On Pain and Suffering- Notes from Rural Chhattisgarh

By Brett Lewis

Dr. Yogesh Jain, founder of JSS takes care of a very undernourished patient. Hunger and Undernutrition are deep problems in this part of India. A 2002 study in Bilaspur found that 41% of men and 43% of women had a BMI (body mass index) of less than 18.5. People with a BMI under this threshold are considered to be underweight.

Dr. Yogesh Jain, founder of JSS takes care of a very undernourished patient.
Hunger and Undernutrition are deep problems in this part of India. A 2002 study in Bilaspur found that 41% of men and 43% of women had a BMI (body mass index) of less than 18.5. People with a BMI under this threshold are considered to be underweight.

I’m writing from a hospital in rural central India, where I’m spending several months as a volunteer at Jan Swasthya Sahyog (People’s Health Support Group), an organization that runs a hospital and various community services in a marginalized tribal region of Chhattisgarh state. I’ve never been around so many sick patients- every day I see people with tuberculosis or cancer or kidney disease- and so much malnutrition. I don’t really know what to make of so much acute on chronic pain. I remember the first day I got here, I witnessed a woman with a muscle eating bacteria get her dressing changed. I could see the whites of the bones in her leg, yet when the doctor scrubbed at her open wound, she didn’t make a sound. She just lay there, her eyes gently closed. When I asked the doctor how she didn’t cry out, he told me that she was used to it. “She’s used to the pain,” was what he said.

That phrase has stuck with me, as I witness person after person enduring a level of physical suffering I can’t even imagine. I see patients with tuberculosis struggle to breathe as if underwater; they are so wasted, I don’t know how their ribs do not crack under the strain. I see cancer patients come in at such advanced stages of their illness that there is often little we can do for them. Even for those who have not yet reached a metastatic stage, they are so malnourished that their bodies are unable to handle effective doses of chemotherapy. At times, I can’t help but wonder what made some patients finally come in to see a doctor, after suffering from their condition for so long. Perhaps there’s a point when enough is enough. Or maybe it is simply chance- that an opportunity had arisen and they had taken it.

I had been here less than a week when I found out a close friend from college had committed suicide. I’m too familiar with depression to blame him for his actions, and with all the pain that I feel at his passing, I can only grasp at the edges of his hurt. Perhaps it’s due to my own grief, but I find myself seeing his pain reflected in the eyes of many of the people I see at JSS. It may be more physical here, but the pain is the same- and the numbness. I see all the hurt and suffering etched into the bones and flesh of these people, and I wonder, how much pain can one get used to? How much hunger can one experience before one can barely eat without feeling full? Before the hollowness is replaced by a simple yet all consuming nothingness?

Because I could say that all these patients are brave- and they are. They take their pain like a pill and go on with their lives. They continue to work, to smile, to love. And yet is it fair to them to call that bravery when they often have no other choice? Sometimes I wish I could see someone cry, to allow grief and anger overtake them, if only for a moment. Because they deserve to be sad, to be angry, to shout at God, why me? Because no one should have to go through so much pain.

Yet perhaps I am missing the bigger picture. For as much as people here are teaching me about pain and suffering, they are teaching me more about living and about loving. One of my first days here, I met Raja, a twelve year old boy who had come in with severe paralysis due to what was diagnosed as transverse myelitis, a neurological disease that causes inflammation of the spinal cord. Despite what must be a terrifying feeling for anyone, let alone a young and active boy, he remained incredibly calm whenever I saw him- throughout all the examinations, throughout doctors continually asking him to do things his body would not allow him to do. Less than a week after I first saw him, I ran into Raja at one of our outpatient clinics. He was walking unsupported, albeit with a significant limp. His contagious joy as he followed me around the hospital was untainted by the fact that he would always have residual paralysis. For now, he was a boy again, and he was happy.

Of course many of the stories here do not have happy endings. Yet that does not take away from the fact that there is so much beauty to be seen amidst all this suffering. Yesterday I watched a resident examine a woman with metastatic ovarian cancer. Swollen and jaundice, she was barely conscious as the resident palpated her distended belly, listened to her straining heart. Yet within such a scene of overpowering anguish, I got a glimpse of incredible peace- it was in the way her husband held her wrist throughout the entire exam. He didn’t move it once, not when the resident was examining the patient, nor when she was explaining to him that there was nothing they could do- that if he wanted, he could take her home for her final days. Several hours later, I heard that the woman had passed away at the hospital. I pictured her falling asleep as her husband held her wrist.

I don’t know if there’s ever a level of pain that one can get used to, and if there is, I don’t know if it’s due to strength or fatigue. I just know that the man doesn’t regret holding his wife’s hand as she passed, despite how painful it must have been.

There’s no getting used to love like that.

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