A few years ago, my mom developed rheumatoid arthritis. Her wrists, knees and toes swelled up, causing crippling, chronic pain. She had to file for disability. She stopped attending our local mosque. Some mornings it was too painful for her to brush her teeth. I wanted to help. But I didn't know how. I'm not a doctor.
Prije nekoliko godina, mojoj majci se pojavio reumatoidni artritis. Njena zapešća, koljena i nožni prsti su natekli uzrokujući kroničnu bol. Morala se prijaviti na invalidnost. Morala je prestati odlaziti u lokalnu džamiju. Neka jutra je bilo prebolno čak i prati zube. Želio sam pomoći. Ali nisam znao kako. Nisam liječnik.
So, what I am is a historian of medicine. So I started to research the history of chronic pain. Turns out, UCLA has an entire history of pain collection in their archives. And I found a story -- a fantastic story -- of a man who saved -- rescued -- millions of people from pain; people like my mom. Yet, I had never heard of him. There were no biographies of him, no Hollywood movies. His name was John J. Bonica. But when our story begins, he was better known as Johnny "Bull" Walker.
No, ja sam povjesničar medicine. Tako da sam počeo istraživati povijest kroničnih bolova. Ispada da UCLA ima cijelu kolekciju povijesti bolova u svojim arhivima. I našao sam priču -- fantastičnu priču -- čovjeka koji je spasio milijune ljudi od boli; ljudi kao što je moja majka. Ipak, nikad nisam čuo za njega. O njemu nema biografija, niti Hollywoodskih filmova. Njegovo ime je John J. Bonica. No, u vrijeme kad naša priča počinje, bio je više poznat pod imenom Johnny "Bik" Walker.
It was a summer day in 1941. The circus had just arrived in the tiny town of Brookfield, New York. Spectators flocked to see the wire-walkers, the tramp clowns -- if they were lucky, the human cannonball. They also came to see the strongman, Johnny "Bull" Walker, a brawny bully who'd pin you for a dollar. You know, on that particular day, a voice rang out over the circus P.A. system. They needed a doctor urgently, in the live animal tent. Something had gone wrong with the lion tamer. The climax of his act had gone wrong, and his head was stuck inside the lion's mouth. He was running out of air; the crowd watched in horror as he struggled and then passed out. When the lion finally did relax its jaws, the lion tamer just slumped to the ground, motionless. When he came to a few minutes later, he saw a familiar figure hunched over him. It was Bull Walker. The strongman had given the lion tamer mouth-to-mouth, and saved his life.
To je bio ljetni dan 1941. godine. Cirkus je tek stigao u mali gradić Brookfield, New York. Gledatelji su pohrlili vidjeti hodače po žici, klaunove -- i ako su sretni, ljudsku topovsku kuglu. Također, došli su vidjeti snažnog čovjeka, Johnnyja "Bika" Walker, mišićavog nasilnika koji te prikliješti za dolar. Znate, tog određenog dana, glas se javio preko cirkusog razglasa. Hitno je bio potreban liječnik, u životinjskom šatoru. Nešto je pošlo po zlu sa krotiteljem lavova. Klimaks njegove točke je pošao po zlu, i njegova glava se zaglavila u lavljim ustima. Ponestajalo mu je zraka; rulja je sa užasom gledala kako se mučio i onesvijestio. Kada je lav konačno opustio čeljust, krotitelj je samo pao na tlo, nepomičan. Kada je došao sebi poslije nekoliko minuta, vidio je poznatog lika pogrbljenog nad njim. Bio je to Bik Walker. Snažni čovjek je dao krotitelju umjetno disanje i spasio mu život.
Now, the strongman hadn't told anyone, but he was actually a third-year medical student. He toured with the circus during summers to pay tuition, but kept it a secret to protect his persona. He was supposed to be a brute, a villain -- not a nerdy do-gooder. His medical colleagues didn't know his secret, either. As he put it, "If you were an athlete, you were a dumb dodo." So he didn't tell them about the circus, or about how he wrestled professionally on evenings and weekends. He used a pseudonym like Bull Walker, or later, the Masked Marvel. He even kept it a secret that same year, when he was crowned the Light Heavyweight Champion of the world.
