Embracing the Complexity of Pain

Kate Bowler: You’ve probably heard the saying ‘what doesn’t kill you makes you stronger.’ But can we take that one back to the drawing board? Like my friend Kristen Howerton said during my podcast episode with her, “what doesn’t kill you will give you a raging anxiety disorder.” Or maybe this one that I joyfully had printed on a T-shirt that I wore during a 5K recently “what doesn’t kill you might try again tomorrow.” And on that note, it’s probably a good time to tell you that my name is Kate Bowler, and this is Everything Happens. A podcast where we get to rewrite the terrible cultural scripts we’ve been given like no pain, no gain or use the pain as fuel to keep going or the pain you feel today will be the strength you feel tomorrow. Really? Try telling that to someone in chronic pain. Someone who’s fibromyalgia or overwhelming fatigue or debilitating migraines keeps them locked out from the life they once loved, or to someone who loves the person for whom pain has interrupted their days, who watches their loved ones suffer, never being able to offer enough relief. Those trite sayings might work as banners inside the nearest big box gym, but for people for whom pain is very real and a very constant and unwelcome companion, we need better language. And today’s guest is just the person for the job. Today, I’m speaking with a physician, writer and researcher, Dr. Haider Warraich, who completed his training as a cardiologist at Harvard Medical School and our very own Duke University. Now he serves as the director of heart failure at the VA in Boston, an associate physician at Brigham and Women’s Hospital and an assistant professor at Harvard Medical School, no big deal. Haider also suffers from chronic pain, which gives him a hard won insight we read in his new beautiful book, The Song of Our Scars, where he invites us all to reexamine how we understand and treat pain, especially chronic pain. Oh my word, friend, I am so glad we’re finally doing this.

Haider Warraich: I am so glad to be here, Kate, and thank you so much for allowing me on this really, really special podcast.

Kate: You’re a doctor, but if you don’t mind, I wondered if we could start with you as a patient. While in medical school, you experienced an injury that changed everything. If you don’t mind starting there. What happened?

Haider: So I was in medical school. I was in the third year of medical school and before that I was just your normal kind of, you know, semi-pro jock. I thought I was invincible. I played sports. I loved playing basketball and lifting weights and whatnot. I was just trudging along through medical school kind of along the way. And then really, one day I was in the gym, I was doing a bench press and I don’t know what exactly happened, but I distinctly remember hearing this loud click in my back almost like a snap. And then my I couldn’t feel my legs, my the weights crashed on my chest and, you know, I couldn’t breathe for those, for those really sort of infinitely long seconds. Then I looked around and got people’s attention. They came to my help. They lifted the weights off my chest. They took me to the emergency room in this wheelchair, which is kind of ricketing along. And in the emergency room, I, you know, because I was a medical student, everyone kind of knew me that took me to the side room, gave me some painkillers and told me, this is all going to go away. And that’s what I believed. I thought that, OK, fine, I’ve gotten hurt. It’s not the first time I’ve gotten hurt in my life, but we kind of know in our minds how this goes. Something bad happens and then it’s awful at the start. But then over time it gets better, and then you can just forget about it and resume your previous life. And that’s the mode I was in. But then, you know, those days became weeks and what what I really had was this crippling back pain. Those weeks became months and the pain just didn’t go away. It really became a part of my life to really a point where my, my previous pain-free self felt like a foreign entity. It didn’t seem like it was me. I forgot what it was like to not be in pain. Whenever I could sleep, my last memory was out of pain, and it was surely the first thing I felt when I woke up. And that’s and I thought that I was going to be the end of my career as a physician because I just couldn’t do anything. I couldn’t concentrate, I couldn’t study. I couldn’t be in the operating room to learn about surgery or be in the clinic just waiting around, seeing patients. Medicine requires you to be outward, to be outward facing, to always keep looking at other people and observing and learning from your teachers, from your patients. And with the pain, everything was just pointed inwards. I could not. I was- all I could think about was how much am I hurting? Would it get worse? What can I do to, you know, get out of whatever situation I was in? And that’s really where without me knowing it, this was somewhere in 2008 or 2007, I believe so. It was, you know, a while ago and and I thought my life was over. I thought my medical career was over. But but now that I look back at it, it was really in some ways, the beginning and certainly the reason why I was able to write this book so many years after.

