The Gift of Pain

by Paul Brand and Philip Yancy
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.”

In 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 of 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".]