Chapter Seventeen

THE UNIFIER

WHEN I REFLECT ON PAIN, I prefer not to think in a detached, academic way. Instead, I focus on one individual, and at such moments my mind flashes back to the refined features of Sadagopan, whom we called Sadan. He personified the soft-spoken, gentle Indian spirit.

When Sadan arrived at Vellore, his feet had worn away from injury to half their normal length and his fingers were shortened and paralyzed. It took two years of tireless effort to halt the pattern of destruction in his feet. Meanwhile, we began reconstructing his hands, one finger at a time, attaching the most useful tendons to the most useful digits and retraining his mind to adjust to the rewired connections. In all, Sadan spent four years in rehabilitation from the many surgeries. Together, we wept at our failures and rejoiced at the gradual successes. I came to love Sadan as a dear friend.

At last Sadan decided he should return home to his family in Madras for a trial weekend. He had come to us badly marred by the disease, which made him an outcast. Now his hands were more flexible, and with a customized rocker-type shoe he could walk without damage. “I want to go back to where I was rejected before,” he said proudly, referring to the cafés that had turned him away and the buses that had denied him service. “Now that I am not so deformed I want to try my way in the great city of Madras.”

Before Sadan left, we reviewed together the hazards he might encounter. Since he had no warning system of pain, any sharp or hot object could harm him. Having learned to care for himself in our hospital and workshop, he felt confident as he boarded the train to Madras.

That first night, after an exuberant reunion dinner with his family, Sadan retired to his old bedroom, where he had not slept for four years. He lay down on the woven pallet on the floor and drifted off to sleep, peaceful and contented. At last he was home, fully accepted once again.

The next morning when Sadan awoke and examined himself, as we had trained him to do, he recoiled in horror. The back of his left index finger was mangled. Instantly he knew the reason because he had seen such injuries on other patients. The evidence was clear: prints in the dust, telltale drops of blood, and of course, the decimated clump of tendon and flesh that had been so carefully reconstructed some months before. A rat had visited him during the night and gnawed his finger. Made insensitive by leprosy, he had felt nothing.

What will Dr. Brand say? he thought. All that day he agonized. Should he return to Vellore early? He decided he must keep his promise to stay the weekend. He looked for a rat trap to protect him that last night at home, only to find the shops closed for a festival. I must stay awake all night, he decided, in order to guard against further injury.

The next night Sadan sat cross-legged on his pallet, his back against the wall, studying an accounting book by the light of a kerosene lantern. Around four o’clock in the morning the subject grew dull, his eyes felt heavy, and he could no longer fight off sleep. The book fell forward onto his knees, and his hand slid over to one side against the hot glass of the hurricane lamp.

When Sadan awoke the next morning, he saw to his dismay that a large patch of skin had burned off the back of his right hand. He sat up, trembling, overcome with despair, and stared at his two hands—one gnawed by a rat, the other melted down to the tendons. He knew well the dangers and difficulties of leprosy, and in fact had taught them to others. Now he was devastated by the sight of his two damaged hands. Again he thought, How can I face the doctors and therapists who worked so hard on these hands?

Sadan returned to Vellore that day with both hands swathed in bandages. When he met me and I began to unroll the bandages, we both wept. As he poured out his misery to me, he said, “I feel as if I’ve lost all my freedom.” And then, a question that has stayed with me, “How can I ever be free without pain?”

Self-Unity

Sadan’s plight is shared by millions of people who suffer from leprosy and other numbing diseases: diabetes, for instance, can have a similar effect on the extremities. Insensitivity offers a stark lesson about the value of pain. At its most basic level pain serves as a warning signal, like a smoke alarm that goes off with a loud noise when it senses fire. Sadan nearly lost his hands because he lacked that signal.

Pain makes another related contribution that often gets overlooked: it unifies the body. In truth, Sadan suffered because the rest of his body had lost contact with his hands. A body possesses unity to the degree that it feels pain. An infected toenail reminds me that the toe belongs to me, an integral part of my body’s health. Hair—yes, that matters, but mainly as a decoration. We can bleach, shape, iron, and even shave it off without pain. What is indispensably me, pain defines.

