Book: THE SONG OF OUR SCARS: THE UNTOLD STORY OF PAIN

Author: Haider Warraich

Price: Rs 599

Published by: HarperCollins

This is Haider Warraich’s third book after Modern Death and State of the Heart. Even though all of them deal with medical history, The Song of Our Scars is inspired by his personal experience of chronic pain after he sustained a back injury while in medical school in Karachi, Pakistan. “It changed my line of work,” he writes in the Introduction. “It took many of my friends from me… And it could have taken away even more: more than once, my pain led me to believe that the only way to release myself from its vice would be to end my life.”

The universal vibe in the title notwithstanding, The Song of Our Scars principally deals with the opioid epidemic of the 21st century in the United States of America which he has seen unfold up close as a medical practitioner in that country. The wake-up call came early, during his internship, when, during a lunch break, a former intern’s email was read out. He was now practising in Lausanne, Switzerland, and had not prescribed opioids in six months, he had written. That was unthinkable in America.

Why that is so is analysed with both clarity and compassion in nine succinct chapters in this book — by combining medical history and case studies with periodic anecdotes of Warraich’s own experience and management of pain.

The first chapter, “How We Hurt: The Biology of Acute Pain”, is the most medically dense in the book, although not incomprehensible to the lay reader. The core chapter, from the point of view of the principle argument of the book, is “Angel of Mercy: How We Learned to Stop Worrying and Love the Pill” (Chapter 6). It traces the beginnings of the opioid epidemic of the 21st century which was triggered by “a flood of opioid prescriptions to patients with chronic pain”, many of whom got addicted to them. Foremost among the pharmaceutical companies that pushed these pills was Purdue Pharma, owned by the Sackler family. It manufactured OxyContin, a drug that was originally meant to provide relief only to terminally ill patients, but was strategically marketed — for greater profit — as a general medicine for anyone in pain. The thing to note here is that palliative care for terminally ill patients was pioneered by Cicely Saunders after the Second World War; she built the world’s first hospice and was looking for a long-acting form of morphine to be administered to patients. It was this search that led to the formulation of OxyContin. But she had no idea that her empathetic cause would be “hijacked… into a business strategy”.

Warraich specifically mentions Saunders as one of his heroes. She could also be called a crusader-healer, and the book offers many more examples of such individuals with exceptional compassion for human suffering, some of whom were also, at the same time, motivated by their own pain to relieve those of others. Mention may be made here of Patrick David Wall (‘Gate Control Theory’) and John Bonica. It is also important to remember the role that wars played in the advancement of medical science because it was in the efforts to alleviate the pain of injured soldiers that new medicines, formulations and treatments were sought.

“The Pain of the Powerless” (Chapter 8) establishes the racial and gendered dimensions of pain, and how, historically, Blacks and women have been disadvantaged (in the West) when it came to medical care. Particularly interesting in this context is the evolution of painkillers for birthing — from ether to chloroform to epidural. Ether, as a general anaesthesia, was first administered in child-birth in Edinburgh in 1847 by James Young Simpson, just months after it proved successful for a dental procedure by William Thomas Morton in Boston. Ether was however not long-lasting in its effect, and further experimentation by Simpson led to the discovery of chloroform as the better alternative. It would eventually be replaced by epidural, which is injected directly into the spinal cord of the birthing mother and is the safest option.

Overall, Warraich’s book is a plea for a more holistic understanding of chronic pain; to see it not just as a physical sensation but also one that spans the mind and the body. Only through such an understanding — and acceptance — of pain, argues Warraich, can it be healed.