The Nearly Impossible Task of Describing Pain

As Emily Dickinson once wrote, pain places the sufferer in an “infinite” present tense: “It has no future but itself.” In “Pain Has an Element of Blank,” Dickinson pinpoints the absence of words, failure of description, and defeat of language that often accompany serious injury or illness. After all, pain demands the kinds of human expression that are the most spontaneous and the least composed: grunts, cries, pleas for help.

Yet writers in every medium try again and again to assign words to the experience. Garth Greenwell is unafraid to depict plainly what often goes unspoken, and his third novel, Small Rain, makes glorious progress toward filling in Dickinson’s blank. Its subject is the sudden onset of debilitating agony amid a life-threatening sickness. The story, with the exception of a brief coda, takes place in the terrifying realm that Susan Sontag called “the kingdom of the ill.” For the unnamed protagonist, who is a writer and teacher, this kingdom is a hospital in Iowa City. He has suffered an infrarenal aortic dissection, in which “part of the inner wall of the artery has detached.” The plot ostensibly depends on tracing the cause and prognosis of the disease: Why did it happen? And what will become of the narrator?

Greenwell chronicles, in realistic and copious detail, day-to-day care in a hospital: the numerous IV lines branching out from the narrator’s body, the torturous trips to the bathroom, the consultations with teams of doctors who can’t find a cause or cure. Long descriptive passages follow the narrator as he is wheeled down a hallway or cleaned by his nurse. These sections cast a spell over the reader even in the most clinical moments; Meghan O’Rourke described the novel as a “close reading” of the medical system.

[Read: Seven books that actually capture what sickness is like]

But Small Rain is not a critique of U.S. health care disguised as a novel. Its power, instead, comes from the dissonance between the terrifying condition of waiting for answers and the flights of imagination that this purgatory, paradoxically, sustains. Confined to and immobilized in his bed, the narrator finds thoughts crowding into the space left blank by the absence of work, errands, and social obligations: poignant memories of meeting his partner, L; traumatic images of the derecho that blows trees down onto their house; and, most unexpectedly, ecstatic reflections on lines of poetry.

In a novel about illness, art might seem beside the point. And yet, the sections of the book that struck me with the most force are its meditations on verse. The novel’s title, in fact, is borrowed from a 16th-century poem (written by an anonymous author) that I often teach in my introduction-to-literature class:

Westron wynde, when wilt thou blow

The small rain down can rain

Christ if my love were in my arms

And I in my bed again

The speaker of this poem suffers: They endure the weather, romantic yearning, and whatever else has taken them away from contentment. But through rhythmic language, the poem anchors an overwhelming, chaotic emotion in the comfort of a contained form. In Small Rain, too, the narrator finds himself in extreme privation. Removed from the world of people, of work, of life with his loving partner, he has become—like the troubled voice in the poem—“a minuscule crouching thing, a bit of matter terribly afraid, utterly insignificant.”

Greenwell’s lyrical prose seems to take a cue from the work in which his narrator finds solace. He shows through the novel that pain, no matter how severe, needn’t shut out the possibilities of language. Even the unpleasant, often ugly experience of physical anguish can elevate and transform human forms of expression.

Throughout Small Rain, a consistency of cadence makes the novel feel like a cohesive whole—not unlike the recurring motif you might hear in a movement of a symphony. Inspiring acts of kindness and moments of mundane bureaucracy are depicted with the same tender attention. In one scene, after a fallen tree is removed from his house and an arborist preserves a ring of it, Greenwell writes, “I thanked her, it was thoughtful of her, a kindness.” Later, when he has to file an insurance claim for the damaged house, the narrator reflects on the “impenetrable language of house insurance or health insurance, language that made my head hurt, that made me feel stupid, I had always just pushed it aside.”

Where another writer might place a period, Greenwell uses a comma, creating an unfamiliar pattern by prolonging the sentence a little further than we might expect. I started to listen for this gentle deviation from speech, this poetic extension of a thought. The rise and fall from comma to comma, the full stop in a period: In the face of uncertainty, of not knowing when the pain will end, Small Rain’s sentences transform the clinical narration of a hospital stay into the soothing murmur of a prayer, or the steady sound of rain.

By the end of the novel, the main character has been released from the hospital. He’s gone home to have dinner with L and his sister. In the coda, he visits a nearby dog park, where he sees “pure life” in the heedless glee of romping rescue dogs. This section of the book punctures the cloistered, enclosed space of the single room. But the resolution of the story isn’t really the point of this novel. We never learn what caused the aortic tear, or what it will mean for the narrator’s future, only that he’ll need to return to the hospital at regular intervals for more scans.

[Read: Hypochondria never dies]

In the middle of the book, when his hope for release and recovery is at its nadir, the narrator thinks about another poem that reflects his own vulnerability in the figure of a small, fragile bird: “Stranger’s Child,” by George Oppen. In this short work, the poet writes about a sparrow, observing it closely in a “cobbled street,” as its feet touch “naked rock.” The narrator remembers teaching the poem to his students, urging them to notice how the poet focuses all of our attention on the bird on the pavement, if only for the time it takes to read the poem. Nothing else, for the moment, exists.

By narrowing its scope to the hospital room, Small Rain keeps its eye not on a sparrow but on a suffering human being. The solution that the novel proposes to Dickinson’s dilemma—how to write about pain when pain defies expression?—is not a stunned silence or an inarticulate cry of despair. The language for pain, instead, is that of poetry, which charges the words of a sentence with the force of beauty, turning chaos into consolation.