When I got sick in December 2019, my diffidence about pain was unhelpful. The ache in my abdomen started during a business trip to Germany. I hailed a cab in Munich in the middle of the night and asked to be taken to a hospital. I failed to convey to the doctors there how much I hurt. I looked fine, did not complain much, was released. The German doctors thought that I had a viral infection and that my abdomen would hurt for a while.
When my appendix burst I did not realize what had happened and ignored the pain: after all, I had been told that I had an infection and that it would hurt for a while. I did the things in Germany that I was supposed to do, then flew to the United States with a perforated appendix. After a couple of days feeling fatigued at home, I went to the hospital and underwent an appendectomy. By then the burst appendix had seeded an infection in my liver, which was visible on the scans taken before the operation. The German doctors had seemingly overlooked my appendicitis; the American ones certainly neglected my liver infection; but somewhere in the mix is the difficulty I have in talking about physical pain.
My tolerance of pain comes from the same place as the rage that saved my life. It has helped me to do work that I value. Yet enduring pain in silence also creates a vulnerability, one that I think I share with other Americans. No one can endure extreme pain indefinitely. If there is a pill, we will all one day take the pill. If there is no one to talk to, no other form of medical care, we will keep taking the pill. The normality of enduring the pain then, imperceptibly, becomes the normality of taking the pill. What never changes is the lack of human contact. We can slip from silence about pain to silence about addiction, as millions of Americans have done.
In the hospital I was given oxycodone after three surgical procedures. I did not take it. Reading now the texts between my wife and the physician friend who was with me during my surgeries, I see an exchange sent after my skin and belly wall were punctured for my second and third liver drains:
“I’ll try to talk to him again about taking the painkillers. He’s always been wary of the opioids.”
“Only if he wants to, Marci. I’m wary of the opioids too.”
I am wary for a number of reasons. When I took them after breaking my back I felt like I was neither awake nor asleep and hated the sensation. My brother, a physicist who has had to undergo several surgeries, says that opioids are harder on his brain than the procedures and the anesthesia. Above all, when I see oxycodone I think of the bottles of it squirreled away in glove compartments, toolboxes, and under cushions all over Appalachia and the Midwest.
Over the decades wise doctors taught me that health care is more than pain and pills. In London in 1992, a doctor treating my migraines told me to “let people take care of you,” which sounded strange to me at the time. In Paris, where I studied and lived alone for a year in 1994 and 1995, my migraines got so bad that I began to lose my sight. When I couldn’t read my books and documents, or even distract myself by watching television, I realized that I had a problem. Stumbling to a hospital one night, unable to read the street signs or my map, I practiced my French for “feeling faint” and “seeing stars.”
Later I saw a neurologist in Paris. I didn’t have much money, but the fees were low. To get to his hospital I took a bus that went past the Eiffel Tower. I always gazed at it, and then at the Parisians on the bus, not a single one of whom even once spared it a glance. The neurologist, who examined me carefully and ran tests, suggested that my worsening condition had to do with separation from people I loved. As a young man, I thought that he was either being very French or making fun of me. It took time for me to realize that he was onto something.
When I saw neurologists for my migraines in Europe in the 2000s and 2010s, after medication became available, I wanted them to just write me a prescription and let me go. Yet the European doctors liked to talk to me about the kind of life that I led, not just about the triggers of the migraines, but also about my priorities and practices. In Vienna, my internist sent me to a neurologist who really knows how to hunker down for a long chat. He made me laugh with his claim that he would find life not worth living if he had to avoid the things I couldn’t eat and drink (namely schnitzel and wine). A few years ago, in an emergency room in Berlin late at night, I was befuddled when the doctor sat at my bedside for an hour talking about how I had spent my day. She gave me the medicine I wanted and a prescription that I could fill at a nearby all-night pharmacy, but she also wanted to think through with me how I became the person who visited hospitals in foreign countries at night.
The French, Austrians, and Germans have the same medicines we do—and they are less expensive and easier to get. In Germany I can get migraine medication without a prescription for a couple of euro at any pharmacy, even at an airport or railway station, provided that I take a moment to explain to the pharmacist why I need it. Every single part of that is impossible here. The difference is not that we have fancy chemicals and the Europeans do not. The difference is that doctors in Europe have time to do something beyond write out prescriptions. I have come to admire doctors who actually have a moment, want to think together with their patients, and seem to care. And I have come to realize that they are working within a system that enables and encourages all of that. And that such systems not only work better but also cost less than our own.
All of this care beyond our country, which I am very fortunate to have had, helps me to understand that there are alternatives beyond pills and pain. It is possible, if the appointments last longer than fifteen minutes and the doctors look at the person rather than the screen, for a patient’s story to be told and understood. Medication is important, but it has its limits.
In the New Haven hospital on New Year’s Eve, a nurse incorrectly administered my migraine medication, injecting it directly into my blood (intravenously) rather than into fatty tissue (subcutaneously). I felt like I had as a kid when I shocked myself on a wall socket, only this lasted longer. The mistake forced a rushed electrocardiogram. The incident reminded me that cardiac side effects are always a risk with triptans, and that my doctors had been trying to reduce my intake. Since leaving the hospital I have taken more seriously some of the good counsel about migraines that I have received over the years.
When there is no one with time to talk, no chance to find another approach, then we come to feel that we have to choose between pain and pills. In our country, where pharmaceutical advertisements are the main source of health information, we keep learning the lesson that suffering is our personal responsibility and that pills are the cure. When painkillers work, that creates a particular danger, because then we can ignore the deeper sources of suffering. We then get in trouble when we increase the dose, or find that medicine no longer works. Suffering and self-medicating are both lonely activities; they can feel like free choices, but they create an imbalance that leaves us in bondage.
American men slip from denying pain to denying that they have a problem with painkillers. They slip from facing everything down, not taking the pill, to giving everything up, and just taking the pill. If life is lived between pain and pills, we end up with too much rage and not enough empathy, too much solitude and not enough solidarity.