Nothing distresses me more than watching my patients in the Louisiana hospital lose contact with their own hands and feet. As pain fades away they begin viewing their own limbs as stuck-on appendages. You and I speak metaphorically of a hand or foot going “dead” when we sleep on it in an awkward position. Leprosy patients seem to regard their hands and feet as truly dead.

The most common injury at Carville, the “kissing wound,” occurs when a cigarette burns unnoticed down to the nub and brands matching scars into the skin between the two fingers. Leprosy patients think of their hands as accessories, not unlike a plastic cigarette holder. One such patient, who was carelessly destroying his hands, said to me, “You know, my hands are not really hands—they’re things, just like wooden attachments. And I always have the feeling they can be replaced because they are not me.”

I have to keep reminding leprosy patients to attend to painless parts of their bodies they may otherwise disregard. Although I try desperately to awaken in them a sense of their bodies’ unity, overcoming their detachment seems impossible apart from pain. Just as pain unifies the body, its loss irreversibly destroys that unity.

In India I had one group of teenage patients nicknamed “the naughty boys” because they tested the limits of our medical longsuffering. These rascals competed to shock others with their displays of painlessness. They would thrust a thorn all the way through a finger or palm, pulling it out the other side like a sewing needle. They juggled hot coals or passed their hands over a flame. When quizzed about a wound on hands or feet, they grinned mischievously and said, “Oh, it must have come by itself.”

Eventually, after taxing all our skill in education and motivational therapy, most of the “naughty boys” gained a respect for their bodies and learned to redirect their ingenuity to the goal of preserving their hands and feet. Throughout the rehabilitation process I felt as if I was introducing the boys to their limbs, urging them to reclaim these numbed parts.

Years later when I began working with laboratory animals, I learned that they had even more estrangement from deadened parts of their bodies. If I denervated rats for an experiment, I had to keep them well fed; otherwise, the next morning I would find these animals with shortened feet and legs. I am told that a wolf or coyote, losing sensation through frostbite or a trap injury, will gnaw through its leg and limp away unperturbed. That image captures for me the worst curse of painlessness: the painless person, or animal, loses a fundamental sense of self-unity.

Roots of Compassion

An amoeba, one-celled, perceives any threat as a danger to the whole. Bodies consisting of many cells need something more, and pain provides that crucial unifying link. Individual cells must suffer with one another for multicellular organisms to survive; the head must feel the needs of the tail. In the human nervous system, one slender nerve cell connecting the toe to the spinal column may span four feet—no other cell in the human body approaches that length.

As I turn from the network of pain in biology to its analogy in a spiritual Body, again I am struck by the importance of such a communication system. Pain serves the same vital role in uniting a corporate membership as it does in guarding the cells of my own body. A healthy body feels the pain of its weakest part.

Naturally, there are differences between the unity attainable in a physical body of linked cells and in a Body composed of autonomous members. No tangible axons stretch from person to person in, say, the global church. Nevertheless, a healthy spiritual Body shares the pain of all its members. When wounded, living tissues cry out, and the whole body hears the cry. And we in Christ’s Body—loving our neighbors as ourselves—are called to a similar level of identification: “If one part suffers, every part suffers with it,” says the apostle Paul (1 Corinthians 12:26).

Deep emotional connections link human beings as surely as neurons (nerve cells) link the parts of our bodies, as shown even in sporting events. Watch the face of a wife sitting in the stands at Wimbledon as her husband plays in the championship tennis match. The action on the court can be read on the wife’s face. She winces at every missed shot and smiles at each minor triumph. What affects him affects her.

Or recall the effect on a nation when a beloved leader dies. I experienced the unifying effect of pain most profoundly in 1963 when I came to the United States to address the student chapel at Stanford University. As it happened, the chapel service occurred just two days after the assassination of President John F. Kennedy. I spoke on pain that day, for I could read nothing but pain on the faces of hundreds of students jammed into that building. I described for them scenes from around the world, where I knew groups of people would be gathering together in prayer and mourning to share the pain of a grieving nation. I have never felt such unity of spirit in a worship service.

Something like those sympathetic connections joins us to members of Christ’s Body all over the globe. When an oppressive government jails courageous Christians, when Islamic radicals behead those of a different religion, or even when my neighbors lose their jobs, a part of my Body suffers and I sense the loss. The pain of others can also come to our attention in less dramatic ways: the whispered signals of loneliness, depression, opioid addiction, discrimination, physical suffering, self-hatred.