No, snažni čovjek nije nikome rekao, on je zapravo bio student treće godine medicine. Išao je sa cirkusom preko ljeta da plati školarinu, ali je to tajio da bi zaštitio svoj lik. Trebao bi biti zvijer, zločinac -- a ne štreberski dobročinitelj. Njegovi kolege medicinari, također, nisu znali njegovu tajnu. Kako je rekao: "Ako ste bili atletičar, bili ste glupavi dodo." Tako da im nije rekao za cirkus, niti da se bavi profesionalnim hrvanjem navečer i vikendima. Koristio je pseudonime kao Bik Walker, ili kasnije, Maskirani Marvel. Također, držao je u tajnosti te iste godine, da je postao Prvak svijeta u lakoj kategoriji.
Over the years, John J. Bonica lived these parallel lives. He was a wrestler; he was a doctor. He was a heel; he was a hero. He inflicted pain, and he treated it. And he didn’t know it at the time, but over the next five decades, he'd draw on these dueling identities to forge a whole new way to think about pain. It'd change modern medicine so much so, that decades later, Time magazine would call him pain relief's founding father. But that all happened later.
Tijekom godina, John J. Bonica je vodio paralelne živote. Bio je hrvač; bio je liječnik. Bio je podlac; bio je heroj. Nanosio je bol, i liječio ga. Nije znao u to vrijeme, da će u sljedećih pet desetljeća, tijekom ovih dvoboja identiteta skovati potpuno novi način razmišljanja o boli. Promijenit će modernu medicinu toliko, da će ga desetljećima kasnije, časopis Time nazvati ocem lijekova protiv bolova. No to se dogodilo kasnije.
In 1942, Bonica graduated medical school and married Emma, his sweetheart, whom he had met at one of his matches years before. He still wrestled in secret -- he had to. His internship at New York's St. Vincent's Hospital paid nothing. With his championship belt, he wrestled in big-ticket venues, like Madison Square Garden, against big-time opponents, like Everett "The Blonde Bear" Marshall, or three-time world champion, Angelo Savoldi.
1942. godine Bonica je diplomirao medicinu i oženio Emmu, svoju voljenu, koju je sreo na jednoj od utakmica prije par godina. I dalje se bavio hrvanjem u tajnosti -- morao je. Njegovo stažiranje u bolnici Sv. Vincenta u New Yorku nije donosilo zaradu. Sa svojim pojasom prvaka, hrvao se u velikim dvoranama, kao što je Madison Square Garden, protiv značajnih protivnika, kao što je bio Everett "Plavi medvjed" Marshall, ili trostruki svjetski prvak, Angelo Savoldi.
The matches took a toll on his body; he tore hip joints, fractured ribs. One night, The Terrible Turk's big toe scratched a scar like Capone's down the side of his face. The next morning at work, he had to wear a surgical mask to hide it. Twice Bonica showed up to the O.R. with one eye so bruised, he couldn't see out of it. But worst of all were his mangled cauliflower ears. He said they felt like two baseballs on the sides of his head. Pain just kept accumulating in his life.
Utakmice su uzele danak na njegovom tijelu; razderao je kukove, slomio rebra. Jedne noći, palac Užasnog Turka je ostavio ožiljak kao Caponeov na jednoj strani njegovog lica. Sljedeće jutro na poslu je morao nositi kiruršku masku da bi ga sakrio. Dvaput se pojavio na hitnoj sa jednim okom toliko nateknutim, da nije mogao ništa vidjeti. Ali najgore od svega su bile njegove oštećene rascvjetane uši. Rekao je da se osjeća kao da ima dvije bejzbol loptice na svakoj strani glave. Bol se nastavila gomilati u njegovom životu.
