The Gift of Pain A book review

Whenever I let my mind wander, and wonder who I would like to
have been if I had not been born C. Everett Koop, the person who comes
to mind most frequently is Paul Brand.
--C. Everett Koop, United States
Surgeon General (Ret.)

I have had the opportunity on several occasions to meet Dr. Paul
Brand. The first time I was struck with his humility and gentleness.
Then I did not know that he was a world-renowned hand surgeon, professor
emeritus at the Department of Orthopedics, the University of Washington,
and a man who had given much of his professional life to serving lepers
in India and the United States. The next time we met, I knew these
things, but I did not know why. Now that I have read The Gift of Pain, a
book by Dr.
Paul Brand and Philip Yancy, I understand why.

Early in the book, Dr. Brand describes a rich life as a child,
growing up in the poverty of the Kolli Malai mountains of India, with
his English missionary parents. Among the locals, malaria gave the area
the name "Mountains of Death."

After a detour into carpentry, Paul Brand went on to medical school,
performing his residency in London during the Blitz, during World War
II. London was soon deemed too dangerous for medical students. Dr. Brand
was shipped off to Cardiff. He writes:

"I do not know the name of my most memorable acquaintance in Cardiff,
a middle-aged Welshman with a shock of dark hair and bushy eyebrows. I
never saw the rest of his body, for it had been severed from his head. I
had proposed an ambitious project for my required dissection: to expose
the twelve cranial nerves of the head and follow them to their site of
origin in the brain."

Dr. Brand describes this journey into the brain with a series of
fascinating detours for the layperson. (This is not a medical textbook,
though perhaps it should be required reading in medical schools.) I
emerged with an overwhelming sense of the Creator's fingerprints present
during the design of the nerves, spinal cord, and brain -- the house
where pain lives.

"Ensconced in an opaque skull, the brain never 'sees' anything. Its
temperature varies only a few degrees, and any fever exceeding that
would kill it. It hears nothing. It feels no pain: a neurosurgeon, once
inside the skull, can explore at will with no need for further
anesthetic. All sights, sounds, smells, and other sensations that define
life come to the brain indirectly: detected in the extremities, escorted
along the nerve pathways, and announced in the common language of nerve
transmission. To a secluded brain, it does not matter where the data
originate."

The middle of Dr. Brand's book is a detective story. The patients
that he began serving felt no pain. It was Dr. Brand who made the
connection: because they felt no pain, his patients constantly injured
themselves. Injuries seemingly never healed. Amputations resulted. The
medical community had long ago written the chain of events off as part
of the disease: leprosy. While modern drugs could treat and usually halt
the advance of leprosy, it was Dr. Brand's pioneering hand and facial
surgeries that began to restore the lives of countless lepers.

But as Dr. Brand learned, a life without pain is a dangerous life,
indeed. And it is not only lepers, but diabetics, who are often
afflicted with this condition. When he came to the U.S. Public Health
Service, a project was begun to duplicate the body's warning system of
pain. It was hoped that such a system would give these patients the same
warning sign regarding impending injury that pain provides, thus
preventing damage to the body. None was ever discovered.

It is the third section of Dr. Brand's book that will be of the most
intense interest and use to those suffering from pain. With the
exception of the patients Dr. Brand describes, that is likely to include
most of us at some point in our lives. He writes:

"If I held in my hands the power to eliminate physical pain from the
world, I would not exercise it. My work with pain-deprived patients has
proved to me that pain protects us from destroying ourselves. Yet I also
know that pain itself can destroy, as any visit to a chronic pain center
will show. Unchecked pain saps physical strength and mental energy, and
can come to dominate a person's entire life. Somewhere between the two
extremes, painlessness and incessant chronic pain, most of us live out
our days."

It is in this third section that Dr. Brand weaves together a lifetime
of medical and human knowledge about pain: how it protects us, and how
we can prevent it from overwhelming us. "What takes place in a person's
mind is the most important aspect of pain," he writes, "and the most
difficult to treat or even comprehend. If we can learn to handle pain at
this third stage, we will most likely succeed in keeping pain in its
proper place, as servant and not master."

To a society that values pain relief to the tune of over $63 billion
per year -- and increasingly to the cost of asking our healers to kill
us to avoid pain, as the physician-assisted suicide movement grips
society -- Dr. Brand brings this message: "Pain and pleasure come to us
not as opposites but as twins, strangely joined."

In this final chapter Dr. Brand speaks most directly to the developed
world. He does so through stories, only one of which I will tell.
Perhaps it is in this chapter that like me, you may learn the "why" of
Dr. Paul Brand:

"In the earliest days of our project with leprosy patients, I was
working in the mud storeroom we grandly called the 'Hand Research Unit'
when a distinguished-looking Englishman ducked in. 'I have a special
interest in the handicapped,' he said, 'and I hear you work with leprosy
patients. Do you mind if I watch?'

"I welcomed him, and for the next three days this man sat in a
corner, observing us. At the end of the third day he said to me, 'I've
noticed there are some people you have to turn away -- those who are too
old or too damaged to be helped by your surgeries. Those are the
patients I'm interested in. I would like to help them.

"And Leonard Cheshire told me his story. During World War II he had
served as group captain, an esteemed position in the Royal Air Force. He
saw action in both Europe and Asia, earning the Victoria Cross and many
other awards. At the very end of the war, President Harry Truman asked
Winston Churchill to choose two British observers to accompany the Enola
Gay, in order to demonstrate that the decision to drop the atomic bomb
was an Allied, not a unilateral, decision.

"On that day, August 6, 1945, Leonard Cheshire looked out his cockpit
window and saw an entire city of people vaporize. The experience
profoundly changed him. After the war he began a new career devoted to
the disabled, founding the Cheshire Homes for the Sick. Today,
Cheshire's organization manages two hundred homes for the disabled in
forty-seven countries (Cheshire himself died in early 1993). Among them
is a home in Vellore, India [the site of much of Dr. Brand's work],
where about thirty leprosy patients live. Medically speaking, they are
beyond help. But as Leonard Cheshire eloquently demonstrated to me, they
are not beyond compassion and love."

[The Gift of Pain, by Paul Brand and Philip Yancy, Softcover, 1997.
Zondervan Publishing House, Grand Rapids, Michigan. Previously titled
The Gift Nobody Wants.]