Pain. Empathy and Doctors
A World War 2 Trilogy - By FRED NATH (Novelist and Neurosurgeon)
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Pain. Empathy and Doctors

I once recall a conversation (a little heated) with one of my nieces when I said I understood how bad a labour pain was. She had started by saying that female obstetricians must be better than male obstetricians. My claim to understand labour pains provoked a rather more volatile response than I think it merited along the lines of, ‘You’re a man. You can’t understand.’

I felt at the time that although I don’t have a uterus, I have delivered 22 babies and witnessed many more deliveries when I trained and since then seen pain in many forms. I do understand. It’s the empathy all doctors strive to have. One never becomes inured.

So, four days ago, I hurt my back (don’t laugh). Initially (I was shifting a mattress) the pain was so bad I just collapsed on the bed and lay there until the worst acute pain died down enough to allow me to get up.

It persisted, but I was able to walk and finish what I was doing. Not surprisingly, the pain gradually escalated throughout that day. By the evening I was unable to walk because every time I put my foot to the floor excruciating pain shot down my leg and it just gave way beneath me.

Day 2 was no better. Day 3 (yesterday) I could weight bear for about five minutes before the pain became too bad and I had to sit down. Today I’m comfortable sitting and can last out upright long enough to make a cup of coffee.

I’ve operated on maybe a thousand lumbar spines in my time and always tried to expedite treatment in patients who seemed to be in a lot of pain, even though a lot of surgeons would wait longer and see if it resolved with pain-killers and rest.

Reflecting on my discomfort, I realise now there is a big gap between empathising and experiencing. My niece may have been right. I don’t have a uterus but I do have a sore back .

Many years ago, some psychologists did an experiment in which they took a Scottie-dog puppy and brought it up in a padded environment, designed so that it was isolated from other dogs and any objects that might stimulate any kind of discomfort. They then prodded the poor creature with pins. It did not react in a normal fashion and seemed unable to avoid those things causing pain. The conclusion was that they had raised a creature that felt pain but did not recognise it was noxious. They thought it meant that most of pain is subjective and without the psychological expectation, pain is not necessarily too bad. There is a grain of truth in that – only a grain.

I think that once one takes away the fear provoked by pain and it is replaced by knowledge and experience, acute discomfort can have much less effect on us than otherwise.

Mindfulness training can help patients with chronic pain because it teaches one to accept the pain, and in their terms (not mine) befriend it. See it for what it is.

Easy to say maybe – it’s just a temporary discomfort and I know it will get better in time, but for those who do not understand their anatomy and do not realise that most pain is temporary it is a fearsome and terrible thing.

I guess I’ve metamorphosised (not like the guy in Franz Kafka’s tale).

 Experiencing pain does make you a bit more empathic. For once, I can tell a patient – ‘I understand the pain you have and its severity.’ It sounds daft, but I would recommend a severe back pain to any Orthopaedic or Spinal Surgeon because it makes you appreciate what your patents are feeling. Not just by extrapolating what you have seen, but by knowing.

My patients will tell you if it’s going to make me a better doctor. One hopes that it will, but you know, memory of pain fades. If it didn’t ,no one would ever have a second labour, would they?

So, we come back to the argument where we started. Do female obstetricians make better labour-carers than men?

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