Next, he watched his wife go into labor at his hospital. She heaved and pushed, clearly in anguish. Her obstetrician called out to the intern on duty to give her a few drops of ether to ease her pain. But the intern was a young guy, just three weeks on the job -- he was jittery, and in applying the ether, irritated Emma's throat. She vomited and choked, and started to turn blue. Bonica, who was watching all this, pushed the intern out of the way, cleared her airway, and saved his wife and his unborn daughter. At that moment, he decided to devote his life to anesthesiology. Later, he'd even go on to help develop the epidural, for delivering mothers. But before he could focus on obstetrics, Bonica had to report for basic training.
Nakon toga, gledao je svoju ženu kako se porađa u njegovoj bolnici. Nadimala se i gurala, sa očiglednom mukom. Njen opstetričar je pozvao stažista u smjeni da joj da nekoliko kapi etera da joj ublaži bol. No, stažist je bio mlad čovjek, samo tri tjedna na poslu -- bio je nervozan i dok joj je davao eter, iritirao joj je grlo. Ona se ispovračala i počela gušiti, a lice joj je krenulo plaviti. Bonica, koji je sve ovo gledao, ga je odgurnuo sa strane, raščistio joj dišni put, i spasio svoju ženu i svoje nerođeno dijete. U tom trenutku je odlučio posvetiti život anesteziologiji. Kasnije, otišao je još dalje razvijajući epiduralnu za porođaje. No, prije nego što se mogao fokusirati na opstetriku, morao se prijaviti za temeljni trening.
Right around D-Day, Bonica showed up to Madigan Army Medical Center, near Tacoma. At 7,700 beds, it was one of the largest army hospitals in America. Bonica was in charge of all pain control there. He was only 27. Treating so many patients, Bonica started noticing cases that contradicted everything he had learned. Pain was supposed to be a kind of alarm bell -- in a good way -- a body's way of signaling an injury, like a broken arm. But in some cases, like after a patient had a leg amputated, that patient might still complain of pain in that nonexistent leg. But if the injury had been treated, why would the alarm bell keep ringing? There were other cases in which there was no evidence of an injury whatsoever, and yet, still the patient hurt.
U vrijeme dana D, Bonica se pojavio u Vojni bolnički centar Madigan blizu Tacome. Sa svojih 7700 kreveta, bila je to jedna od najvećih vojnih bolnica u Americi. Bonica je ondje bio zadužen za kontrolu boli. Imao je samo 27 godina. Liječeći toliko pacijenata, Bonica je primjetio slučajeve koji se protive svemu što je naučio. Bol bi trebala biti nešto kao alarm -- na dobar način -- način da tijelo signalizira ozljedu, kao što je slomljena ruka. No, u nekim slučajevima, kao kada su pacijentu amputirali nogu, taj pacijent se i dalje žalio na bol u nepostojećoj nozi. No, ako je ozlijeda izliječena, zašto alarm nastavlja zvoniti? Bilo je drugih slučajeva, gdje uopće nije bilo dokaza o ikakvoj ozlijedi, ali ipak, pacijenta je boljelo.
Bonica tracked down all the specialists at his hospital -- surgeons, neurologists, psychiatrists, others. And he tried to get their opinions on his patients. It took too long, so he started organizing group meetings over lunch. It would be like a tag team of specialists going up against the patient's pain. No one had ever focused on pain this way before.
Boncia je potražio sve specijaliste u svojoj bolnici -- kirurge, neurologe, psihijatre i ostale. Pokušao je dobiti njihova mišljenja o svojim pacijentima. Potrajalo je, no počeo je organizirati grupne sastanke tijekom ručka. Bila je to ekipa specijalista koja se bori protiv boli pacijenata. Nitko se dosad nije usredotočio na bol na ovaj način.
After that, he hit the books. He read every medical textbook he could get his hands on, carefully noting every mention of the word "pain." Out of the 14,000 pages he read, the word "pain" was on 17 and a half of them. Seventeen and a half. For the most basic, most common, most frustrating part of being a patient. Bonica was shocked -- I'm quoting him, he said, "What the hell kind of conclusion can you come to there? The most important thing from the patient's perspective, they don't talk about."
