The Privacy of Pain: On Garth Greenwell’s “Small Rain”

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Garth Greenwell | Small Rain | Farrar, Straus and Giroux | September 2024 | 320 Pages

Pain is a quintessentially private experience. Emotions, sensations, and ideas are often hard to put into words, but suffering is notoriously difficult to articulate—a problem compounded by the urgency of doing so. If you feel a pain in your chest, do not wait to share that information until you’ve determined whether “stabbing” or “pulsing” is a better descriptor.

The narrator-protagonist of Garth Greenwell’s Small Rain, a poet living in Iowa, has built his career on the subtle differences between words. At the start of the novel, though, he experiences a sudden, violent pain in his stomach and abdomen. Wary of hospitals—it’s the first COVID summer—he curls up on his office floor for half a day until the pain lessens. “I became a thing without words in those hours,” he says. His partner, L, comes to check on him: “I told him I was sick, it was the most I could manage […] Pain had sealed me off from sociability.” A few days later, he finally goes to the hospital, but the additional time for reflection has made his condition no easier to articulate. “They asked me to describe the pain but the pain defied description, on a scale of one to ten it demanded a different scale. It was like someone had plunged a hand into my gut and grabbed hold and yanked, trying to turn me inside out and failing and trying again. Like that, while somebody else kneed me in the groin.”

Why is pain so hard to describe? Of course, there’s the obvious issue: it monopolizes any brain space that might have been used to cultivate apt metaphors and precise descriptions. But even Greenwell’s well-wrought sentences—more vivid than most—leave the sensation out of reach. I have only the roughest guess (thankfully!) at what a hand plunged into my gut would feel like. 

The philosopher Elaine Scarry suggests that suffering’s resistance to language is more than a side effect. In The Body in Pain, she argues that the difficulty is intrinsic to suffering itself. The very fact that you are suffering means you are experiencing something unavailable to others. Physical pain, Scarry writes, “bring[s] about […] this absolute split between one’s sense of one’s own reality and the reality of other persons.”  It is at once irrefutable—for the person experiencing it—and unverifiable, for anyone else. Pain is inescapably one’s own.

Greenwell’s protagonist is keenly aware of this fact. He feels it not only as a patient—“There was a great gulf and I was on one side of it alone,”  he says—but as a witness to others’ pain. In the ER waiting room, he can hardly keep himself from a kind of voyeurism, observing the other patients and wondering about their suffering. “There was something terrible about watching the people around me, terrible and irresistible, I wanted to see into their lives but I had no right to; it was an intrusion, like looking into the lit windows of houses at night, which is something else I can’t resist.” 

Greenwell’s readers are likely to recognize themselves in this description. Small Rain glues us, terribly and irresistibly, to the story of the narrator’s own condition. Will he survive? Will the doctors figure out what caused the pain, and why? The narrator is soon transferred to the ICU, where we learn he has a rare aortic condition. Most people don’t survive damage to the aorta—but healthy people in their forties don’t usually experience such damage in the first place. “The big mystery is why this happened to you,”  a doctor tells him.

For the medical staff, that mystery is riveting. “Things are going to get busy quick, everyone wants to see you,” a nurse says. “You’ve got them all excited.” Nurses, technicians, young doctors, and older supervisors parade through his room, performing tests, hooking up IVs, or merely satisfying their inquisitiveness: one physician conducts an ultrasound on him before confessing that “he wasn’t part of my team, he was just curious to see such an interesting case.”

The medical mystery is compelling, even as the protagonist chafes at being seen this way. In one conversation, he reveals a piece of his medical history that he hadn’t shared with earlier doctors. The effect is tantalizing: is this the key to the puzzle? For the novel’s readers, as for its physicians, the hunt for medical knowledge does the reassuring work of replacing an unavailable experience with what we can observe and classify. Scarry points out that descriptions of pain—stabbing, drilling, burning—often imply cause (a knife, a drill, a flame), which suggests that learning the actual cause might make the pain more comprehensible, more communicable. Indeed, when he receives his initial diagnosis, the narrator feels his situation crystallize. It’s not a term he understands, but now it becomes possible to talk about it concretely; his condition itself seems to become concrete.

