Notable Asian American Writers

Dr. Paul Brand

Writer



Pain and Pleasure--Unlikely Twins
Adapted from Pain: The Gift Nobody Wants
by Dr. Paul Brand and Philip Yancey
When I speak to church or medical groups I often tell stories from my childhood or my surgical career in India, and I get unexpected responses. "Oh, you poor thing," someone may say, "growing up without plumbing or electricity or even radio. And the sacrifices you make working with such sad people under those harsh medical conditions!" I stare dumbfounded at the sympathizer, realizing with a start how differently we must view pleasure and fulfillment. With the luxury of age I can now look back on three-quarters of a century, and without a doubt the times that seemed to involve personal struggle now shine with a peculiar radiance. In my work with leprosy patients, our medical team faced hardships, yes, and many barriers, but the very process of surmounting those barriers produced what I now remember as the most ecstatic moments of life. And as I watch my own grandchildren growing up in suburban America, I covet for them the richness of life that I enjoyed in the "primitive" conditions of the Kolli Malai ranger of India.

I grew up in India, the son of missionary parents. One vivid childhood memory is of strawberries. Mother tried to grow strawberries in our garden, but bugs, birds, cattle and the unfriendly climate of the Kolli Malai conspired against them. When a hardy fruit finally did manager to defeat its enemies, we would hold the ceremony of strawberries. With no refrigerator for storage, we had to eat it right away. My sister Connie and I shivered with excitement. We gathered around the table with our parents and ogled, smelled and savored the fruit. Then, under intense scrutiny from us kids, Mother would divide the berry into four equal portions. We arranged the pieces on a plate, added milk or cream, and ate our portions slowly and delectably. Half the enjoyment came from the taste of the strawberry, and half from the joy of sharing.

In search of the good life
Now, of course, I can go to a corner market near my home and buy a pint of strawberries, flown in from Chile or Australia, any month of the year. But I am sure the sheer pleasure of eating those strawberries does not compare with my experience from childhood. Perhaps the same principle may help explain a trend that seems almost universal in the reminiscences of older people: they tend to recall difficult times with nostalgia. The majority of Londoners who survived the Blitz now remember it as the happiest period of their lives. In the U.S., the elderly swap stories about World War II and the Great Depression; they speak fondly of blizzards, the childhood outhouse, and the time in graduate school when they ate canned soup and stale bread three weeks in a row. Against a dim background of hardship and deprivation there came to light new resources of sharing and courage and interdependence that brought unexpected pleasure and even joy.

I may risk sounding like an old man reminiscing about "the good old days," but nonetheless I now suspect that the affluent world of the modern industrialized West has become a more difficult place to experience pleasure. This is a deep irony, because no society in history has succeeded so well in eliminating pain and exploiting leisure. Yet happiness tends to recede from those who pursue it. It comes alongside, at unexpected moments, a byproduct rather than a product.

In the Kolli Malai ranger we lived very simply. The nearest village bazaar was ten miles away, the nearest railway forty miles. We had no electricity, no running water, no television, few books, and only one manufactured toy that I can recall. Yet not for one moment did I feel deprived. On the contrary, the days went far too fast for all I wanted to do. I made my own toys out of the bits of wood or rock. I learned about the world not by watching nature specials on television, but by observing first-hand such wonders as the ant lion, the weaverbird and the trap-door spider.

Now I see children who rush around on Christmas day from one electronic toy to another, bored with them all in a few hours. I have no doubt my own childhood was happier. I do not mean to imply that one society is better than another; I have learned from both East and West. But as a parent who has tried to rear children in both environments, I firmly believe that the modern world with all its affluence is indeed a more difficult place to experience lasting pleasure.

The problem of pleasure
Westerners have mastered the art of controlling nature, substituting a new reality for the "natural" reality known to the vast majority of people who have ever lived on this planet. Technology gives us many benefits. Water flows from the tap at any hour; climate-controlled devices in cars and homes keep the temperature steady summer or winter; we buy shrink-wrapped steaks in cheerful supermarkets, far from the mess of the slaughterhouse; our bathroom shelves are lined with remedies for aches of stomach, head and muscle.

Such mastery, though, creates the illusion that everything can be controlled by technology. Those who live closer to nature tend to acquire a more balanced view of life, encompassing both pain and pleasure. In village India I grew up in stern conditions of heat and cold, hunger and good food, birth and death, were part of the rhythm of life. Whereas now, living in a technologically advanced society, I am tempted to view all discomfort as a problem that can should be solved. I have come to believe that the very success of technology contributes to "the problem of pleasure." In some cases it provides the means (birth control) to change cultural taboos and enjoy short-term pleasures (promiscuous sex), thus opening up the possibility of long-term pain (family breakdown, sexually transmitted diseases). In other more subtle ways, technology allows us to isolate the pleasure phenomenon from its "natural" source and replicate it in a way that may ultimately prove harmful.

