By David Nagel, MD.
Editor’s Note: Dr. Nagel is a pain management specialists in New Hampshire who is a frequent (and highly valued) contributor to the National Pain Report.
“Kemmerich groans. He is feverish. We get hold of an orderly outside and ask him to give Kemmerick a dose of morphia.
He refuses. “If we were to give morphia to everyone, we would have to have tubs full…”
Erich Maria Remarque
From All Quiet on the Western Front
I never sought to be a pain management specialist. I wanted to be a physiatrist. I wanted to work with people with disabilities, to find a way to help them adapt to their challenges.
Little did I know those I cared for would help me more than I ever helped them. They guided me in directions I never imagined. Caring for them allowed me to learn about myself sometimes for the better, sometimes for the worse.
Their suffering taught me about their pain; physical, emotional, spiritual. Engaging with them distracted me from my desires and I felt an incredible responsibility to help them in a meaningful way.
And so I became a pain management specialist. I am still not totally sure what that means. While I knew that I could not eliminate pain, I felt an unreasonable need to do so, not to help the patient, but rather to ease myself of the very real suffering I felt at my inability to eliminate their pain.
As Schweitzer said, “Pain is a more terrible lord of mankind than even death itself.” I have come to understand that is true both for the sufferer and those in their presence.
Still, I sought to find a way to make changes at the personal and societal level, and I tried to bring together those in a position to help. With great effort, we succeeded, and we learned from each other.
At the peak of our success, I learned a new lesson: the allure of power and money often dictate our paths. Yet, those powers drive the Eisenhower equivalent of the medical-industrial complex whose self-interest often harm more than they help.
And so those in need suffer while those in power grow wealthy.
How do they live with themselves? I wonder.
How do I live with myself? I wonder…
It has now been fifteen years since my group decided to close my pain practice. A variety of reasons were given, most were merely a façade for shifts to a revenue centered business model.
I have never been comfortable with the choices that were made. I wrote the book Needless Suffering; How Society Fails Those with Chronic Pain as a way of both healing my wounds and those of society. It was my hope that nobody would be forced to make the decisions I had to make in accepting a new practice, one contrary to my beliefs.
I am increasingly seeing that search as futile. Like Remarques’s character Kemmerich, I see patients in pain every day who are denied access to care, whether it be morphia or otherwise. I am a witness to their needless suffering, and I feel called to help.
As a result, I sought and continue to seek ways to re-invent myself, to re-create the fuzzy Shangri-la I had once built with others.
They are all gone now, but I reasoned that I could once again recreate this play with a new cast of characters.
Realizing I could not create such change in my current practice, instead as a very real Rudolph, I would have to travel on alone to help find a home for those we view as misfits.
Our current world is often unfriendly to those who seek to make change alone. So I sought the comfort of others; my own Yukon and Hermie. Even in this world, there are rules, ones that often don’t make sense, but define what we do. To better understand those rules, I sought legal counsel as a starting point.
At great expense I met with two attorneys from two different states. After listening to my rather passionate presentation of what I hoped to do, both responded in the same way:
While we understand your need to do this, to care for those in need, it is our obligation to inform you of our legal opinion that the risk is too great and you should not do this.
To which I answered,
Then who is to care for those in pain?
When one understands that this legal opinion is being given to every medical practice in the United States, it is not hard to see how difficult it becomes for those in pain. For a brief point in time, someone did care. Now they are gone. And so those in pain suffer alone. People are dying. That is real.
Is that not important?
So, what do we do to change these trends? How do we create a voice that cannot be ignored? That must be the starting point. Only once that is accomplished, can we care for those in need.
Gandhi said, “The truth may turn out in terms of the current moods and trends of a blind society to be supremely unprofitable.”
In order to make a difference, to help those in need, we must find a way to get beyond our greed and our fear.
David M. Nagel, M.D. is a specialist in Physical Medicine and Rehabilitation and Pain Management, and author of Needless Suffering: How Society Fails Those with Chronic Pain.
(Editor’s Comment. Buy the book. This guy gets it.)
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