But this accumulation of medical knowledge still leaves something out of reach. Even after his physicians have identified the physiology that produced his suffering, there remains a disconnect between the narrator and most of the medical staff. Medical insight has little bearing on the extent to which these doctors enter into their patient’s experience. When the doctor who performs the ultrasound locates the tiny tear that caused the narrator’s pain, he points it out to a pair of younger doctors and barely speaks to the protagonist. Scarry attributes this sort of disconnect to the privacy of pain: despite the fact that the narrator’s condition can be named and thus communicated, he is the only one who can feel the pain that condition entails. His experience of it fundamentally cannot be shared by anyone else.

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But perhaps this emphasis on physiological experience misses the point. According to the philosopher Stanley Cavell, the ability to fathom someone’s physical sensations doesn’t actually produce the kind of connection we’re after. Cavell imagines a case where a person really does feel exactly what someone else is experiencing: First sprains his ankle and Second also feels the twist; First is hungry and Second’s stomach also feels like an empty knot. The hypothetical Second certainly knows First’s pain. But Second only knows that pain because it has become his own. His feat is not empathetic so much as telepathic.

Cavell suggests that “knowing someone’s pain” does not depend on information successfully gleaned. Instead, it’s a function of our response to the person in pain—what Cavell calls acknowledgment. “Acknowledgment goes beyond knowledge,” he writes, “in its requirement that I do something or reveal something on the basis of that knowledge.” For instance, saying “I know I am late” or “I know I am a nuisance” does not simply report a fact. It acknowledges the situation: confessing, admitting to it. Saying “I know your pain” operates similarly. It is not an expression of certainty but of sympathy.

Pain comes between us, not in the form of an unbridgeable divide, but as a question hanging in the air. “Your suffering makes a claim upon me,” Cavell writes. Like a conversational move, suffering takes place in a register of acknowledgment: it calls for response. It’s not enough to understand someone’s physiological experience—and it’s also not quite the point. “To know you are in pain is to acknowledge it, or to withhold the acknowledgment.” 

It is this acknowledgment that is most at stake in Small Rain. Despite the medical mystery that propels the story, the novel is much more concerned with a deeper set of questions: What does it mean to share in another’s pain? And to what extent does our care for others depend on understanding their suffering?

I have a friend who worked as a doula both before and after having children. “It must be easier to support people giving birth now that you’ve done it yourself,” I suggested once. “Actually, the opposite,” she said. Before she had experienced labor herself, she was entirely focused on the verbal and physical cues that would help her understand what the birthing person needed. Afterward, she had to work very hard not to assume she knew what they were going through.

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In hospital settings, the term “quality of care” functions as shorthand for how effective the hospital’s services are, as determined by a variety of metrics: readmission rates, patient satisfaction, average length of stay. But Small Rain is attuned to “quality of care” as the kind of care on offer—that is, the texture of it. Nurses are “quick, skilled,” “gruff,” or “brisk and confident;” “one mov[es] slowly, methodically,” while another delivers shots “bluntly” with a “jabbing” motion: “She was nervous, I thought, she held herself rigid like a dancer or a cadet.”

These subtleties of tone and movement have a profound effect on the narrator’s experience. When a nurse gently rubs his ankle during a painful exam, he realizes that “she was the first person here who had touched me in a way that had no medical purpose, no measurable end but comfort […] I responded out of all proportion, I felt I loved her for that touch.” A nurse practitioner, conducting an intake exam, notices old scars on the narrator’s forearm. “She paused, but just briefly, she didn’t say a word,” the narrator says. “I liked her, I decided.” Both respond to the narrator’s experience with Cavellian acknowledgment: attending to it, allowing it to shape their actions. Like the distinction between perceiving someone and making eye contact, these moments of care offer a kind of reciprocity for what they witness.

Not all encounters are so successful. When the narrator’s blood pressure rises unexpectedly, possibly due to a lapse in communication, the head nurse’s reassurance misses the mark. “I know you’re concerned but these hiccups are normal, it’s important not to overreact,” she says. The narrator “bristled at her tone, which was paternalistic, condescending.” But her response also lacks a certain specificity, an attentiveness to the narrator’s distinct situation. That failure echoes the earlier lapse, when the weekend nurse assumed his target blood pressure was the same as that of other patients and became “decidedly hostile” when he says otherwise. The narrator’s primary issue is with the lapse in medical care, not the tone of the nursing staff. But it’s not clear that the two are separable.

