The Challenge of Describing Pain

As Emily Dickinson once wrote, pain places the sufferer in an “infinite” present tense: “It has no future but itself.” In “Pain Has an Element of Blank,” Dickinson captures the absence of words, the failure of description, and the defeat of language that often accompany serious injury or illness. Pain demands the most spontaneous and least composed human expressions: grunts, cries, and pleas for help.

Yet writers persistently strive to articulate the experience of pain. Garth Greenwell is unafraid to depict what often goes unspoken, and his third novel, Small Rain, makes significant progress toward filling in Dickinson’s blank. The novel centers on the sudden onset of debilitating pain amid a life-threatening sickness. With the exception of a brief coda, the story unfolds within what Susan Sontag called “the kingdom of the ill.” For the unnamed protagonist, a writer and teacher, this kingdom is a hospital in Iowa City. He suffers from an infrarenal aortic dissection, where “part of the inner wall of the artery has detached.” The plot involves tracing the cause and prognosis of the disease: Why did it happen? And what will become of the narrator?

Greenwell chronicles, in meticulous detail, the day-to-day care in a hospital: the numerous IV lines, the torturous trips to the bathroom, and consultations with teams of doctors who can’t find a cause or cure. Long descriptive passages follow the narrator as he is wheeled down a hallway or cleaned by his nurse. These sections captivate the reader even in the most clinical moments, resembling what Meghan O’Rourke described as a “close reading” of the medical system.

But Small Rain is not a critique of U.S. health care disguised as a novel. Its power lies in the dissonance between the terrifying condition of waiting for answers and the flights of imagination this purgatory sustains. Confined to and immobilized in his bed, the narrator finds thoughts crowding into the space left blank by the absence of work, errands, and social obligations: poignant memories of meeting his partner, L; traumatic images of the derecho that blows trees down onto their house; and, most unexpectedly, ecstatic reflections on lines of poetry.

In a novel about illness, art might seem beside the point. And yet, the sections that struck with the most force are its meditations on verse. The novel’s title, in fact, is borrowed from a 16th-century poem (written by an anonymous author) that I often teach in my introduction-to-literature class:

Westron wynde, when wilt thou blow

The small rain down can rain

Christ if my love were in my arms

And I in my bed again

The speaker of this poem suffers: enduring the weather, romantic yearning, and whatever else has removed them from contentment. Through rhythmic language, the poem anchors overwhelming, chaotic emotion in the comfort of a contained form. In Small Rain, the narrator also finds himself in extreme privation. Removed from the world of people, work, and life with his loving partner, he becomes—like the troubled voice in the poem—“a minuscule crouching thing, a bit of matter terribly afraid, utterly insignificant.”

Greenwell’s lyrical prose takes a cue from the work that his narrator finds solace in. He shows that pain, no matter how severe, needn’t shut out the possibilities of language. Even the often-ugly experience of physical anguish can elevate and transform human expression.

Throughout Small Rain, a consistency of cadence makes the novel feel cohesive—akin to the recurring motif you might hear in a movement of a symphony. Acts of kindness and moments of mundane bureaucracy are depicted with the same tender attention. In one scene, after a fallen tree is removed from his house and an arborist preserves a ring of it, Greenwell writes, “I thanked her, it was thoughtful of her, a kindness.” Later, when he has to file an insurance claim for the damaged house, the narrator reflects on the “impenetrable language of house insurance or health insurance, language that made my head hurt, that made me feel stupid, I had always just pushed it aside.”

Where another writer might place a period, Greenwell uses a comma, prolonging the sentence a little further than expected. I started to listen for this gentle deviation from speech, this poetic extension of a thought. The rise and fall from comma to comma, the full stop in a period: In the face of uncertainty, of not knowing when the pain will end, Small Rain‘s sentences transform clinical descriptions of a hospital stay into the soothing murmur of a prayer, or the steady sound of rain.

By the novel’s end, the main character is released from the hospital. He goes home to have dinner with L and his sister. In the coda, he visits a nearby dog park, where he sees “pure life” in the heedless glee of romping rescue dogs. This section of the book punctures the cloistered, enclosed space of the single room. However, the resolution isn’t the novel’s main point. We never learn what caused the aortic tear or what it will mean for the narrator’s future, only that he’ll need to return to the hospital for more scans.

In the middle of the book, when his hope for release and recovery is at its lowest, the narrator recalls another poem that reflects his vulnerability in the figure of a small, fragile bird: “Stranger’s Child” by George Oppen. In this short work, Oppen writes about a sparrow, observing it closely in a “cobbled street,” its feet touching “naked rock.” The narrator remembers teaching the poem, urging students to notice how the poet focuses our attention on the bird on the pavement, if only for the time it takes to read the poem. Nothing else, for the moment, exists.

By narrowing its scope to the hospital room, Small Rain focuses on a suffering human being rather than a sparrow. The novel proposes a solution to Dickinson’s dilemma—how to write about pain when pain defies expression? The solution is not stunned silence or inarticulate cries of despair. Instead, the language for pain is that of poetry, which charges words with the force of beauty, turning chaos into consolation.

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