Taste illustrates the difference between a "natural" and "artificial" pleasure. Taste buds distinguish only four categories--salty, bitter, sweet and sour--which act as gauges to help us determine what foods are good for us. Bitter and, to a lesser extent, sour tastes warn against spoiled and poisonous substances; salty and sweet guide us toward healthier foods. Remarkably, the body can adjust the level of perceived pleasure as an incentive to meet a particularly urgent need. In India I once experienced sever salt deprivation after sweating all day in an operating room with no cooling system. I felt painful abdominal cramps and, suspecting the cause, I forced myself to drink a tumbler of water into which I had stirred two heaping teaspoonfuls of salt. To my amazement, the drink tasted delicious, like nectar. My acute physiological need had altered my perception so that drinking brine truly game me intense pleasure.

In a natural state, the body knows its needs and grades its responses to meet them. (For this reason animals will travel miles in search of a salt lick.) However, as humans have gained the ability to extract and isolate the pleasurable aspects of food, we have introduced the possibility of upsetting the natural physiological balance. Now that we can efficiently mine salt, store and then market it, Western societies ten to consume too much. Older people have to go on low-sodium diets to counteract the bad effects.

The same principle applies to sweetness, almost universally deemed a pleasurable taste. We eat apples, grapes and oranges and reward our taste buds with the natural sugars that occur in these fruits, while at the same time gaining benefit of their vitamins and nutrients. Refined sugar as such does not exist in nature, and the mastery of how to grow and process it in a concentrated form is a very recent achievement. In fact, the industrial world did not produce mass quantities until the nineteenth century, from which point sugar consumption increased exponentially--nearly 500 percent between 1860 and 1890 alone--opening a Pandora's box of medical problems.

Now, modern corporations use sugar as a taste enhancer to increase sales of breakfast cereals, ketchup and canned vegetables. Soft drinks are a ubiquitous source: the average American drinks more than five hundred cans of soft drinks a year. Diabetes, obesity and many other health problems stem from the overconsumption of sugar, a consequence of our modern ability to isolate a pleasurable taste and reproduce it for purposes unrelated to nutrition. Aggressive marketing has spread the sugar addiction to less developed societies who, until recently, got sugar from beneficial fruit or from sugar cane (which is fibrous and makes the chewer work hard to derive sweetness).

As I look around me, I see many examples of the same patter: modern society excels at the ability to isolate and repackage pleasure, thereby short-circuiting its natural pathways. We can even duplicate the effects of adventure-- sweaty palms, a racing heartbeat, tense muscles--in people who are slouched in plush theatre seats watching a movie. We can artificially stimulate the body to excite the sympathetic nervous system and release adrenaline, but vicarious adventures ultimately do not satisfy. It is not my danger, but someone else's. I may get some of the side-effects, but not the full value I would get from actually climbing a mountain or shooting rapids. In such a high-tech environment, it is easy for the young especially, to confuse true fulfillment with vicarious pleasure--life as a video game. They don't see pleasure as something to reach for and attain after active struggle. Instead, they are tempted to experience life vicariously, sitting in front of a flickering television set, receiving sensory stimulation through the eyes and ears alone.

Pain and pleasure mixed
Later I read the following passage in Saint Augustine's Confessions:

What is it, therefore, that goes on within the soul, since it takes greater delight if things that it loves are found or restored to it than if it had always possessed them? Other things bear witness to this, and all are filled with proofs that cry aloud," Thus it is!" The victorious general holds his triumph: yet unless he had fought, he would never have won the victory, and the greater was the danger in battle, the greater is the joy in the triumph. The storm tosses seafarers about, and threatens them with shipwreck: they all grow pale at their coming death. Then the sky and the sea become calm and they exult exceedingly, just as they had feared exceedingly. A dear friend is ill, and his pulse tells us of his bad case. All those who long to see him in good health are in mind sick along with him. He gets well again, and although he does not yet walk with his former vigor, there is joy such as did not obtain before when he walked well and strong.


"Everywhere a greater joy is preceded by a greater suffering." Augustine concludes. This insight into pleasure is one that we in the affluent West need to remember. We dare not allow our daily lives to become so comfortable that we are no longer challenged to grow, to seek adventure, to risk. An internal self-mastery builds when you run farther than you have run before, when you climb a mountain higher than any other, when you take a sauna bath and then roll in the snow. The adventures themselves bring exhilaration; meanwhile, challenge, risk and pain combine to bolster a confidence that may serve well in times of crisis.
In short, if I spend my life seeking pleasure through drugs, comfort, and luxury, it will probably elude me. Lasting pleasure is more apt to come as a surprising bonus from something I have invested myself in. Most likely that investment will include pain--it is hard to imagine pleasure without it.

