Eula Biss: The Pain Scale
Selected Excerpts
“The sensations of my own body may be the only subject on which I am qualified to claim expertise. Sad and terrible, then, how little I know. “How do you feel?” the doctor asks, and I cannot answer. Not accurately. “Does this hurt?” he asks. Again, I’m not sure. “Do you have more or less pain than the last time I saw you?” Hard to say. I begin to lie to protect my reputation. I try to act certain.”
“There is no evidence of pain on my body. No marks. No swelling. No terrible tumor. The X-Rays revealed nothing. Two MRIs of my brain and spine revealed nothing. Nothing was infected and festering, as I had suspected and feared. There was no ghastly huge white cloud on the film. There was nothing to illustrate my pain except a number, which I was told to choose from between zero and ten. My proof.
‘This is a pathology,’ the doctor assured me when he informed me that there was no definitive cause of my pain, no effective treatment for it, and very probably no end to it. ‘This is not in your head.’ It would not have occurred to me to think that I was imagining the pain. But the longer the pain persisted, and the harder it became for me to imagine what it was like not to be in pain, the more seriously I considered the disturbing possibility that I was not, in fact, in pain.”
“Assigning a value to my own pain has never ceased to feel like a political act. I am a citizen of a country that ranks our comfort above any other concern. People suffer, I know, so that I may eat bananas in February. And then there is history . . . I struggle to consider my pain in proportion to the pain of a napalmed Vietnamese girl whose skin is slowly melting off as she walks naked in the sun. This exercise itself is painful.
‘You are not meant to be rating world suffering,’ my friend in Honduras advises. ‘This scale applies only to you and your experience.’
At first, this thought is tremendously relieving. It unburdens me of factoring the continent of Africa into my calculations. But the reality that my nerves alone feel my pain is terrifying. I hate the knowledge that I am isolated in this skin — alone with my pain and my own fallibility.”
Discussion Questions
Trying to put pain into words so someone else will fully understand, is, in some sense, impossible. Biss gets at this impossibility in many powerful ways. What stood out to you?
Suffering for patients in pain, especially women, is so often compounded by being disbelieved by doctors. Biss expresses this many ways. Did you relate? What did you learn?
Pain is paradoxically universal yet isolating. How does Biss help us think about pain in connection with others?
What can we take from Eula Biss’ essay and Emily Dickinson’s poem, “Pain Has An Element of Blank”, to improve the care of patients in pain?
Reflections from #MedHumChat
“Our bodies speak to us in a strange, secret language. Sometimes, words cannot capture it. We grasp at common metaphors (pain as “burning,” “twisting”) which never sounds right, but all we have is words — language.”—@ESilvermanMD
“I've had a pain experience dismissed as "in my head" and I felt humiliated and ashamed. Took a second opinion to validate a real reason for the pain, but I'll never quite forget the initial shame I felt bc of an "expert" opinion. Shame begets greater suffering.”—@alinasato
“drawing on my experience working w/ women with fibromyalgia - because "the MRI is normal" and patients describe the disease as "invisible" they express feeling very isolated. You can't walk through a medical center and know who feels the way you do”—@meggerber
“For me--resist the urge to quantify and reflexively treat. Like with unexplained fever, pain needs investigation, not just Tylenol. To do so means to listen, empathize and wait. Understand that the patient feels this won't end, and may speak that way.”—@Ndouthit
“An acknowledgement of all the ways we systematize & dehumanize pain. An opportunity for individual clinicians to meet patients in pain on a human level. ‘I can't know exactly how this feels for you. I will stay with you.’”—@allison_tandem
About this #MedHumChat
Eula Biss’s essay, “The Pain Scale,” was paired with Emily Dickinson’s poem, “Pain Has An Element of Blank” for a #MedHumChat discussion on March 20, 2019 exploring Subjectivity & Pain.
The pieces for this chat, along with the discussion questions, were selected by Colleen Farrell
About the Author
Eula Biss is an American non-fiction writer specializing in creative writing as well as science & literature. She teaches as an “Artist in Residence” in the Department of English at Northwestern University. You can learn more about her here.