The early 1990s gave rise to an entirely new medical field: Pain Medicine, or Algiatry, a discipline devoted to the prevention of pain. At first blush a noble endeavor. But we have learned since that the quest to eliminate pain is not without consequences.

A man whose face expresses moderate pain/William Hebert/Wellcome Images/CC 4.
Source: A man whose face expresses moderate pain/William Hebert/Wellcome Images/CC 4.

The acting administrator of the Drug Enforcement Agency estimates that 59,000 Americans died last year from drug overdose, in no small part due to abuse of prescription pain medications. I have been practicing medicine long enough to have witnessed firsthand how this nightmarish epidemic began, a quarter-century ago. A perfect storm comprised of criticism of doctors for their alleged indifference to patients’ pain and suffering and the appearance of new narcotic painkillers such as MS Contin and OxyContin blew away the warnings of Addiction Medicine specialists about the risk of addiction these drugs carried. In California, where I practice, all primary care physicians were required to take special courses on pain management as a condition of licensure. I endured an entire weekend of sanctimonious lectures imploring me to prescribe more narcotics. I quipped many times back then that Pain Medicine had the upper hand over Addiction Medicine and we were all going to suffer for it. Funny at the time, but no one is laughing now.

A deluge of ER visits and deaths from accidental overdose followed, with a surge in admissions to chemical dependency treatment programs and a follow-on narcotic epidemic amongst teenagers, who migrated to the cheaper alternative of heroin after first scoring OxyContin from parental medicine cabinets.

The preservation of life and elimination of pain and suffering remain the raisons d`être of my profession, but can there be too much of a good thing? What would it be like to never experience pain? Sin Dolor, a moving short story by T.C. Boyle, explores this very question in his brilliant depiction of a child with congenital insensitivity to pain. This rare condition is caused by a genetic variant known as PRDM12-CIP disorder, but it was still weird science during the time in which Boyle’s story is set.

Mercedes Fumes brings her four-year-old son Dámaso to the town doctor, the first-person narrator of the story, for burns on his hands. But these aren’t just any burns. These are black, oozing eschars on his palms that came from snatching hot coals off the brazier she uses to cook the indigestible tacos she and her husband Francisco hawk on the street. The doctor doubts her story and wonders about child abuse.

“No one, not even the fakirs of India (and they are fakers), could hold onto a burning coal long enough to suffer third-degree burns.”

“He’s not normal, Doctor. He doesn’t feel pain the way others do.”

She urges him to prick her son with a needle. The doctor swabs Dámaso’s arm and takes a syringe from the cabinet. Dámaso doesn’t flinch. He gives no indication anything happened at all.

“We call him Sin Dolor, Doctor…The Painless One.”

The next time the doctor sees the boy, now eight, he is with his father, Francisco. Dámaso comes in limping, favoring his right leg, which the doctor discovers is broken, a fractured tibia. That he walked in on. Without the slightest whimper. The doctor again suspects child abuse, but Francisco Fumes tells him Dámaso did it by jumping off the roof of a shed. The doctor realizes he has stumbled onto an unprecedented medical marvel.

“I felt the boy’s gaze on me. He was absolutely calm, his eyes like the motionless pools of the rill that brought water down out of the mountains…For the first time it occurred to me that something extraordinary was going on here, a kind of medical miracle…”

He is seized by ambition, an intense desire to claim credit for discovering what must be “…a mutation in his genes, a positive mutation, superior, progressive…” He befriends Dámaso in hopes of spectacular medical fame.

“If that mutation could be isolated—if the genetic sequence could be discovered—then the boon for our poor suffering species would be immeasurable. Imagine a pain-free old age. Painless childbirth, surgery, dentistry…What an insuperable coup over the afflictions that twist and maim us and haunt us to the grave!”

He encourages Dámaso to spend time at his clinic and to come to his home for dinner. He contacts a geneticist he knows from medical school in Guadalajara, who implores him to send scrapings from the inside of Dámaso’s mouth for analysis. But Francisco Fumes becomes jealous of the attention lavished on his son—and of Dámaso’s response to it. He forbids all contact between Dámaso and the doctor, destroying the doctor’s ambitions and his son’s only chance to escape his circumstances, “…the stew of misinformation and illiteracy into which he’d been born…”

Five or six years pass before the doctor sees Dámaso again. “…Though I heard the rumors—we all did—that his father was forcing him to travel from town to town like a freak in a sideshow, shamelessly exploiting his gift for the benefit of every gaping rube with a peso in his pocket.”

Finally, they meet again, Dámaso now thirteen and supporting his family by performing cheap carnival tricks that aren’t tricks, burning and slicing and maiming himself for the crowd without a hint of pain. After witnessing one such performance, the doctor observes that Dámaso has changed.

“He seemed to walk more deliberately than he had in the past, as if the years had weighed on him in some unfathomable way…”

Later, he learns the price Dámaso has paid for being a medical freak. “I have no friends, Doctor, not a single one. Even my brothers and sisters look at me like I’m a stranger. And the boys all over the district, in the smallest towns, they try to imitate me.” He tells the doctor that he does what his family asks of him—exploiting his painlessness, profiting from his miracle in the most vulgar of ways—out of a sense of duty to them.

“But what they’ll never understand, what you don’t understand, is that I do hurt, I do feel it, I do.” He taps himself over his heart. “Here,” he says. “Here’s where I hurt.”

He dies a week later, after leaping off a three-story building to satisfy the little sycophants who idolize him. “Jump!” they shout. “Sin Dolor! Sin Dolor!” He dies without a twinge of pain.

The story concludes with the doctor treating a small girl who has stepped on a sea urchin. “As delicately as I could, I held her miniature heel in my hand, took hold of the slick black fragment with the grip of my forceps and pulled it cleanly from the flesh, and I have to tell you, that little girl shrieked till the very glass in the windows rattled, shrieked as if there were no other pain in the world.”

Perhaps, as T.C. Boyle so poignantly suggests, a certain amount of pain is vital to our human nature.

Copyright Richard Barager

About the Author

Richard Barager M.D.

Richard Barager, M.D., a physician in Orange County, California, is the author of The Atheist and the Parrotfish.

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