Kate: And the first line of the book is one of the most validating sentences I’ve ever read. You write, “pain is a fundamental truth.” Tell me about pain as being such a basic part of being human.

Haider: You know, it’s as far as I can tell you as a physician that you know, every physician that you’ve ever met in your entire life, they have been trained to see the person across from them, the patient through the lens of pain. In the very first teaching session that any physician will ever get about how to say, take a medical history or how to perform an exam, it’s going to be about a person in pain. And so it forms a basis of how, as a physician, I’ve come to view the world. But pain is something that is- pain is not a disease, right? Pain is not like cancer or heart disease. It is a normal function that the human body has. And it really starts from the very first moment when the baby is born, you can see that they are crying out and that creates like this visceral reaction because we know exactly what that means. And oftentimes, if you’re a physician like me who gets to sort of be with patients at in their very last moments, unfortunately it can also be the last thing that someone experiences. And in between, you know, pain can be an unwanted guest in your life, but it can also be someone who just sometimes takes over your life and we just not prepared for that type of pain.

Kate: Yeah, until I started being someone in pain, I did think of it like an exception. Maybe the moment that you go through or now like a phase, a thing to be overcome, a temporary setback and the triumphant parade of my life experiences. Your language around pain is so affirming because it helps me understand a little bit more about how subjective the experience of pain is. Because I mean, one thing we do in this in this community is we try to be very validating and non-minimizing about people’s experience. But that’s not to say that it isn’t subjective and lived, and I think you you give us a lot more to think about in terms of like the framework.

Haider: I think what’s happened in medicine and in science is that the word subjective has kind of become a dirty word. You know, it’s become essentially a way of saying that it sometimes is equated with that this is not real as opposed to objective. And you know what is objective and a broken bone is objective or an aneurysm is objective. But but when somethings become subjective, they somehow lose legitimacy in a way. And you know, what is subjective today is really just what remains a what is something that medicine cannot study. So whatever whatever medicine cannot study in a way that there is a scan that it can run or a blood test it can run that can give it a number. If you have something that doesn’t fit those tools, what you have is subjective. If you think about the way people in pain describe how they feel, it’s very, very specific. They can tell you exactly how it feels, they can tell you and they can sometimes point it for the finger, sometimes in all these different ways. And yet the way we measure pain is essentially by asking folks how they feel. Sometimes you just make it like, make it fit the constraints of medicine. We’ve developed this like scale of one to ten. Ten being the worst pain of someone’s life and one being like no pain. And often these forms are accompanied by these smiley faces, and this one is overjoyed and ten is just, you know, drenched in sweat and just crushed in suffering. It’s not a perfect system for many, many different ways. Because pain is relative. It can change from moment to moment it’s informed by essentially, your entire life and your entire autobiography and your culture is synthesized in that moment when you are asked to put it on a number, which is, I think, minimizes the scope of what what this sensation means and what it represents. So I think what is a beautiful thing about pain is that is subjective because it forces us as physicians to get out of our algorithms and our numbers and our X-rays and CT scans and actually talk to someone to listen to them and pay attention. And unfortunately, we’ve reduced that to something that is somehow less than. Somehow less than what might show up on a blood test or a cat scan. And I think that that is one of the things that patients with pain, especially chronic pain, really struggle with.

Kate: Yeah, I have found this to be a regular obstacle for me in getting the treatment that I need because so often my performance of pain is quite cheerful, it is thrilled to be there at that time. So since I was like deep into labor when I was turned away at the E.R. for not having quote the look of someone in labor. And I remember saying, Oh, this is going to be a huge problem. Unfortunately, I am amazing at being miserable and I feel like it’s so much to do with my socialization, with my worry about being too much for other people, maybe about five years of not being believed for, like what turned out to be a joint disorder and told that it must be some kind of psychological manifestation. So you argue that pain needs to be performed in order to be recognized like the social aspect of pain. And that just sounds so familiar to me because it reminded me of my hilariously cheerful self wearing a chemo pack, whereas my husband, if he gets like a light cold like the hoodie goes up over his head. So how is pain a performance?

