[The following passage is from Paul Brand’s Pain: The Gift Nobody Wants, 1988. The son of English missionaries working in India, Brand went on to become a surgeon who developed new, innovative techniques for hand surgery. He also revolutionized our understanding of leprosy: the disfigurement and the loss of limbs is caused by the lack of respect for the body that results from the condition of painlessness (which is caused by the disease) and not because the disease causes the flesh to become “non-healing” or to change in any way.]
Most amputees experience at least a fleeting sensation of a phantom limb. Somewhere, locked inside their higher brains, a missing hand or leg perseveres in vivid memory. The limb may seem to move. Invisible toes curl, imaginary hands grasp things, a “leg” feels so sturdy that a patient rolls out of bed expecting to stand on it. The sensations vary: a feeling of pins-and-needles, a nagging awareness of heat or cold, the pain of phantom nails digging into phantom palms, or perhaps just an enduring sense that the limb is still “there.”
Over time, these symptoms usually taper off. Sometimes sensations fade away only partially, so that the brain retains the perception of a hand—but no arm—dangling from a shoulder stump. Among an unfortunate few, this phantom limb sensation includes long-term pain, a pain like no other. They feel large nuts being screwed onto phantom fingers, razors slashed across phantom arms, nails pounded through phantom feet. Nothing gives a doctor such a sense of profound helplessness as phantom limb pain, for the part of the patient’s body screaming for attention does not exist. What is there to treat?
I observed a strange encounter with severe phantom limb pain during University College days. The school administrator, Mr. Bryce, suffered from Buerger’s disease, which restricted the blood flow in one of his legs. As circulation gradually worsened he felt constant, unrelieved pain in that leg. Smoking contributed to the thombosis, and for Mr. Bryce a single cigarette would cause enough vasoconstriction to bring on excruciating pain.
Dr. Godder, Bryce’s surgeon, was at his wit’s end. An obstinate man, Bryce had adamantly rejected any thought of amputation, and Godder was struggling to keep his patient from overdependence on pain medication. (At that time, there were no effective grafting techniques for reestablishing blood supply to the leg.)
“I hate it! I hate it!” Bryce would mutter about his leg. After several months of this defiance, at last Bryce gave in. “Take it off, Godder, take it off!” he railed in his raspy voice. “I can’t stand it anymore. I’m through with that leg.” Godder scheduled surgery immediately.
The night before the operation Dr. Godder received a strange request from Bryce. “Don’t send this limb to the incinerator,” he said. “I want you to preserve it for me in a pickling jar, which I will install on my mantle shelf. Then, as I sit in my armchair in the evening, I will taunt that leg: ‘Ha! You can’t hurt me anymore!’ ” Bryce got his wish, and when he left the hospital in a wheelchair, a large museum bottle went with him.
The despised leg, however, had the last laugh. Bryce suffered from phantom limb pain in the extreme. The wound healed, but in his mind the leg lived on, hurting him as much as ever. He could feel the phantom calf muscles go into ischemic cramp, and now he had no prospect of relief.
Dr. Godder explained to us students that the leg, which should have been amputated two years before, had achieved an independent existence in Bryce’s tormented mind. Even people born without limbs may have a felt image of the limb in the mind, and may experience phantom pain. Bryce had a richly developed felt image reinforced by feedback from the cut nerves in the stump. He hated that leg with such ferocity that the pain, which began as a signal reporting in from the periphery, had etched a permanent pattern in his brain. The pain existed at stage three only, in his mind, but that was sufficiently torturous. Though he could glare at the leg on the mantle shelf, it leered back at him inside his skull.
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