Nakon toga, potražio je knjige. Pročitao je svaki medicinski udžbenik kojeg se mogao dočepati, pažljivo zapisujući svaki spomen riječi "bol". Od 14000 stranica koje je pročitao, riječ "bol" se pojavila u 17 i pol. Sedamnaest i pol. Za temeljni, najučestaliji, najfrustrirajući dio bivanja pacijentom. Bonica je bio šokiran -- citiram ga, rekao je, "Do kojeg, dovraga, zaključka da ovdje dođeš? O najvažnijoj stvari sa gledišta pacijenta, oni ni ne pričaju."
So over the next eight years, Bonica would talk about it. He'd write about it; he'd write those missing pages. He wrote what would later be known as the Bible of Pain. In it he proposed new strategies, new treatments using nerve-block injections. He proposed a new institution, the Pain Clinic, based on those lunchtime meetings. But the most important thing about his book was that it was kind of an emotional alarm bell for medicine. A desperate plea to doctors to take pain seriously in patients' lives. He recast the very purpose of medicine. The goal wasn't to make patients better; it was to make patients feel better. He pushed his pain agenda for decades, before it finally took hold in the mid-'70s. Hundreds of pain clinics sprung up all over the world.
Tako da je tijekom sljedećih osam godina Bonica pričao o tome. Pisao je o tome; napisao je te stranice koje nedostaju. Napisao je ono što je kasnije postalo poznato kao Biblija boli. Tu predlaže nove strategije, nove postupke korištenjem injekcija za blokadu živaca. Predlaže novu ustanovu, kliniku boli, na temelju tih sastanaka za ručak. No, najvažnija stvar o njegovoj knjizi je što je ona predstavljala neku vrstu emocionalnog alarma za medicinu. Očajnička molba liječnicima da shvate bol ozbiljno u pacijentovom životu. Preinačio je samu svrhu medicinu. Cilj nije bio da pacijentima bude bolje; nego da se pacijenti osjećaju bolje. Gurao je svoj plan desetljećima, dok se napokon nije primio sredinom '70-tih godina. Stotine klinika za bol su iznikle diljem svijeta.
But as they did -- a tragic twist. Bonica's years of wrestling caught up to him. He had been out of the ring for over 20 years, but those 1,500 professional bouts had left a mark on his body. Still in his mid-50s, he suffered severe osteoarthritis. Over the next 20 years he'd have 22 surgeries, including four spine operations, and hip replacement after hip replacement. He could barely raise his arm, turn his neck. He needed aluminum crutches to walk. His friends and former students became his doctors. One recalled that he probably had more nerve-block injections than anyone else on the planet. Already a workaholic, he worked even more -- 15- to 18-hour days. Healing others became more than just his job, it was his own most effective form of relief. "If I wasn't as busy as I am," he told a reporter at the time, "I would be a completely disabled guy."
No, kako se to dogodilo -- tragični preokret. Godine hrvanja su sustigle Bonicu. Bio je izvan ringa preko 20 godina, ali je tih 1500 profesionalnih nastupa ostavilo traga na njegovom tijelu. U srednjim 50-tima, obolio je od osteoartritisa. Tijekom sljedećih 20 godina imao je 22 operacije, uključujući četiri operacije kralješnice, i zamjenu kuka za zamjenom kuka. Jedva je mogao podići ruku, okrenuti vrat. Hodao je pomoću aluminijskih štaka. Prijatelji i bivši studenti su postali njegovi liječnici. Jedan se sjeća da je Bonica primio vjerojatno više injekcija za blokadu živaca nego itko drugi na planeti. Iako je već bio radoholičar, radio je još više -- 15 do 18 sati dnevno. Liječenje drugih je postalo više od samog posla za njega, postalo je najučinkovitiji oblik olakšanja. "Da nisam toliko zaposlen," jednom je rekao novinaru, "bio bih potpuno onesposobljen čovjek."