Haider: So, so this was something that I really hadn’t thought about until I was researching for this book, and I interviewed a person who had been in pain and she had written about it herself. But she described her existence as a pain patient, especially when it pertained to seeking health or seeking health care was essentially a performance. You know, what that means is that if you come to the hospital and she tried to walk without a limp or she didn’t use a cane and she tried to, you know, in her own way, muster up strength to look, quote unquote normal, and then would report that she was in eight out of ten pain. Or again, you know, just showing how odd these scales are, but that’s the language of medicine. So if a physician would ask how much pain she, then she would say, well, eight or seven, or it would be high a number. And then the physician and their team would actually doubt her veracity because they would look at her and see, like, well, the other patients who were in pain were in this much. I mean, they’re either writhing in pain or, you know, they are shaking or they have some type of obvious handicap. They have a bone sticking out of their leg. But on the other hand, let’s say that she she did feel like, well, this is what she needs to do to be taken seriously. Like if she felt that, well, if I have to and I wouldn’t say play act, but respond to what the pain wants her to do, which is to not use that limp or guard it from getting hurt further or a release or succumb to it fully. Then someone might feel like, Oh, you know, she or he is over-acting. Or maybe they’re doing this because they want something. Maybe they want opioids, or maybe they want, you know, disability or something like that. So. And and I think that patients, whether unconsciously and consciously just learn to do that, they learn to perform in a way that they feel they’re going to get their needs met. And I certainly felt that myself, you know, when I before I got hurt, I had friends, one of my very close friends who himself had had back pain. And you know, I would often, you know, we were just friends, but I often made fun of him because he looked fine. He looked totally fine. And yet he talked about this pain that I had no way of relating to. And it wasn’t until I got hurt myself that I began to realize how because I didn’t have a scar, I didn’t have, you know, an obvious deformity or disability. It does feel like that this performative aspect of pain is so important, especially if no one’s going to believe you in the first place. So if you’re a woman, or if you’re if you’re a black person, or if you’re if you’re a poor person or if you’re an immigrant, then the burden is on you even more so to prove to everyone that how you feel is in fact legitimate, and that the treatment that and that you deserve to be cared for, that you deserve to be treated. And that burden is unfair, but the effects of it are very real.

Kate: Yeah. I think when you frame it that way, it makes me realize that like my, my performance of pain was trying to meet like the social costs of the problem. I wanted to look like someone who deserved help, who people wanted to care about. And unfortunately, it also meant that I was not nearly honest enough about how much pain I was in, which made it harder sometimes to treat me.

Kate: The scope of chronic pain is wild. Can you give me a sense of how big this phenomenon is?

Haider: Yeah. So chronic pain affects one in five Americans. So this number, there is a number that was much higher, which is probably an exaggeration. And this is based on if you ask people if they have had, you know, chronic pain in the last three months or six months, you’ll get about one in five people. And it’s not just in the United States, it’s across the across the world, really. What has made this an even more vexing problem has been the opioid epidemic, which it has really put patients who are in chronic pain kind of in the middle of, you know, two really difficult situations, which is one is that they have chronic pain, which is bad enough. And now they are having to they’re on this medicine that is can help folks in acute pain and can help them feel better. But had these long term side effects that, you know, we’ve all sort of been witness to how sort of damaging these medicines can be. And are now stuck in between this kind of policy shift where we went from a rhythm with this pendulum swinging one to another where we’ve said, well, everyone should be on opioids now we’re saying no one should be on opioids. The thing about chronic pain is that it affects people most often at their so-called the prime of their lives. You know, again, that’s debatable what that means. But if you look at disability and if you look at job loss or if you look at loss of employment, pain is the number one cause of disability of people not being able to work more so than cancer, more so than heart disease, more so than any other condition. Not only is it very common, it strikes people you know, when they least expect it, when they think that, Oh, now I’m done with my college and now I can work and I can make a living, I can have a family or, you know, whatever their goals might be. That’s when pain really, really gets them. Mm-Hmm.

