Pain, which lodges at the heart of the opioid crisis, is baffling. We struggle to describe, understand, and treat it. To endure it. Which is why FDA Commissioner Scott Gottlieb convened last week a group of people suffering from chronic pain. He wanted to hear their stories. I imagine that it was instructive for Gottlieb to encounter some raw, intimate narratives of suffering in this “patient-focused drug development” meeting.
Philip Roth, the legendary novelist who died on May 22, would have understood Gottlieb’s intentions. “[P]ain could make you awfully primitive if not counteracted by steady, regular doses of philosophical thinking,” he wrote in “The Anatomy Lesson,” his classic 1983 novel.
That book is a must-read if you’re a nurse, doctor, or patient; a caregiver, pharmaceutical researcher, medical device designer, or health care executive; or even if you’ve ever been in a hospital to visit a friend or loved one. How do I know this? I’m a fan of Roth’s work. OK, maybe I’m a bit obsessed with it. Roth has long been essential to my writing life — I’ve published about him many times before — and I work for an innovation design firm, EPAM Continuum, that’s focused on health care. “The Anatomy Lesson” has much to say about both patient and provider experience around pain.
The book is about death and survival, disease and treatment, anguish and addiction and healing. Nathan Zuckerman, Roth’s longtime fictional counterpart, facing the death of his mother shortly after his father dies, is afflicted by a pain which doctor after doctor after doctor fails to properly diagnose. “[H]e didn’t seem to have a disease that anybody could take seriously,” Roth writes. “Just having a neck, arms, and shoulders was like carrying another person around.”
The pain leads to all kinds of ridiculous, funny, and sad adventures for Zuckerman. At his wit’s end, he decides to give up writing and makes absurd plans to become a doctor. The pain makes writing impossible, and so, for the first time in his adult life, he moves away from his desk. “Instead of solitude, company; instead of silence, voices; instead of projects, escapades; instead of twenty, thirty, forty years more of relentless doubt-ridden concentration, a future of diversity, of idleness, of abandon.”
I found, as I reread the book again, all kinds of lessons, particularly for those whose lives are rooted in health care.
Because contemporary medicine operates at the pace of speed dating, physicians need to become better, and faster, at picking up what their patients are really telling them. How to do this? It seems unlikely they’ll find the time to expand their powers of perception during the crowded workday. A skim of a patient’s electronic health record will give, at best, a one-dimensional look at his or her life.
Novels can help. It’s not just that literary fiction has been shown to increase empathy (the science might be useful in convincing a certain kind of doctor that the book will be useful), but there’s something specific about the endlessly detailed inner life of Nathan Zuckerman as a patient that will help make a doctor more receptive to the pain of his or her patients. Zuckerman thinks deeply about his own pain, and about the business of being a doctor — his drug-addled fantasy of giving up fiction for medicine might make a few physicians smile. The notion that behind each patient, let’s say, sits a novel’s worth of material becomes much more real once you’ve actually read the 291 pages of “The Anatomy Lesson.”
As the opioid crisis deepens, doctors need to understand the mechanisms and psychology of pain and addition, and how to engage in a dialogue with those who suffer from the disease. “The Anatomy Lesson” is very much about the relationship between pain and addiction. It kicks off with a quote from an orthopedic textbook: “The chief obstacle to correct diagnosis in painful conditions is the fact that the symptom is often felt at a distance from its source.”
Naming pain is necessary part of treatment — for Zuckerman and everyone else — and it’s the name of the game in “The Anatomy Lesson.” Roth does an excellent job demonstrating how even a highly successful and educated person, like Nathan Zuckerman, can realistically slip into the pit of addiction. Zuckerman is a conscientious character, one who carefully counts out the pain pills he deals to himself, even though he also supplements those pills with alcohol and marijuana. The dialogue at the end of the book, between Zuckerman and his friend, anesthesiologist Bobby Freytag, is a wonderful model of how to speak honestly with someone suffering from addiction. “You’re going to stay here as my patient until you’re no longer addicted,” says Bobby. “That means three weeks at least. There’s to be no cheating, Zuck. The cure for alcoholism isn’t two little martinis before dinner. We’re going to eliminate the drugs and the drink and we’re going to do our best to find the cause and eliminate that pain that causes the need to get blotto. Is that clear?”
Another reason for people who are suffering or are in the business of treating the suffering to read “The Anatomy Lesson” is that they can probably use a laugh; the book contains some vast laughs, anchored in Roth’s realistic treatment of Zuckerman’s suffering. For instance, when an orthopedist suggests that Zuckerman’s pain was caused by his time using manual typewriters, he buys an electric typewriter (remember, this is the early 1980s). Zuckerman imagines the typewriter thinking: “I am a Correcting Selectric II. I never do anything wrong. Who this man is I have no idea. And from the look of things neither does he.”
The humor in this volume is acute and sharp, and might be especially beneficial to someone isolated by illness. There’s a kind of slapstick comedy in watching the hyper-self-aware Zuckerman suffer in his orthopedic collar, and we can all indulge it. In fact, Roth is itching for us to laugh!
I suspect that Roth might have found the idea of using “The Anatomy Lesson” as a health care tool comical — but perhaps no more so than the human condition itself. As he writes in the novel: “That was commonly believed to be a function of great literature: antidote to suffering through depiction of our common fate.”
Ken Gordon is the content, conversation, and community strategist at EPAM Continuum, a global innovation company.
It figures that pain would be a humorous topic among Doctors. Considering how this author confuses pain and addiction, and makes light of the subject it is no wonder we have a problem in this country. Re-framing every patient with pain as an addict has not improved the death rate for addicts, the suicide rate. or the lives of people living with constant chronic pain.
At least for some the toll of death, despair and lack of an adequate evidence based response on any level, can be funny.
I agree. Picking up pain medication at a pharmacy these days is to run a gauntlet of suspicious glances, hostile muttering and outright rudeness. The commercials that have recently begun showing people dropping cars on themselves, smashing their hands with hammers and other absurdities haven’t helped matters. Now every pharmacy assistant fancies themselves as an addiction specialist, delivering patronizing “advice” to individuals unlucky enough to encounter them. And now to be an object of mirth to physicians is truly rubbing salt in the wound.
Convinced me to get the book. Please consider more inclusive language throughout…all of those involved in providing direct care need deeper immersion in the humanities. As you said, the time available for individual encounters will scarcely expand.
I must read this novel..
I must read this book..