Breaking the Barrier: A Commentary on David Biro's Listening to Pain

by Rashmi Kumar

I remember going to the hospital with a torn meniscus in high school. The knee pain was unbearable, and I had tears streaming down my face as I hobbled into the ER. I sat there, rocking back and forth, icing my knee as I clutched it, hoping I could stop the pain from spreading. The ER doctor walked in and started the examination. After greeting me he asked, “How would you rate your pain on a scale of 1 to 10?” I wanted to yell out, “A billion!! Are you crazy, I’m crying from pain! Why would you even ask that?!” Yet, I tried to push through the pain and replied with a tentative 8. Did I know what pain ‘1’ or ‘10’ felt like? No way! I surmised; it wasn’t the worst pain I had felt so it couldn’t be the highest value. With that useless bit of information, he could do nothing. Why ask me that question anyway? Besides logging it onto a chart, what does that information truly provide him? Does he know the true magnitude of my pain? Will he prescribe the correct dosage of painkillers? In moments like this I bemoan the state of patient-doctor interactions. Enough is enough. It is time to think beyond pointing to cartoon faces of pain or asking patients to rank their pain on a scale of 1 to 10. We must delve deeper to understand the concept of patient pain as a unique phenomenon capable of building a barrier between the patient and the physician.

David Biro’s “Listening to Pain” is a guide to understanding a patient’s suffering. A Rashmi Kumar practicing physician and a cancer survivor who received a bone marrow transplant, Biro is a fantastic leader into the unknown world of pain as both an emotional and physical response. His book captures a sense of yearning to find a fitting way to describe pain. “Listening to Pain” uses metaphorical language to find a way to relate to patients in ways physicians have not before. I originally had reservations about this idea; metaphorical language, in my mind, is a literary device that is usually analyzed in a novel, poem, or other prose. However, Biro illuminates that metaphorical language is all around us. When we say, “I feel a stabbing pain,” this is a metaphor. When we say, “the tumor invaded and spread everywhere to conquer other organs,” we are personifying a disease. Through metaphor, we speak about pain even when it often has the capacity to silence us. In these cases, our pain is unheard, and Biro remarks that there is an alarming amount of patient cases in which the prescribed pain medication is insufficient due to a misunderstanding of the depth of the pain.

To this, my follow-up question was, “if we are capable of creating metaphors, why are doctors and patients unable to communicate through them?” Biro suggests that it is the curse of repetition. The same metaphor of a “stabbing” pain has been used so often that the metaphor itself has become defunct. Inherently, this is a limitation of using metaphors. The communicated intensity of the pain is dulled in the same way the metaphorical image of a stabbing pain has dulled through overuse. Biro suggests that we must constantly “reinvent” and be imaginative with our metaphors. He describes a scenario from a published novel in which a young boy describes his ear pain metaphorically. Children speak metaphorically with the utmost instinct because they do not have the extended vocabulary of adults; therefore they compare and link their experiences to everyday encounters with a distinct sort of ease. The young boy in the book describes the roar in his ear as similar to the sound of a train rushing through a tunnel. While to some it may seem silly that we would describe pain with such figurative language, it seems far sillier to be shown pictures of five faces in pain and asked to point to the one you feel most like.

How can we construct metaphors to describe our pain? It is all well and easy when a character from a novel or author is describing their pain metaphorically, but how can everyday people accomplish this? Here, Biro’s book fails to give a detailed account of creating metaphors. What he focuses on instead is allowing the patient to be aware of another form of communication, and requesting doctors to be more conscientious of listening to patients as they employ these metaphors. Perhaps by stopping short of providing a list of metaphors to use, Biro is practicing what he preaches. He does not want to become categorical or repetitive about describing pain.

It is relevant to point out that Biro does not focus on emotional pain, which is a distinct entity from physical pain that requires different metaphors. Emotional pain must be externalized with language for it to be recognized, and it can even be more difficult to deal with emotional anguish than physical pain, which can sometimes be taken care of with Tylenol or Advil. Physical pain is also fleeting, and our body is conditioned to forget such pain. A prime example is labor pains in women. If these memories of physical pain were not selectively repressed, women would cease to have children. Emotional pain, however, is lingering and harder to access because of how it adapts, builds and seems to grow over the years. Biro’s book is more concerned with physical pain rather than emotional pain, perhaps because people are more willing to discuss the former to get immediate relief than the latter, making his ideas about using metaphorical language more applicable and informative. In any case, pain is a dichotomous force capable of emotional and physical effects. This being said, it becomes even more critical that we find a way to understand patient pain.

David Biro’s “Listening to Pain” is an incredible read that can open your mind to a culprit that ails all patients. Biro suggests that as long as there is communication, the barrier will remain breachable. Biro’s book is a metaphysical ride that forces us to think about the origin of pain, our own battles with both physical or emotional pain, and to examine the words we unknowingly use to communicate what we feel. While it leaves some lingering questions, they are the kind that we have been grappling to answer for decades, and Biro takes us a step closer to breaking the barrier between the patient and the physician. In Biro’s metaphorical fashion, I would say his book is a shaft of light into the dark recesses of an innate human response and is a suggested read for those interested not only in medicine, but also language, communication and the way internal conditions affect interpersonal relationships.