Kate: I’ve been in chronic pain since maybe I was probably about 28 when it first started and I was a graduate student just trying to finish up my dissertation and I had pain in my arms, which spread to the point where I couldn’t when I used to get trapped in bathrooms because like my arms, I couldn’t, I didn’t have the like twisting gesture, and I just remember standing there being like, Well, I guess I could just wait till someone finds me. I found the slipperiness of how to describe how to find better language for it to be so tricky. So I thought maybe other people like me would appreciate maybe a vocabulary lesson in pain. Could you tell me about the difference between nociception, pain and suffering?

Haider: So nociception is basically what you might call the quote unquote the physical aspect of pain. What does that mean? So your nerves, your skin and your bones and are innovated with are filled with all these neurons that are looking for any type of negative sensation. So heat or cold chemical or forceful surf or mechanical force. So if you, for example, eat spicy food, the receptors in your tongue are going to get activated, they’re going to send signals to your brain. That signal by itself doesn’t mean anything. Just because you have nociception doesn’t actually mean that you will hurt. And pain is not just based on what you feel in the moment. It’s based on context. It’s based on, you know, it’ll give you a good example. If someone squeezes you hard, that might be something you might not notice. But but let’s say the last time you had a similar sensation, you were being assaulted or you were in a place where you felt insecure. That might feel very, very different. A marathon runner might feel very different based on which side of the finish line he’s on. You know, as soon as he or she probably crosses over, they can finally fully attend to how their body feels. But most of the time, those nociception is followed by pain and pain is not just a physical sensation, it is an emotional sensation. It’s informed by your memory. It’s it really informed by who you are. So as a small example, if you are someone who has experienced racial discrimination, that actually increases how sensitive people are to pain because again, they’re worried and they’re fearful that they’re going to be mistreated or they’re going to be misjudged or they’re not going to be taken seriously. It’s like a combination. You know, one of the researchers I spoke to describe pain as an emotion felt by a part of the body. And if you think about the sensation that most closely resembles pain in your brain, it’s actually memory. And the tie between memory and pain is actually very, very rich. And in fact, one of the conditions that seems to mimic chronic pain the most is actually PTSD. And so now that we have pain, well, what is suffering? Suffering is essentially our interpretation of the pain, and it’s probably the part of pain that I think is most, most human. A therapist that I spoke to someone, Ann-Marie, who had chronic pain herself, then actually got a doctorate and wanted to help other people. She she basically called pain, clean pain and suffering as dirty pain. And suffering is what tells us that you’re not good enough. Suffering is a voice that tells us you’re not going to get better. Suffering is the voice that tells us that we’re never going to be the same. We’re never going to have friends. We’re never going to be happy and can often, you know, live long after the pain has receded. Then sometimes you can suffer without having pain. We all know that, right? Yeah. And there are so many examples. I mean, just just hearing about the news sometimes can cause you to suffer, even though you might not feel physical pain, but sometimes you may have pain, but you might not suffer. Let’s say you have, you know, appendicitis and you know that you’re you’re in a lot of pain. But but once you get your surgery, that pain is going to be over. Your appendix is going to be taken out. But also, you can have pain without nociception. So you can, so think about something like phantom limb pain, for example, which is a very obvious example. Phantom limb pain is pain that you might have in a part of your body, usually a limb long after it’s been lost via amputation. And you don’t need any nociception. You don’t need any signals coming in from down below to cause you to suffer or to cause you to have pain. You know, I think so, so many times in medicine, especially, we’ve wanted to simplify things. We want, you know, to reduce pain to a scale. Oh, it’s nine. It’s a ten. Seven and a half, you know? But but I think I think if we are going to help people or if you’re going to actually move forward, we have to embrace the complexity of pain.