“How can a man who is warm understand one who is cold?” asked Alexander Solzhenitsyn as he tried to fathom the apathy toward millions of Gulag inmates. In response, he devoted his life to perform the work of a nerve cell, alerting us to pain we may have overlooked. In a Body composed of millions of cells, the comfortable ones must consciously attend to the messages of pain, cultivating a lower threshold of pain. The word compassion itself comes from Latin words cum and pati, together meaning “to suffer with.”

Today our world has shrunk, and as a Body we live in awareness of many cells. A litany of suffering fills our media outlets. Do I fully attend? Do I hear their cries as unmistakably as my brain hears the complaints of a strained back or broken arm? Or do I instead filter out the annoying sounds of distress?

Closer, within my own local branch of Christ’s Body—how do I respond? Tragically, those who are struggling with divorce, alcoholism, gender or sexual identity, introversion, rebelliousness, unemployment, or marginalization often report that the church is the last group to show them compassion. Like a person who takes aspirin at the first sign of a headache, we want to silence them, without addressing the underlying causes.

Someone once asked John Wesley’s mother, “Which one of your eleven children do you love the most?” She gave a wise answer to match the folly of the question: “I love the one who’s sick until she’s well, and the one who’s away until he comes home.” That, I believe, is God’s attitude toward our suffering planet. Jesus always stood on the side of those who were suffering; he came for the sick and not the well, the sinners and not the righteous.

God gave this succinct summary of the life of King Josiah: “He defended the cause of the poor and needy, and so all went well.” And then this poignant postscript: “Is that not what it means to know me?” (Jeremiah 22:16).

Another Kind of Unity

Skeptics see divisiveness as the church’s greatest failure. In response, leaders exhort denominations and interfaith groups to join hands in a national or worldwide campaign. From my experience with the body’s nervous system, I would propose another kind of unity, one based on pain.

I can read the health of a physical body by how well it listens to pain— after all, most of the diagnostic tools we use (fever, pulse, blood cell count) measure the body’s healing response. Analogously, the spiritual Body’s health depends on whether the strong parts attend to the weak.

I have performed many amputations, most of them the result of a hand or foot no longer reporting pain. There are members of the corporate Body, too, whose pain we never sense, for we have denervated or cut whatever link would carry an awareness of them to us. They suffer silently, unnoticed by the rest of the Body.

I think of my Palestinian friends, for example. In places like Bethlehem, children have grown up knowing nothing but occupation and war. They play not in parks but in crumbling buildings pockmarked by rifle fire and explosives. Palestinian Christians feel abandoned by the church in the West, which focuses so much attention on Israel and assumes all non-Israelis in the Middle East to be Arab and Muslim. Beleaguered Christians in places like Lebanon and Syria plead for understanding from their brothers and sisters in the West, but we act as though the neuronal connections have been cut, the synapses blocked. Few hear their pain and respond with Christian love and compassion.

I think of the LGBTQ population scattered throughout our churches and colleges. Surveys show that a significant percentage of students in Christian colleges struggle with same-sex attraction. Yet some college administrations simply pretend those issues do not exist. Those students are left to flounder, cut off from the balance and diversity of the larger Body and from the acceptance and understanding that they need.

I think of the elderly, often put away out of sight behind institutional walls that muffle the sounds of loneliness. Or of battered children who grow up troubled, unwelcomed into foster homes. Or of refugees who feel cut off from participation in the larger Body. Or of prisoners sealed off behind electric fences. Or of foreign students who live in enclaves of cheap lodging, or of the homeless who lack any lodging at all.

Modern society tends to isolate these problems by appointing professional social workers to deal with them. No matter how well-intentioned, institutionalized charity can isolate hurting members from close personal contact with healthy ones. Both groups lose out: the charity recipients who are cut off from person-to-person compassion and the charity donors who offer care solely as a material transaction.