Pain transformed
When I return to India on hospital business, if my schedule possibly allows, I drop in on some of my old patients, especially Namo, Sadan, Palani and the other boys from the original New Life Center, where we were learning at that time the reason people with leprosy developed destructive ulcers on their feet and hands was simply because leprosy had destroyed their nerves of pain. The challenge in those days was to learn how to protect the feet from accidental damage and to keep vigilant to avoid the injuries from which pain protects people.

They are middle-aged men now, with gray, thinning hair and wrinkles around the eyes. When they see me, they pull off their shoes and socks and proudly show me the feet they've manager to keep free of ulcers all these years. (Sadan is especially proud of his new shoes with Velcro strips instead of laces, more convenient for his damaged hands.) I examine their feet and their hands, congratulate them for their vigilance, and we sit down together for a cup of tea.
We reminisce about old times and catch up on each other's lives. Sadan keeps records for a leprosy mission that oversees fifty-three mobile clinics. Namo has become a physiotherapist of national reputation. Palani heads up training in the physiotherapy unit of the Vellore hospital where I used to work. I listen to their stories about work and family, and my mind goes back to the scared, scarred boys who first volunteered for experimental surgery.

I have never made much money in my lifetime of surgery, but I feel very rich because of patients like these. They bring me more joy than wealth ever could. And they bring me hope for other suffering people. In Namo, Sadan and Palani I have indisputable proof that pain, even the cruel, stigmatizing pain of a disease like leprosy, need not destroy. "What does not destroy me makes me strong," Dr. Martin Luther King, Jr., used to say, and I have seen that proverb come alive in many of my former patients.
Once, Sadan actually told me, "I am happy that I had the disease leprosy, Dr. Brand." I look incredulous and he went on to explain, "Without leprosy I would have spent all my energy trying to rise in society. Because of it, I have learned to care about the little people."

A mother's bequest
A special privilege of working in the field of leprosy is that it has brought me into touch many really remarkable people who have chosen to dedicate their lives to making life worthwhile for patients who have suffered so much. A characteristic of such self-giving people has been that they each seem to have a deep reservoir of joy and sense of fulfillment that more than compensates for whatever they may have sacrificed. I suppose this should not surprise me, since it merely reinforced one of the earliest lessons of my parents. My mother, especially, gave me a deep legacy, one that it took me years to recognize full y and appreciate.
I lived with my parents for nine happy years before going away to England for schooling. There I stayed with two aunts in a manor house in a suburb of London, the estate home my mother had grown up in. The Harris family was a prosperous one, and the house contained numerous reminders of what life had like for Evelyn, my mother, in her pre-missionary days. It was furnished in mahogany, with cabinets filled with priceless heirlooms.
My aunts told me that Mother used to dress with a certain flair, and showed me some of her silks and laces and long-plumed hats still hanging in the closet. She had studied at St. John's Wood School of Art, and I saw the watercolors and oils she had painted years before. There were portraits of my mother, also; my aunts told me that the men students used to compete for the privilege of painting beautiful Evelyn. "She looks more like an actress than a missionary." someone had remarked at her farewell party before the voyage to India.
When my mother returned to England after my father's death from blackwater fever, though, she was a broken woman, beaten down by pain and grief. Could this bent, haggard woman getting off the ship possibly be my mother? I remember making a foolish adolescent vow, so shocked was I at the change in her: If this is what love does, I will never love another person so much.
Against all advice, my mother returned to India, and there in the Mountains of Death her soul was restored. She poured her life into the hill people, nursing the sick, teaching farming, lecturing about guinea worms, rearing orphans, clearing jungle land, yanking teeth, establishing schools, digging wells, preaching the gospel. While I was staying in the manor house of her childhood, she was living in a portable hut of plastered bamboo and thatch. On camping trips into the country-side she would sleep in a tiny mosquito net shelter that gave no protection from the elements (when storms came in the night, she wrapped herself in a raincoat and propped an umbrella over her head). She traveled constantly, from village to village.
Mother was sixty-seven when I first came to India as a surgeon. We lived only a hundred miles apart, although it took a full twenty-four hour journey to reach her place up in the hills. Her active years in the mountains had taken a toll. Her skin was weather-beaten, her body infested with malaria, and she walked with a limp. She had broken an arm and cracked several vertebrae being thrown off a horse. I expected she would be retiring soon. How wrong I was. At the age of seventy-five, still working in the mountains, Mother fell and broke her hip. She lay all night on the floor in pain until a workman found her the next morning. Four men carried her on a string-and-wood cot down the mountain path to the plains and put her in a jeep for the agonizing 100-mile ride over rutted roads. I was out of the country when the accident occurred, and as soon as I returned I scheduled a trip with the express purpose of persuading Mother to retire. I knew what had caused the accident. Pressure on the spinal nerve roots from the broken vertebrae had caused her to lose some control over the muscles below her knees. Limping, and with a tendency to drag her fee, she had tripped over a door sill while carrying a jug of milk and a kerosene lamp.
"Mother, you're fortunate that someone found you the next day," I began my rehearsed speech. "You could have lain there helpless for days. Shouldn't you think about retiring?" She stayed silent, and I took the opportunity to pile on more arguments. "your sense of balance is no longer so good, and your legs don't work well. It's simply not safe for you to live alone up here where there's no medical help within a day's journey. Think of it. Just in the last few years you've had fractures of your vertebrae and ribs, a concussion of the brain, and a fad infection on your hand. Surely you realize that even the best of people sometimes retire before they reach eighty. Why don't you come to Vellore and live with us? We have plenty of good work for you to do, and you'll be much closer to medical help. We'd look after you, Mother." My arguments were absolutely compelling--to me, at least. Mother was unmoved. "Paul," she said at last, "you know these mountains. If I leave, who will help the village people? Who will treat their wounds and pull their teeth and teach them about Jesus? When someone comes to take my place, then and only then will I retire. In any case, what use is there in preserving my old body if it's not going to be used where God needs me?"
That was her final answer, a decision she stuck to until she died at the age of ninety-five, still in active service, by which time some of her Indian helpers had taken on responsibility for her work.
For mother, pain was frequent companion. So was sacrifice. I say it kindly and in love, but in old age Mother had little of physical beauty left in her. The rugged conditions, combined with the crippling falls and her battles with typhoid, dysentery, and malaria had made her a thin, hunched-over old woman. Years of exposure to wind and sun had toughened her facial skin into leather and furrowed it with wrinkles as deep and extensive as any I have seen on a human face. Evelyn Harris of the fancy clothes and the classic profile was a dim memory of the past. Mother knew that as well as anyone--for the last twenty years of her life she refused to keep a mirror in her house.