Kate: Yes. So I’m a historian who studied a lot about a certain version of mind power that rose to the fore in the late 19th century, where people imagined their bodies as having ultimate especially spiritual control over their experience. You know, it was a time of tremendous experimentation with like the placebo effect and mesmerism and all kinds of things in which the body seemed very suggestible and under the control of the mind. But part of the American obsession with mind power is we love these neat little aphorisms about pain. A lot of like pain is necessary, but suffering is optional kinds of things as if if we just exert more control over our bodies that we can sort of just think of it like an arrow shoving down. You like mind, mind to body. I was reminded of that yesterday when I was on a little hike and I I always have to walk past the place where, a little bit ago, I was bitten by a poisonous copperhead and I had to go to the hospital and I every time even just talking about it, even every time I walk throughs on the place, I feel a full prickle. And it’s such a distinct kind of nerve pain that was as a result of the lack (snake noise) the prong-y teeth. And I think before I read your book, I might have thought, Well, this is this is something over which I should exert kind of mental control, but I feel like you’re offering a much more kind of miasma easy depiction of of how we experience and then interpret pain.

Haider: I really think that that’s, you know, how are we going to, of how are we going to help people who are in pain or in suffering or were suffering? I think that’s really where the focus has to be on our, you know, just our mind has as much of a capacity to heal as it has to hurt. You know, as as much as it can cause us to be in indescribable suffering. I think that is also where some of the keys lie to us being able to, you know, not eliminate pain because I don’t think that that’s a goal that we can achieve as much as you’d would like because, you know, we know that there there are people who are born on Earth who actually don’t feel pain and their lives are actually no better. If they’re if, if anything, they’re worse than our lives. They live shorter lives. They get hurt and they don’t take care of themselves. They don’t learn from mistakes that they’ve made, et cetera, et cetera. You know, one of the one of the phrases that I think most of our listeners, you know, will fear that someone will yell at them, is that what you feel is all in your head? And that is just a very quick way of just basically erasing someone, right? Saying that, oh, actually everything that’s important to you, everything that your experience does not matter, it’s a simulation. And yet I think we need to reclaim that in some way. I think just because something is in your head doesn’t mean that it’s unimportant. Just because something is subjective, doesn’t mean that someone doesn’t deserve love and support and therapy and and our attention. You know, I work at the at the VA, so I take care of some of our veterans, which is a great privilege that I have. Think about PTSD, for example, people who have been in war decades ago and their lives are just not the same. So, so, you know, is PTSD all in the head. I mean, tell that to my patients or tell that to us who who deal with it. So I hope that we can get over this idea of mine versus body dualism that, oh, what’s in your mind it only lives in your mind and doesn’t affect your body, or that what lives in your body, you know, doesn’t go what what we’re dealing with is a continuum. And that’s why pain is a fundamental truth because it is right in the middle. It is right in the middle of what’s off your body what’s off your mind. And I think that that’s really what we need to get into is that if we accept that, then we can get over these artificial demarcations and actually get to the business of helping people feel better. That is a goal of medicine. It’s not to treat a blood test, it’s not to treat an X-ray it’s to treat a person. And I think that acknowledging pain as something that exists and that that crosses that sort of artificial boundary might well be the first step in getting there.

Kate: It sounds to like that’s another great argument for why diagnoses feel so important. They have been so important to me for the five years that I had no idea why my arms didn’t work. I it, it left me open to any interpretation which felt which I struggled a lot with embarrassment, with explaining, with trying to get medical leave everything from paperwork to your standing at a party and you have to answer questions. Sounds like one of the great benefits of offering people diagnoses is it’s like it gives us better language for our suffering for like the meaning behind the stories that our bodies are telling us.

