I believe my mother thought that needing to medicate her own discomfort would be a kind of moral and physical weakness. This applied only to herself; if I told her that I was hurting, or that one of her grandchildren was in pain, she would have been anxious for something to help. She felt our pain, you might say, but she denied her own.
I’ve spent the past couple of weeks thinking about pain in children and writing about pain in children — acute pain and chronic pain, pain with shots and pain after surgery, pain medicines and pain specialists. I asked the pain experts I interviewed about the different ways that different people experience pain from the same stimulus: Why does one child cry inconsolably after a needle stick while another, same age, same size needle, watches with curiosity as the shot is administered and doesn’t even flinch?
There is a great deal of variation in how much pain people experience, I was told, and by and large we should take people at their word. Some people are more prone to soreness, some are relatively less sensitive, some hypersensitive, and there are differences in the ways that different people process pain, and in the ways they respond to drugs. And “hypersensitive” is not a code word for “complains more” — it’s a neurological category.
And then of course there are psychological factors. That is not to say that pain is psychogenic, said Dr. Charles Berde, the founder of the division of pain medicine at Boston Children’s Hospital, and one of my teachers when I did my training there. People who are anxious or terrified of pain, people who have post-traumatic stress disorder, may actually experience more pain, he said, because the pain circuits in their brains are revved up.
Doctors with children, maybe especially pediatricians with children, fall along a spectrum, or maybe it would be truer to say, oscillate between two poles when it comes to how seriously we take our own children’s complaints. On the one hand, we can sum up a child’s minor illness with a certain jaded well-I’ve-certainly-seen-worse shrug; so you have a headache, go lie down in a dark room.
But like all doctors, I know too much, and sometimes that can send you in the other direction. My youngest child once woke up saying his stomach was hurting. He had pain in the classic place where the appendix often attaches, he was demonstrating textbook symptoms of appendicitis. I had him so firmly diagnosed that nothing could dissuade me. As it turned out, he didn’t actually have appendicitis, he just had a good story for it, as we say.
That’s the oscillation I mean; when it comes to my own children, I tend to start with total denial: it’s nothing serious, don’t exaggerate, don’t make a fuss. But then a little switch flips, and I jump right from suggesting a cold cloth on the forehead for a headache to being certain I’ve missed diagnosing meningitis and we urgently need a spinal tap.
And that in part reflects certain specific pain codes that can freak me out, with my own children, with the children of friends, and with patients. With children, after all, it’s fine to be pretty relaxed about chest pain, most of the time (adolescents with chest pain always think they’re having heart attacks, goes the pediatric wisdom, but they generally aren’t), but we pay a lot of attention if a younger child seems to have hip pain because infants and young children can develop rare — but serious — hip infections.
There’s groin pain in a boy that can mean a pulled muscle or a too-small athletic cup, and there’s groin pain in a boy that can be a sign of testicular torsion, a medical emergency. And mixed in with all the headaches and stomach aches of childhood, there are those constant pediatric threats, the headache which is meningitis, the stomach ache which is appendicitis.
When it comes to my own health, or the health of my family, if I think that headache or that belly ache (or that groin ache) is not evidence of some bad underlying process, I tend to be pretty dismissive of the pain. Maybe that’s in part because the experience of practicing medicine has left me humbly aware of the much more severe pain that other people suffer, but maybe I’m just being my mother’s daughter.
For the extraction of my wisdom teeth I got by with nitrous oxide only, and needless to say, I toughed it out afterward without using the painkillers. I can’t actually explain why, though maybe in some sense I was just applying my mother’s standards. And she was in attendance for the birth of my first child — her first grandchild — which I had decided in advance would involve no pain medication.
That had also been true of her own first labor — I was born in a nursing home in Trinidad, where my parents were spending the year while my father did anthropological field work, and my mother had not only told me the story, she had written the whole thing up in a memoir. So I knew she had managed without anesthesia, following the advice in her copy of Grantly Dick-Read’s natural childbirth classic, “Childbirth Without Fear,” originally published in 1942.
How did my own sensations during that long labor compare to the pains other women experience during labor? How did they compare to what my mother had felt in the 1950s? (I also knew that her first labor had been so quick that I was born in the anteroom, onto old newspapers, because they didn’t have time to get her into the delivery room; my own first labor went on for more than 24 hours, and it seemed to me that my mother remarked on how long I was taking a wholly unnecessary number of times.)
While on the one hand, it can feel like pain erases our individuality and reduces us to something less than the people we want to be, it is also clear that we experience pain very much as who we are, in terms of biology, psychology, personality and temperament. I can try to be careful that my own unreasonable attitudes don’t end up penalizing my patients — but I also embrace my own discomfort and remember my mother whenever I get a particularly bad twinge, and feel somehow smug about not taking pain medicines.
Or maybe better, I can demonstrate generational progress by taking a few ibuprofen when my shoulder aches after a long day of carrying a heavy bag, and reflecting on the complexities of feeling anyone else’s pain.
