love, though, that turned out to be irrevocable. I never didn’t have pain again.

  Of course, I know now that the pain was related not to Kurt, but to swimming! Although I had occasionally splashed around hotel pools, the only times I swam long distances were with Kurt. That day, I had strained my neck and shoulder, beginning a cascade of symptoms stemming from an underlying condition of which I had been unaware. But what did I know of cervical spondylosis, spinal stenosis, occipital neuralgia, impingement syndrome, rotator cuff disease?

  I was years away, at that point, not only from having that information but from seeking or valuing or, one might even say, believing in it—at least with any of the same depth with which I felt the truth of other, unacknowledged meanings. As soon as I got pain, the thin veneer of science schooling began to crack, revealing conceptions of pain formed over millennia by art and literature, philosophy and religion.

  THE DESCENT OF PAIN

  It’s a small space, a crevice over which tangled roots cross like hands. The deer takes an idle leap; her hoof falls through the lattice. She tries to leap again, but pain holds fast and her body quivers and falls. She pants, panicked, but the desire to flee is checked against pain. She tries to stand once again, but pain tightens its grip.

  In the deer’s leg, sensory receptors known as nociceptors are activated in the basic process of tissue protection common to many multicelled creatures, from horses to earthworms. This process is known as nociception, from the Latin nocere, “to hurt or injure,” and the root -cept, which can mean “begin.” These receptors are, indeed, “the beginning of hurt,” responsible for sending nerve signals warning of a bodily threat.

  Nociceptors register mechanical (crushing), chemical (poisons), thermal (burns), or other stimuli that have the potential to damage cells. The threshold for activating normal pain-detecting nociceptors is similar among all members of a species: in humans, for example, the pain threshold for heat is about 108° F. At a lower temperature, the water feels pleasantly warm, but right around 108° F the pain-detecting neurons activate and send an alarm.

  Nociceptors are attached to two different types of nerve fibers, A-delta fibers and C fibers, which transmit information from the periphery of the body to specialized receptors in the spinal cord. A-delta fibers are nature’s warning alarm; they produce a fast, sharp, distinctly localized pain. Indeed, the information conveyed by the A-delta fibers doesn’t even need to reach the brain to have an effect; when the signals reach the nociceptors that sit in the spinal cord, they trigger an immediate muscular action that causes the creature’s body to move away from the harm. C fibers, on the other hand, are activated after the alarm has sounded and damage has already occurred. They produce a slow, persistent, diffuse pain that indicates continuing injury and forces the creature to tend to its wound after the danger has passed.

  The other deer continue to trot, disappearing into the woods. Yet vast respiratory and cardiovascular changes take place in the injured animal as the brain stem reacts to news of the injury by activating the autonomic nervous system (the part of the nervous system that regulates heart rate, breathing, and so forth) and triggering a massive release of adrenaline and other hormones. The vital purpose of the hormones is to pump up the immune system and help the liver and muscles produce and absorb more sugar, which will generate more energy to flee or fight. Rising heart rate and blood pressure prepare the deer to escape.

  While danger causes the body to generate energy initially, the wounds—along with the subsiding of endorphins, adrenaline, and the other hormones—later create a sense of sluggishness to force rest. Pain activates the immune system as the injured tissue causes an inflammatory reaction that sensitizes nerves, which causes greater pain. White blood cells release substances that promote fever and sleepiness, helping healing by increasing blood flow to the area, consuming dead cells, and delivering nutrients to the site. The entire area becomes sensitized so that even a light touch there will hurt. This sensitivity is adaptive because it ensures that the site of the injury is protected and rested.

  Pain also affects the hypothalamus, the part of the brain that controls hormone release, sleepiness, waking, hunger, thirst, and sexual drive. In the hierarchy of drives, pain is the highest—the most important to survival—so all other drives are stilled. As the feeling of agitation and alertness ebbs, the deer begins to feel heavy, warm, drowsy.

  Each of these reactions—together composing the body’s response to grave wounds—is a product of a neurobiology millions of years in the making. The basic sequence of responses to pain is common across many species: vigorous activity to escape danger, combined with unresponsiveness to all other external stimuli, followed by guarding of the wound and lethargy during recovery.

  There are also characteristic behavioral responses, such as repetitive motions (e.g., rocking to and fro), vocalization, grimacing, crying, or whimpering, which serve to warn others in the group of danger and to impress upon them the severity of the threat. Although human pain behavior seems designed to evoke care from others, when most animals are wounded, others of their species will instinctively keep their distance to let the injured member of the group heal. Moreover, the animal isolates itself from its own herd or family for fear its injury will be jostled. When a human comes near, it will try ever more frantically to escape. If the human tried to examine the leg, the deer would desperately thrash her head and kick with her other legs. If the deer were a fox or a wolf, she would bite.

  If the deer were a worm who had just lost the tail of its body, it would slither away without a second thought—or, indeed, a first one. Nature endows even invertebrates, like sponges and leeches, with the damage-sensing nociceptors of mammals and the reflexes to withdraw from danger, but with one key difference: this stimulus-response is not thought to cause the invertebrate pain.

  Since nature didn’t give invertebrates the thinking parts of the brain that would enable them to recall dangers and avoid them in
the future, she also didn’t curse them with the apparatus of a central nervous system to make them suffer from their blunders. Instead, she gave the worm, like plants, spare or replaceable parts to cover mishaps. Anyway, nature (it feels unnatural to write about nature without personification) is not concerned with the worm’s death, because the worm has dozens—perhaps hundreds—of offspring.

  The deer, on the other hand, is dear. Nature has a limited supply: deer produce few offspring, and they take a long time to mature. Mammals have no spare body parts and cannot grow new ones; a broken leg is the deer’s demise. So nature endows the deer with a cortex to generate pain to ensure that she will protect her leg.

  Even fish have an efficient nociceptive sensory apparatus involving nerves, a spinal cord, and a primitive cortex to process nociceptive signals. Moreover, they respond with behaviors characteristic of animals with more complex cortices (like mammals) in pain, and these behaviors can be reduced by opiate pain medication. Still, pain involves not only detecting harmful stimuli but also having a negative psychological experience, and some researchers argue that the brain of a fish lacks the complexity that is necessary for consciousness. Pain requires—indeed, is a function of—consciousness: the greater the level of cortical development, the greater the capacity to feel pain. Fish have small, primitive cortices. Mammals’ cortices are much more complex than those of other animals, and primates’ are the most so. Moreover, only primates possess an interoceptive cortex—a part of the brain believed to be critical in pain perception. The human interoceptive cortex is greatly enlarged.