To feel pain, you need to pay attention to it. Pain can capture your attention, and once it’s captured, you may not be able to release it. It can hold you prisoner in this way, and force you to invent increasingly clever ways of escaping it.
You hear about people having a high threshold for pain or a low one, as if pain leaked into your body over some kind of baffle. But in fact, every healthy human being has about the same pain threshold, the point at which you notice a mildly unpleasant sensation — pressure, heat, prickling, whatever — that would be intolerable if it were stronger. What varies wildly from one person to the next is the point at which you would describe the sensation as actually painful, and the point at which the pain becomes intolerable.
Chronic pain doesn’t take you by surprise. You can plan for it, as you would a deadline, or a business trip. Will you accept the pain this time, or push it away? You can contain the pain, isolate it: this body has nothing to do with you. You can defer the pain, but it will seek you out later, and will not be denied.
What about the other pain, equally chronic? Will it keep that pain at bay if you never talk of your mother, dead of a stroke before she was forty, or your brother, shot down over the Pacific, or your daughter, stricken by a virulent infection? If you collect all their pictures and put them away, will that make the pain recede, or will pain take the place of pictures and become a way of keeping your memories alive?
He couldn’t tell if he was going uphill or down. There had been a ridge, that’s where the machine gun was, so he must be going downhill. He blacked out, it was like falling and falling, but when he came to, he was in the same place. He had thought his leg hurt before, but he was wrong. Now it really hurt. He pushed the pain aside. It had crept up on him, but he could squeeze it down to a pellet, a seed, and store it away. He inched forward on the trail.
Ed was in the kitchen of a house he had never been in, talking to a dark-haired, middle-aged woman dressed like a G. I., in dungarees and an undershirt. She wasn’t Katie, but she looked vaguely familiar, like an aunt he had never met. He looked at his hands — they were baggy and wrinkled and freckled with age. His body was, well, it wasn’t his body. He asked the woman, maybe she knew: “How did I get so old?”
The woman shook her head and smiled wryly. “I don’t know, Dad. I ask myself the same question.”
He didn’t really need an explanation: he was getting the hang of this. He was old, and he was getting older.
Getting old was not the real question, though. The real question was why the pain didn’t recede with time. Why didn’t it fade, just as his dexterity and strength were slowly fading? Why did a glance at Katie’s desk, at the misshapen kid-made ashtray with the naïve sketch of a horse’s head, yield a stab of pain? Why did she keep it there, when the wound re-opened every time he looked at it? Why didn’t she put it away, as he had put away the photographs?
“Your mother was a beautiful young woman,” he said. “So lovely. So lovely. She let herself get old.”
Ed raised his head and peered through the leaves. There was a motionless marine lying on the ground ahead of him. The guy was wearing a combat pack, and he was soaked and dirty, and had been moving away from the front. He was facedown, his arms and legs too still. Dead, for sure. Between them ran a line of disturbed vegetation, bisected at an angle by the path that had been their goal.
Suddenly he didn’t feel as though he could go any further either. He could see the dark ahead, like a pit. It would be so easy to fall in.
When you’re injured, your body uses pain to keep you from moving the injured part. Parts of you that aren’t actually injured may hurt. What is going on here? The chemistry of those uninjured parts changes. The pain circuits in your spinal cord readjust to produce a widespread area of pain. It makes you want to hold still, doesn’t it? It feels better if you hold still, and it’s better for you, too. Damaged tissue — muscles, joints, and ligaments — needs time to recover, even after a minor injury. If you don’t hold still and let them heal, the membranes that cover the surfaces of these tissues become chronically inflamed, and death-dealing bacteria eagerly find their way to the very marrow of your bones. Pain protects you from this. Pain keeps you still and safe. Pain works.
Lung cancer starts out small, a few cells with a reproductive imperative. At that stage, it doesn’t hurt. Your body doesn’t even recognize that it is being colonized — these are your own cells — so it doesn’t fight back, it doesn’t warn you. You have no idea that the tumor is there, but as it grows, it will block small air passages. Your body will try to remove the dysfunctional parts of your lung via inflammation. Macrophages come to your aid, the diseased tissue swells and pushes against nerve endings, and that hurts. Much of your pain, when you have cancer, comes not from the cancer itself, but from your body’s reluctance to give your cancer the room it needs to grow.
Like the pain of childbirth, the pain you feel from cancer does not function as a warning. It comes too late.
Ed was sitting in a wheelchair, in an alien body that wouldn’t do what he wanted. It took so long to die. The doctor looked at him and said, “Goodbye, old friend. We’ve come to the end of the road.” Then the doctor looked beyond him, and continued the conversation with somebody that Ed couldn’t see. “I can prescribe some palliative measures, and I think you should make arrangements with Hospice. My nurse will give you a phone number.”
Ed understood that the doctor wasn’t an old friend, but he didn’t say anything. He was having trouble thinking. He had always been careful about taking painkillers when his leg bothered him, but now the doctors kept telling him he didn’t need to be careful. He didn’t want the drugs: he wanted his head to be clear. He wanted to be able to move, get in and out of bed, pull himself up onto the board and slide across it to the wheelchair. If the drugs were strong enough to deaden the pain, he couldn’t do that.
And if it weren’t for the pain, he wouldn’t know where the world started and the imagination left off. If he hurt, he must be alive. If the priests were right, they were all waiting for him there: his parents, his brother, his uncle, his daughter. If that was true, what was all the pain about? If he really believed in heaven, shouldn’t he just give up and die? How was pain protecting him here?
Like crawling through the jungle, or getting out of bed, dying was work. It wasn’t a matter of giving up. It was a matter of pulling himself forward, inch by inch. He wasn’t alone. He could hear familiar voices, and there was always someone sitting there next to the bed. But they couldn’t help with the actual dying part. Katie was there, but the spirit had gone out of her, and she couldn’t help either.
He heard his sister’s voice nearby, talking to somebody. “He’s still holding on. Tell him that it’s okay to let go. Let him know it’s all right.”
Someone sat down next to him and took his hand. She said quietly, “It’s okay, Dad. You can go now. It’s okay. You can go.”
Part of dying, if you had any time to think about it at all, was letting go — not an easy thing to do, after holding on for so long, after making it through all the mud. At the very center of dying was wanting to let go, and eventually the wanting comes to you, whether you invite it or not. Easy and hard are not a part of wanting.
Right now he didn’t want to let go. He heard footsteps approaching, the sound of sucking mud. Marines. He recognized the boots. They stopped in front of the other soldier.
“He’s dead.”