Haider: In many ways, a diagnosis is a way of recognition of someone’s suffering that what you’re experiencing is real. And for many patients with chronic pain that that search itself can become so devastating because it might mean more tests, it might mean seeing another doctor, it might mean being humiliated by a receptionist, or it might mean, you know, there’s this endless sort of search that can be so exhausting. I mean, I think about patients, for example, who now have long COVID. Many of these patients, they’re not going to if we keep subjecting them to the same standard that unless we find something that lights up on an MRI scan that you’re not going to be, you’re not going to be a part of this, the party, we’re going to leave a lot of people out in the cold.

Kate: I can think of so many people in my life who are swimming between diagnoses and trying to find language, because if they find language, they can find a treatment. But so much of the experience, at least for me, has been one of of just fear, because it’s not just that I can’t bear the present, I usually can, even if it’s really hard, but it alters my view of the future. It almost, it lies to me and always tells me that this it will be like this forever. How does our experience of the enduringness of pain change not only the present, but our attitude toward the future?

Haider: So pain shrinks your life in a way that few things can. So I remember, you know, before for my injury, I had this full vibrant life and then after it was just I was just stuck to my, my room. I often didn’t have the strength to go to the bathroom. I feel like nothing scared me more than a flight of stairs. And and you know, my my social circle shrank and shrank and shrank until it was just basically just me. And when I looked in the past, I saw someone I didn’t recognize. I saw someone who was too careless who should have been more careful, who shouldn’t have been lifting those weights without having warmed up, or who should have been, you know, who should have appreciated all the health that he had. And when I looked in the future, I didn’t want to look in the future because I felt like I don’t want to look at more of this. But I didn’t see any other way. So I was really stuck not only physically in that sort of space, but also temporarily in that space. And and I don’t know what happened, but I did get better. And there is no there is no miracle at play. There is no surgery that solves things. There is no silver bullet. There wasn’t even a sort of new diagnosis. It was just, I think part of it was love. Part of it was the love of the physical therapists who work with me. It wasn’t the exercises they were doing, but it was the their thoughtfulness and the fact that they made time for me and sometimes they let me stay extra. It was the people around me who cared, who are the ones left over after everyone else had disappeared, who helped me get better. And one of the things that one of the one of the areas of research that I feel is very promising, and again, it might not be for everyone, is this idea of acceptance therapy. And acceptance therapy doesn’t mean that you accept the fact that you are in pain. It doesn’t mean the mean that you shouldn’t seek your diagnosis. It shouldn’t, it doesn’t mean that you shouldn’t seek medical care if you’re not feeling good. But it shifts your focus away from trying to be pain free all the time, but focusing on just living your life with the pain despite the pain. Yeah. And what studies suggest is that people might not always have lower pain intensity, but the things that they can do and their quality of life and the quality of their relationships and their satisfaction with their life does get better. You know, pain just feels like this slippery thing that the more you try and control it, the more you try and overcome it, the more it just keeps growing and growing. Because it because it feeds on attention, it feeds on fear, right? It feeds on this fear. And the more we feed it, the more it grows.

Kate: I love what you’re saying about if you stare at it too directly that it then sort of swells to take up even more space. So like right sizing the relationship of pain in our lives instead of just forcing it to be like a totalizing framework that you’re either in completely in pain or completely out of pain. I think what you’re describing sounds much more like we have a we can accept a more dynamic relationship than with our own bodies and then our own expectations.

Kate: Is accepting pain then part of just maybe our culture? Wouldn’t this be such a great gift is maybe this conversation about pain will help us live more beautifully and more realistically alongside the things we don’t choose, the things we can’t easily solve. It feels like you’re asking us to be maybe a person in a different way.