The narrator forms his closest hospital relationship with an ICU nurse named Alivia. She cares for him with what the narrator calls “little graces”: easing the sting of his shots by pinching the skin first; wiping down his body with deft efficiency. “She had a way of working that took my self-consciousness away,” the narrator reports; “her own lack of embarrassment helped cancel what might have been shame.” She makes him feel like a human, not a conundrum or logistical task. “I loved that she was talking to me like a real person,” he thinks.

But Alivia, like the rest of the care team, offers these kindnesses in her capacity as a medical professional. What to make of care that is bounded in this way? Can it count as genuine in the same way as care offered outside of professional obligation? When the narrator feels a rapport with a rainbow-pinned rheumatologist—“everyone else had seemed so relentlessly heterosexual” —he reflects on the peculiar cast that her profession lends their interaction. “I wondered if the tone was sincere, the manner she had of making me feel that what happened to me mattered to her, my outcome; I wondered if it was real or merely an act, a way of navigating or enduring the day. I was nothing to her, really, I was her job, she would clock out and enter her real life, which had nothing to do with me.”

Identifying “real life” feels newly urgent to the narrator since his hospitalization. Without medical knowledge of his own, it’s difficult to tell whether his doctors are sugar-coating his situation, protecting him from its harshest implications. “It was a relief to have the unvarnished truth,” he says of one doctor’s frank assessment. But how do kindness and connection fit into the picture? Are they part of the reality the narrator now inhabits—or merely varnish on a bleak situation?

In one sense, the answer doesn’t matter: “I was grateful to her anyway, whether it was real or not, I was grateful for her kindness even if it was a performance.” But it’s also possible that the question itself gets something wrong. “They weren’t the right categories, I knew, sincere or performed, they didn’t pertain exactly, they weren’t proper to her office,” the narrator says.

There’s a Cavellian ring to these unsettled categories. Just as physiological information misses the point in understanding another’s pain, distinguishing between “real” and “performed” care misses something about how care actually happens. It is, fundamentally, performed—something one does, an answer to another. A person might describe false feelings (“I care so much about you!” through a plastered smile) but the act of acknowledging someone, recognizing them in all their specificity, precludes falseness. One cannot pretend to make eye contact.

Greenwell offers a way to recognize the significance of care expressed within professional boundaries. The narrator remembers the high school students he used to teach: “I thought about […] how important it had been to let go of a certain understanding of sincerity,” he says, “how important it had been to learn to leave my feeling for my students in the classroom, to mark some separation from the rest of my life; and how that didn’t invalidate what I felt but demarcated it, it set a boundary that made it finite but didn’t make it unreal.” Small Rain insists on the value of this bounded care. The novel proposes a form of connection dependent not on factual knowledge, private feeling, or even enduring commitment, but the ability to see and respond to one another.

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Small Rain is a study in acknowledgment: a redirection toward relationship over information. “To recognize another,” the narrator hypothesizes, “means to imagine them in relation, to conjure for every stranger the stranger to whom they are dear.” These relational webs act as a source of meaning and wonder for the narrator, for mundane objects no less than profound ones. After a week without solid food, his awe at a potato chip—the way that engineering, farming, and cultural production collude to produce such a precisely calibrated pleasure—at once evokes the French sociologist Bruno Latour on actor-network theory and Meryl Streep’s speech in The Devil Wears Prada: “That blue represents millions of dollars and countless jobs.”

Greenwell’s beautifully meandering sentence structure creates its own webs of connection. The approach recalls Virginia Woolf’s depiction of consciousness, the way that distinct ideas cohabitate within a single stream of thought. In one scene, a doctor examines the narrator’s torso, a process that involves applying pressure to his already-aching body. The doctor shares a last name with the narrator’s favorite soprano, leading him to recall an aria of hers in detail—a reminiscence interrupted periodically by the discomfort of the exam. These shifts in topic recast his musical descriptions with particular poignancy: focusing on the soprano’s voice offers a way to cope with physical discomfort. His recollections are part of the experience, not a sidebar to it. 

Greenwell’s interweaving threads foreground the relationality at the heart of the novel: meaning as grounded in the links between people, between ideas. As the protagonist mulls over questions of existence from his hospital bed, he finds that these transcendent topics are inextricable from ordinary life, in a banal way (“I realized how crucial to humanness that was, too, being able to shit”) as much as a beautiful one. He describes the home he shares with L as “full of little graces that were L’s graces: flowers in vases, a yellow teapot.”  He delights in a pair of sparrows outside his hospital window, “They were wonderful, really, commonness didn’t cancel wonder, or I didn’t see why it should, not all the time.” 