In the human body, when an area loses sensory contact with the rest of the body, even when its nourishment system remains intact, that part begins to wither and atrophy. In the vast majority of cases—ninety-five of every hundred insensitive hands I have examined—permanent injury or deformation results. Likewise, loss of feeling in the spiritual Body leads to atrophy and deterioration. So much of the sorrow in the world is due to members who simply do not care when another part suffers.

The apostle Paul set out clearly how members of Christ’s Body should respond to those who suffer:

Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God. For just as we share abundantly in the sufferings of Christ, so also our comfort abounds through Christ. . . . And our hope for you is firm, because we know that just as you share in our sufferings, so also you share in our comfort. (2 Corinthians 1:3-5, 7)

Many accounts of Christians who have suffered, beginning with the book of Job and the Psalms and continuing through the writings of the saints, speak of a “dark night of the soul” when God seems strangely absent. When we need God most, God seems most inaccessible. At this moment of apparent abandonment, the Body can rise to perhaps its highest calling: we become in fact Christ’s Body, the enfleshment of his reality in the world.

When God seems unreal, we can demonstrate that reality to others by expressing Christ’s love and character. Some may see this as God’s failure to respond to our deepest needs: “My God, why have you forsaken me?” I see it as a calling for the rest of the Body to unify and to embody the love of God. I say this carefully: we can show love when God seems not to.

Pedro’s Palm

One of my favorite patients at Carville, a man named Pedro, taught me about developing greater sensitivity to pain. For fifteen years he had lived without the sensation of pain in his left hand, yet somehow the hand had suffered no damage. Of all the patients we monitored, only Pedro showed no signs of scarring or loss of fingertips.

While mapping sensation on Pedro’s hand, one of my associates made a surprising discovery. One tiny spot on the edge of his palm still had normal sensitivity so that he could feel the lightest touch of a pin, even a stiff hair. Elsewhere, the hand felt nothing. A thermograph showed that the sensitive spot was at least six degrees hotter than the rest of Pedro’s hand (bolstering our theory, still being formulated, that warm areas of the body resist nerve damage from leprosy).

Pedro’s hand became for us an object of great curiosity, and he graciously obliged without protest as we conducted tests and observed his activities. We noticed that he approached things with the edge of his palm, much as a dog approaches an object with a searching nose. For instance, he picked up a cup of coffee only after testing its temperature with his sensitive spot.

Pedro eventually tired of our fascination with his hand. To satisfy our curiosity, he told us, “You know, I was born with a birthmark on my hand. The doctors said it was something called a hemangioma and froze it with dry ice. But they never fully got rid of it because I can still feel it pulsing.”

Somewhat embarrassed that we had not considered that possibility, we verified that the blood vessels in his hand were indeed abnormal. A tangle of tiny arteries supplied an extra amount of blood and directed some of it straight back to the veins without sending it through all the fine capillaries. As a result, the blood flowed very swiftly through that part of his hand, keeping its temperature close to that of his heart, too warm for the leprosy bacilli to flourish.

A single warm spot, the size of a nickel, which Pedro had previously viewed as a defect, gave him a great advantage after he contracted leprosy. That one remaining patch of sensitivity protected his entire hand.

In a church that has grown large and institutional, I pray for similar small patches of sensitivity. I look for modern prophets who, whether in speech, sermon, or art form, will call attention to the needy by eloquently voicing their pain. A healthy Body values these pain-sensitive members, just as Pedro valued his tiny spot of sensitivity.

“Since my people are crushed, I am crushed,” cried Jeremiah (Jeremiah 8:21). And elsewhere,

Oh my anguish, my anguish!

I writhe in pain.

Oh, the agony of my heart!

My heart pounds within me,

I cannot keep silent. (Jeremiah 4:19)

Micah, too, wrote of his grief at his nation’s condition:

Because of this I will weep and wail;

I will go about barefoot and naked.

I will howl like a jackal

and moan like an owl. (Micah 1:8)

These prophets stand in great contrast to insensitive Jonah, who cared more about his comfort than about an entire city’s destruction. The prophets of Israel sought to warn an entire nation of its social and spiritual numbness. I sense a need for modern Jeremiahs and Micahs—too often dismissed as young radicals—who can direct our attention to those in need of compassion and comfort.

By ignoring pain, we risk forfeiting the wonderful benefits of belonging to the Body. For a living organism is only as strong as its weakest part.