Thomas Farber

Aches and Pains


Dr. Lawrence Levin’s Poems and Essays from an Ordinary Room was published shortly after his death at age sixty-four. In it, he described surgery for a pinched nerve and ensuing hopelessness: years of “rage, rage, resentment, fear and sorrow.” From far too much experience, Levin wrote, “With luck, acute pain is a positive adaptation for our benefit,” danger signals eliciting care. Healing, hopefully, to follow. But, he noted, “Not so with chronic pain.”

Doctors often use the visual analogue scale (VAS) to rate “subjective characteristics,” that is, the immeasurable—what the patient says he feels. Zero to ten, no pain to worst pain ever. As rheumatologist, Levin found patients resented having to respond to the VAS. And/or that as physician he saw no correlation between numbers chosen and visible signs of arthritis.

One day, himself now experiencing chronic pain, “feeling alone, raw with misery and disappointment, and desperately helpless,” Levin composed his own rating scale. By four, he’s at “I don’t like this,” by six, “The intrusion is unrelenting,” by nine, “Dear God. Deliver me from this suffering.” And Dr. Levin’s ten? “I am overcome.”

Virginia Woolf would have understood. In On Being Ill, she wrote, “But let a sufferer try to describe a pain his head  to a doctor and the language at once runs dry. . .He is forced to coin words himself, and, taking his pain in one hand, and a lump of pure sound in the other (as perhaps the people of Babel did in the beginning), so to crush them together that a brand new word in the end drops out.”


“I’m sick and tired,” something else kids used to say. Sick and tired of homework/someone else complaining/having to walk to school in the snow and slush. But not actually sick, not actually tired.

Words that came to mind all these years later when an elderly friend said he was “tired of life.” He didn’t mean any problem in particular, just didn’t want yet another surgery, another hospitalization, no more chronic. . . not even pain, but discomfort.

“Enough already!” from the Yiddish genug shoyn. Think of Leonard Cohen’s “I ache in the places where I used to play.” Wry, self-deprecating. (Cohen died at eighty-two.) Versus kvetching: “complaining, whining.” Petulant grousing. . .

“Quit it!” we also said when I was young. And, “Quit your bellyaching!”

After my knee replacement surgery—amazing, almost superhuman, that a knee could be replaced!—a nurse told me, “You have to learn to live with your aches and pains.” She meant well, but I heard the imperative.

The nurse’s admonition came when I asked for more painkillers. Timing is all: HMOs had discovered opioid abuse with as much authentic surprise as Hollywood discovered sexual harassment. To allay the nurse’s concerns, I explained, “For more than a decade now I don’t drink liquor at all, never drank much anyway; haven’t smoked tobacco in more than four decades; no marijuana since early 1974, no cocaine since the early 1980s (and back then only if free).”

I might at a better moment, or as my better self, have remembered what great care the staff was providing. And that more medical resources were being spent on this one body than on the entire population of some countries. Also, I might have remembered the nurse had her own problems: tough commute, compassion fatigue, marching orders from above. Other patients too much like me. But when she repeated that I had to learn to live with my aches and pains, I started to reply, “Actually, you should learn to live with my aches and pains.” Luckily, the nurse was already speaking over what I was saying, telling me to ask the surgeon.


I was left thinking about the words “aches” and “pains”. To begin with, the nouns are not married to each other. Should be divorced. Or separated forever, like Siamese twins at birth. As for the three-word phrase—aches and pains—two nouns & conjunction, use of it should be prohibited by law. Further, each noun, even employed separately, should ever/only be invoked one ache or one pain at a time. If multiple aches or multiple pains are involved, each should be numbered, sums then totaled.

Doing this, you might get, in the course of one transit of the sun, thirty-two aches & twenty-seven pains. Not to mention that by being legally required to calibrate not just duration but factoring in the VAS number such as it is—that is, the subjectively perceived intensity—one might achieve some idea of what was never conveyed by the formerly legal aches and pains.

This for starters, though of course you have sensations not taken into acount by either word. Twinges, for instance (Old English twengan, “pinch, wring”), such a crunchy monosyllable catching a bit of the hurting. And then there’s grimace. Think grim, the grim reaper. (Grimace: the fear-aggression smile, tightening of lower face muscles women passing you on the sidewalk offer to simultaneously avoid/acknowledge/dismiss. Not that one blames them. . .)

Happy endings? Hydrocodone. My orthopedic surgeon assumed risk of addiction had to be weighed against misery of chronic pain. I was also blessed with a doctor friend who said he’d give assistance if needed. When I told him he was a lifesaver, he replied he couldn’t save anyone, but could try to help.

A thought. There’s that line of Nietzsche’s: “Whatever doesn’t kill you makes you stronger.” People in our positivity-plus nation of victimized complainers say this. May even believe it, unless they offer it wryly, ironically.

Photo by Andrea Young

Thomas Farber has been awarded Guggenheim and, three times, National Endowment fellowships for fiction and creative nonfiction, and been selected a Fulbright Scholar, recipient of the Dorothea Lange-Paul Taylor Prize, and Rockefeller Foundation scholar at Bellagio. His recent books include Here and Gone, The End of My Wits, Brief Nudity, The Beholder, and Acting My Age (forthcoming). Former Visiting Distinguished Writer at the University of Hawai‘i, he teaches at the University of California, Berkeley. “Aches and Pains” is from Acting My Age, the winter 2020 volume of Mānoa: A Pacific Journal of International Writing.