A son's eulogy
Yet with all the objectivity a son can muster, I can truly say that Evelyn Harris Brand was a beautiful woman, to the very end. One of my strongest visual memories of her is set in a village in the mountains, possibly the last time I saw her in her own environment. When she had approached, the villagers had rushed out to take her crutches and carry her to a place of honor. I remember her sitting on a low stone wall that circles the village, with people pressing in from all sides. Already they have listened to her praise them for protecting their water supplies and for the orchard that is flourishing on the outskirts. They are listening to what she has to say about the love of God for them. Heads are nodding in encouragement, and deep, searching questions come from the crowd. Mother's own eyes are shining, and standing beside her I can see what she must be seeing with failing vision; intent faces gazing with trust and affection on one they have grown to love.
No one else on earth, I realized then, could command that kind of devotion and love from these people. They were looking at a bony, wrinkled old face, but somehow her shrunken tissues had become transparent and she was all lambent spirit. To them and to me, she was beautiful. Granny Brand had no mirror made of glass and polished chromium; she could see her own reflection in the incandescent faces around her.
A few years after that scene, my mother died. At her request, villagers buried her without a coffin, in a simple cotton sheet so that not wood would be wasted and her body would return to the soil and nourish new life. Her spirit, too, lives on--in a church, a clinic, several schools, and in the faces of thousands of villagers across five mountain ranges of South India.
A co-worker who knew my mother well once remarked that Granny Brand was more alive than any person he had ever me. By giving away life, she had found it. Pain she knew well. But pain need not destroy. It can be transformed--a lesson my mother taught me that I have never forgotten.

Adapted by David Biebel from. Pain: The Gift Nobody Wants, by Dr. Paul Brand and Philip Yancey, Zondervan/Harper Collins publishers, 1993.
First North American serial rights obtained by CMDS.
This page was obtained from and given permission by the CMDS.
Paul Brand, M.D., is a well-known CMDS member with many accomplishments, including pioneering work on leprosy and attaining world stature as a hand surgeon. Dr. Brand and his wife, Margaret, live in Seattle, Washington.
Philip Yancey is a freelance writer who lives with his family in Colorado. He is Editor at Large with Christianity Today, and has authored several books including Disappointment With God and Where Is God When I Hurts. He and Dr. Brand have co-authored two other books on the wonders of the human body, In His Image and Fearfully and Wonderfully Made.

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