Haider: It’s tough to tell anyone to feel a certain way, especially about something that you don’t know and you don’t know what they’re going through and you don’t know what they’ve been through, et cetera. But I do think that we have to find a way to live the pain. That way might be different for everyone. That way might be different for me, it might be different for you, but I think at least for now, and I think based on everything I’ve learned through this book and talking to people, I don’t think that either as individuals we’re going to eliminate pain from our lives just because I feel good now. There’s no guarantee that I won’t be in pain tomorrow. One of the things that I do for patients who’ve had chronic pain is I try to separate the fear from pain because that is pain’s ultimate power. And that’s what it wants you to feel. It wants you to be extremely afraid of it. That, oh, if you turn your back a bit more, you’ll break your back and you’ll never walk again. But that fear will stop you from, you know, going to the mall or sitting for five more minutes with your friends or going to that birthday party. But I think once you’ve established that pain is not a threat to you and is not going to make you hurt more, and I think that that’s really important, we need to find a way that we can we can prioritize our what we want to do over it and might not be possible for everyone. It’s the process, and one of the biggest unused resource in all of medicine are pain psychologists. Because they’re not going to fix your pain, but they’re going to find give you a different way of living with pain. That I think is something that if you or have a loved one who is in pain, you need those tools and it doesn’t minimize anyone’s suffering, it doesn’t tell you that what you feel isn’t real, but it just tells you or teaches you a different way of living with pain. Just like how therapy helped so many people in so many ways for so many things that we feel, I think pain is the sort of next frontier we need to accept all the help we can get, no matter where it comes from and what it looks like. Yeah.

Kate: Haider, what a gift. I wish you were my doctor.

Haider: I would have no time for you. I would have no time for you. I’d be harried and between appointments, and I would always tell you you’re late and…

Kate: I have so many problems. I would give them all to you. Thank you so much for doing this with me.

Haider: And it was such a pleasure to be able to talk to you.

Kate: We can feel so trapped, so trapped in the bodies we have, the days we have, the discomfort and ‘what does this mean for the trip I had planned on’ feelings. Whether we can hold the people we want to hold and expand our world. And I know that everyone is going to try to rush for a solution for you for pain. Instead of doing that, let’s just try to see everything we can from where we stand. Let’s bless it, which is to say try to put it in its place even if it’s out of place. So here’s a blessing for if you are in pain and your body feels like the enemy. Blessed are you on this pain-filled day. When getting out of bed seems to be an award worthy triumph. When you can’t remember what it feels like to not be so aware of your own body. When you arrange your weeks around appointments or side effects. Or when you stop telling the truth altogether about how badly it hurts, how scared you are of your own mind or the boring details of another non-diagnosis because you’re afraid people have stopped caring. You speak a language of suffering the world doesn’t try to understand. So blessed are you whose world has shrunk to a space so small it’s defined most by what is no longer possible. You count dear one. And so does your pain. It does not and did not disqualify you from belonging. For the truth of it is that life is painful, and what makes it so is the beautiful and terrible living side by side, our loves and our losses. Bless you loves.

Kate: Oh, before I go, I know you have a zillion things pulling at your attention every week. Our hope is that this podcast offers you just a couple of minutes to be a person. We send out a weekly email to keep you up to date on our latest guests or let you know if I’ll be in a city near you or just to send blessings because we fundamentally believe in blessing the crap out of each other. If that sounds interesting to you. Sign up for free at KateBowler.com/newsletter. It would be an honor to be in your inbox. When you do, you’ll automatically receive a blessing for being human because, well, couldn’t we all just use a little permission to live our regular dumb, beautiful lives? So that’s KateBowler.com/newsletter, and I would love to hear from you. Our team reads all of the little podcast reviews that you leave, and they are really special to us. We love to know what you liked about a certain episode or if there’s a guest you want to hear from. We want to be here for you. So come find us. We review or find me online. I’m at KateCBowler on Twitter and Facebook and Instagram, and all the other places you go to figure out what people from high school are doing. So come find me there. Here’s the part where I get to thank everyone who makes this work at the Everything Happens initiative possible. Lilly Endowment, the Duke Endowment, Duke University, Divinity School and faith and leadership and online learning resource. Thank you for your generous support and my team. Jessica Ritchie. Harriet Putman Gwen Higginbotham, Jessie Broome, Keith Weston, JJ Dickinson, Karen and Gerry Bowler, Jeb and Sami. Your gifts make this work shine. I’m Kate Bowler and this is Everything Happens.