On a business trip to Florida in the early 1980s, Bonica got a former student to drive him to the Hyde Park area in Tampa. They drove past palm trees and pulled up to an old mansion, with giant silver howitzer cannons hidden in the garage. The house belonged to the Zacchini family, who were something like American circus royalty. Decades earlier, Bonica had watched them, clad in silver jumpsuits and goggles, doing the act they pioneered -- the Human Cannonball. But now they were like him: retired. That generation is all dead now, including Bonica, so there's no way to know exactly what they said that day. But still, I love imagining it. The strongman and the human cannonballs reunited, showing off old scars, and new ones. Maybe Bonica gave them medical advice. Maybe he told them what he later said in an oral history, which is that his time in the circus and wrestling deeply molded his life.
Na poslovnom putu u Floridu na početku 1980-tih, bivši student je vozio Bonicu u Hyde park u Tampi. Prolazili su pored palmi i stali ispred stare palače, sa ogromnim srebrnim topovima sakrivenim u garaži. Kuća je pripadala Zacchini obitelji, koji su predstavljali nešto kao američko cirkusko plemstvo. Desetljećima ranije, Bonica ih je gledao, odjevene u srebrne kombinezone i zaštitne naočale, kako izvode točku koju su izmislili -- Ljudsku topovsku kuglu. No, sada su bili kao i on: u mirovini. Ta generacija je danas mrtva, uključujući Bonicu, tako da ne znamo točno o čemu su pričali taj dan. No ipak, volim zamišljati. Snažni čovjek i ljudske topovske kugle ponovno na okupu, uspoređuju stare ožiljke, i nove. Možda im je Bonica dao koji liječnički savjet. Možda im je ispričao ono što je kasnije rekao usmenom predajom, kako mu je vrijeme u cirkusu i hrvanju duboko oblikovalo život.
Bonica saw pain close up. He felt it. He lived it. And it made it impossible for him to ignore in others. Out of that empathy, he spun a whole new field, played a major role in getting medicine to acknowledge pain in and of itself.
Bonica je iskusio bol iz prve ruke. Osjetio ju je. Živio ju je. A to je onemogućilo da ju zanemari kod drugih ljudi. Iz empatije, razvio je cijelo novo polje, igrao veliku ulogu da medicinska struka prizna bol samu po sebi.
In that same oral history, Bonica claimed that pain is the most complex human experience. That it involves your past life, your current life, your interactions, your family. That was definitely true for Bonica.
U toj istoj usmenoj predaji, Bonica je tvrdio da je bol najsloženije ljudsko iskustvo. To uključuje tvoj bivši život, tvoj trenutni život, tvoje interakcije, tvoju obitelj. To je definitivno bilo istinito za Bonicu.
But it was also true for my mom. It's easy for doctors to see my mom as a kind of professional patient, a woman who just spends her days in waiting rooms. Sometimes I get stuck seeing her that same way. But as I saw Bonica's pain -- a testament to his fully lived life -- I started to remember all the things that my mom's pain holds. Before they got swollen and arthritic, my mom's fingers clacked away in the hospital H.R. department where she worked. They folded samosas for our entire mosque. When I was a kid, they cut my hair, wiped my nose, tied my shoes.
Ali je bilo istinito i za moju majku. Lako je doktorima da vide moju majku kao neku vrstu profesionalnog pacijenta, ženu koja svoje dane provodi po čekaonicama. Ponekad ju i ja vidim na taj način. No, kako sam vidio Bonicinu bol -- ostavštinu njegovog ispunjenog života -- počeo sam se prisjećati svih stvari koje bol moje majke obuhvaća. Prije nego su natekli i postali artritični, prsti moje majke su tipkali u bolnici na odjelu za ljudske resurse gdje je radila. Savijali su samosu za cijelu džamiju. Kada sam bio dijete, šišali su mi kosu, brisali nos, vezali vezice na cipelama.
Thank you.
Hvala vam!
(Applause)
(Pljesak)