The Gift of Pain by Paul Brand

Author:Paul Brand
Language: eng
Format: epub
Publisher: Zondervan
Published: 2020-06-22T00:00:00+00:00

13

Beloved Enemy

With the help of the thorn in my foot, I spring higher than anyone with sound feet.

Søren Kierkegaard

I must confess that I sometimes question my crusade to improve the image of pain. In a society that routinely portrays pain as the enemy, will anyone listen to a contrarian message extolling its virtues? Does my own outlook merely reflect the oddity of a career among patients with the bizarre affliction of painlessness? The United States government eventually began asking these same questions. Why should Carville research money go toward restoring and enhancing pain when researchers elsewhere were focusing on how to suppress it?

In the early years our grant proposals for thermograph machines, ink-filled slipper-socks, and pressure transducers were usually approved. Visionaries in Washington supported basic research into pain even though it had immediate practical relevance for only a few thousand leprosy patients (and some Tennessee Walker horses). In the late 1970s, however, a new belt-tightening spirit made such research increasingly hard to justify. Each year the U.S. Public Health Service scrutinized the budget of the Carville hospital, weighing whether they could afford to invest so much money in research that would primarily benefit leprosy patients in other countries.

About this time, quite by accident I stumbled across a new practical application for what we had learned about pain at Carville, a fortunate turn of events that soon validated our entire investment in basic research. Although only a few thousand leprosy patients live in the United States, millions of diabetics live here, and we found that our ideas about pain had direct relevance to them as well.

Late one evening as I was scanning a medical journal I noticed the phrase “diabetic osteopathy.” It struck me as odd: since when did diabetes, a disease of glucose metabolism, affect bones? Turning the page, I saw X-ray reproductions which looked exactly like X rays of the bone changes in the feet of my insensitive leprosy patients. I wrote to the authors, two doctors in Texas, who graciously invited me to visit them and discuss the topic.

A few months later I found myself in their Houston offices, involved in a good-natured contest of “dueling X rays.” They would place an X ray of deteriorating bone on a light table, and I would rummage around in my briefcase until I found a matching X ray of bone absorption in a leprosy patient. We compared X rays of all the bones of the foot, and almost without exception I could duplicate each osteopathic problem they presented. The demonstration made a great impression on the doctors and interns assembled, for most of them had no experience with leprosy patients and thought they had described a syndrome peculiar to diabetes.

The Sugar Club

Next, the Texas doctors invited me to speak to the Southern Sugar Club, a genteel group of diabetes specialists from southern states who meet regularly to review the latest findings on diabetes. I addressed the subject of feet, challenging their assumption that the common problem with diabetic feet—ulceration so

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