Instead of pursuing full comprehension, grand truths, or deep certainties, Small Rain reorients us to the ordinary, the material, and the temporary. The narrator’s poetry students—like his doctors—treat their subject as “a puzzle they could solve, a treasure hunt.” The narrator invites them to instead relish its indeterminacy. “Isn’t the poem more beautiful for it, for the difficulty, for the way we can’t quite make sense of it, settled sense, I mean, for how it won’t stay still; isn’t the non-sense what makes it bottomless, what lets us pour and pour our attention into it.”

It would be a stretch to say that the narrator finds his medical situation more beautiful for its unsettledness. But the deeper questions raised by his hospital stay—the value of a life and how best to live it—resist definitive answers, and the narrator’s approach to poetry offers a way to inhabit that existential indeterminacy. His reflections exhibit a tentative quality that attests to the indecipherable complexities in one another and the world around us. “Maybe there are only ever provisional truths,” he says, “about the big questions I mean, the questions about how to live, maybe only competing truths, and maybe that isn’t the same thing as no truths at all, maybe we have to take them as they come.” Small Rain finds truths that are makeshift and ordinary, but no less meaningful for it.

In this respect, the novel recalls the final pages of Woolf’s To the Lighthouse, when the painter Lily Briscoe reflects on life, death, and meaning:

The great revelation had never come. The great revelation perhaps never did come. Instead there were little daily miracles, illuminations, matches struck unexpectedly in the dark […] One wanted, she thought, dipping her brush deliberately, to be on a level with ordinary experience, to feel simply that’s a chair, that’s a table, and yet at the same time, It’s a miracle, it’s an ecstasy.

Small Rain offers moments of meaning and connection as “matches struck unexpectedly in the dark”: irrefutably real; profoundly significant; and yet grounded in the everyday ordinary of small acts of care.

Small Rain’s close attention to the provisional and bounded—the awe the novel finds in particularities held in relation—chimes with the narrator’s approach to poetry. But it’s also a way of describing the work of the novel itself. It suggests a way of thinking about the care within its pages, the characters’ acts of attention and readers’ own in turn.

The philosopher Kendall Walton has described fiction as make-believe: we know the characters are invented, but we imagine them to be real. He argues that our emotional responses operate in much the same way. Just as the story is fictitious, so too are the feelings they elicit. Otherwise we would lock all our doors in fear of Grendel’s rage; we would spurn potential suitors out of yearning for Edward Rochester or Isabel Archer. Like fiction itself, Walton says, our emotional responses are a form of make-believe. Pretend characters inspire pretend feelings.

But Small Rain argues that bounded care is still care. In fact, these limits sharpen our ability to pay close attention. “That’s the power of a frame,” the narrator tells his poetry students: 

To take a bit of the world, a person or a sparrow, to make a boundary within which we can establish that relation that is the only acceptable relation, in which we can see all that there is to see and feel all that there is to feel, which is what makes me think that the disciplined attention of art is a moral discipline, even when the content of that morality isn’t obvious, in the way Cézanne paints an apple, say, or the bowl that gathers the apples, the hundreds of strokes he makes, each an act of seeing, a judgment, each an attempt to activate in us that awareness we nearly always shut down.

In Small Rain, the shortcomings of facts and knowledge make space for attention and acknowledgment. The novel begins with a medical mystery: what is wrong with the narrator, and what will happen to him? But the mystery changes shape as the novel redirects us to questions that are at once bigger and smaller. What makes life meaningful? Why do potato chips taste so good? The novel’s moments of transcendence emerge most clearly in its close attention to the mundane, in the very recognition of the mundane as inextricable from the value of life, and of relationship.

I think of my doula friend, giving birth to her second baby in our shared Oakland apartment on a warm spring night. I remember the inwardness of her work, how none of us—not her husband, not her midwife, much less I—could join in the labor. It was hers, irreducibly hers. When it was time to push, she lay on her side on a yoga mat with her husband behind her to catch the baby. “We need someone to hold her leg,” the midwife said. My friend said my name, and it felt like a gift—the gift of a way to help. I sat in front of her, her leg in my hands. The amniotic sac was still intact, like a small balloon, but on the third push it finally broke, splashing onto my skin as the baby emerged into her father’s waiting arms.

Every single person is born, and she was also born, red and flecked with white cream: the most miraculous ordinary. I gently lowered the leg and covered my friend’s shaking goosebumpy arms.