My Wednesday reflection on service and my recent experience in the ER (from both sides of the curtain) got me thinking about pain.

Simply put my job as a physician can be boiled down to two primary objectives – 1. To treat treat/cure disease, and 2. To alleviate suffering. And, of course, in the application of each of these there is the ever present imperative to “benefit and yet not to harm.” Based on my observations thus far, there are three primary reasons people come to the ER – 1. They come for treatment, 2. They come for reassurance, 3. They come for pain pills.

PAIN PILLS: THE BANE OF AN ER PHYSICIAN’S EXISTENCE

It sucks to feel used, it is no fun to be lied to. It sucks to be in pain, it is no fun to be ignored. And thus the conflict that gets played out hundreds, nay thousands of times in American emergency rooms each day. The classic dilemma of distinguishing between those who are “drug seeking” and those who are in “real pain,” begs any number of questions. Who is to say they are different people? Whose right is it to determine or judge the level of pain another individual is experiencing? Is all pain bad? Does pain always need to be treated? Are narcotics over-used? Are narcotics under-used? Is it a doctor’s job to relieve patients of all pain and at what cost?

These questions and more have led me to a broader reflection on the meaning of pain in our culture. What follows is a collection of scenarios, quotes, and common sayings related to or inspired by pain. I am curious to hear what the topic brings up for you.

• “No pain, no gain.”

• Narcotics: Illegal, Prescribed, Controlled, Addictive, Pain-alleviating, Sleep-inducing, Potentially-lethal, Expected.

• The brand name of prescription narcotics and muscle relaxants are also household names: Vicodin, Percocet, Flexeril.

• Most people I know have been prescribed a narcotic for one reason or another at one point on their life.

• The juxtaposition of a sweating writhing man passing a kidney stone rating his pain at a 6-7/10 and a young woman with a sprained ankle resting comfortably in bed rating it at a 10/10 and demanding narcotics.

• “A lot of people run a race to see who is fastest. I run to see who has the most guts, who can punish himself into an exhausting pace, and then at the end, punish himself even more.” -Prefontaine

• An elderly woman is dying. Her disease causes her severe pain even at rest and makes her feel as though she is suffocating. Morphine could help alleviate both, but she refusing saying, “I don’t want to get addicted.”

• The husband of a young woman with chronic headaches threatens to kill an ER physician for not giving his wife more Dilaudid stating,”You are obligated to treat her pain.”

• “Cutters” – inflicting physical pain on themselves to relieve existential, emotional, psychological distress.

Merely the body’s messenger of injury and imbalance?

Perhaps a villian to be slayed at all costs?

Or is it a virtue to be endured and even relished?

Discuss.

Gone was the sizzle and spin of a century of American political speech writing. American politicians have spent lifetimes cultivating the skill of speaking without conveying meaning. They use as many words as possibile to say as little as possible. Today, president Obama displayed a rare political quality: he used an economy of words to convey a wealth of meaning. For as long as I’ve paid attention to politics, I have witnessed it drift further and further into the hyperreal of entertainment and doublespeak. Obama has appeared as the “unexpected” that interrupts the dissemination of the hyperreal.

My generation has been waiting for that speech. We have been waiting for an America that we could take pride in building. We have waited, and waited, and waited, and have not built a damn thing! Simply because it seemed that there was nothing worth doing. The American dream seemed feeble because its current iteration was just wealth for wealth’s sake. Approaching the primaries, the country did not seem ready for Obama. During them I remember saying: “Let Hillary win and clean up Bush’s mess, then Obama can come back when he has a little more experience.”

Today, maybe for the first time, I have hope for this country. I have hope for its leadership. I have hope for its future. And somehow, I believe that as one citizen, I can play a part in building America.

And yet, the critics were not so moved. Following the address I listened to some interviews on NPR, and was very surprised at the reaction. I paraphrase: “He should have sung,” said a former speech writer. “What we got was nuts and bolts; a very matter of fact speech. You could tell that the audience wasn’t really into it. Usually Obama soars in his speeches, this was low to the ground. It was the wrong choice.” At first I was aghast. Then I mulled it over I realized, this former speech writer is out of touch. He was expecting the same old thing: heavy on the rhetoric, light on the meaning. What he failed to realize is that the audience understood that this address was not entertainment. They understood that what they were witnessing was not spectacle. It was something new, something unexpected.

Two lines from the speech mark the difference between old America and the new America that is emerging from this election. Those of us who are young enough to have formed our identity in a global age resonnate deeply with the president when he says: “that as the world grows smaller, our common humanity shall reveal itself.” We are aware that the world is full of human beings, not nation states; and that as human beings, our interests transcend geography, race, and religion. This awareness stands in stark contrast to the isolationist policies of our ancestors.

The second line interprets much of the rest of the speech, and it is spoken to a generation that has not known how to grow up, let alone know what to do once they did. It is a line that ushers in a new era of political thought in America. Out of many memorable ones, this takes the cake: “We remain a young nation, but in the words of Scripture, the time has come to set aside childish things.”

I walked away from that speech a different man. Though I cannot speak for America, I believe that my reaction is not unique. In the midst of doubt and apathy about an uncertain future, in the midst of what seemed like an endless process of waiting for collapse, unexpectedly, someone decided to stop waiting. Today, he stood in front of us as our new president, and I found myself wanting to stand with him.

Our group of loyal Obama supporters clicked over to Fox News to see how they were ‘covering’ the ‘news.’ Brit Hume looked like a lost child; when your reporting exists in the hyperreal, there’s nothing to do when the real comes crashing back in. We watched for a few minutes while the camera aimlessly followed a nameless blond anchor woman around the set. It wasn’t worth our time.

That’s when it started to sink in. Barack Obama is president elect of the United States of America. The words started to carry new connotations. President is no longer a word to be ashamed of. The United States of America no longer has to be a farce. I feel a little strange wearing my Planet Hollywood t-shirt today. Normally I love the irony of it. But this morning I want something more substantial than irony for breakfast. I want to wear more than irony on my sleeve.

In a way I find myself struggling just like Brit Hume–what do I do now that the real has crushed the facade? As Barack said in his acceptance speech last night (I paraphrase): “This election is not the change we seek, it is only the opportunity to make the change.”

For those of us here at Happy Mortal, let me say it: “Let the rebuild begin.” Or, in snappy talk: “Yes we can.”

Yes we can…do what? Well, that’s what we’re here to talk about. I never would have believed that so many of us would be in this together. In the hyperreal of American politics, we would have had our one night stand and gone on our merry way. Today, we wake up together with hope for the future, and a long day of work ahead of us. Somehow this changes everything, or at least it gives us the opportunity to change.