Ingenious Pain tells the life story of James Dyer, a surgeon in eighteenth-century England who is gifted--and cursed--with the inability to feel physical or emotional pain. Beginning with his postmortem, the novel traces the thirty-three years of his life, from his illegitimate conception on a frozen river, through the rise of his career from itinerant quack's assistant to ship's surgeon, and then to the court of Empress Catherine of Russia where he meets Mary, a mysterious woman who performs magical surgery on him with her hands, enabling him for the first time to feel and, as a result, to love.

At first this new ability drives him mad, and he is submitted to the infamous torments of Bethlehem Hospital. He gradually recovers, but his new sensitivity has disrupted his identity as a surgeon. He performs one last operation, saving the life of a Negro wrestler by opening his chest and massaging his heart. His own death, not long after, seems to signify that he has at last become a normal man, and this is a form of redemption.


The novel is most fascinating in its characterization of Dyer as the stereotypical surgeon, a study in clinical detachment taken to its logical and self-destructive conclusion--he is a superbly efficient but unfeeling machine, performing amputations, cesarean sections, and even brain surgery, in record time, with little or no care for the patient--and in his learning to be a normal man, one capable of empathy and thus of suffering. The consequences of Dyer's emotional and physical numbness and the excruciating torments and pleasures he experiences when he finally begins to feel are presented in fascinating detail.

His inability to suffer is manifested in his failure to appreciate stories, and the understanding of narrative is presented as central to suffering and to being fully human: "In pain he discovers his history." (p. 262) His rehabilitation is ironically and movingly marked by his playing the role of Bottom in a bedlam production of Shakespeare's Midsummer Night's Dream. He falls in love with Titania.

The story is partly told in the letters of the Reverend Julius Lestrade, Dyer's patient and rescuer. Lestrade's narration creates a convincing sense of the novel's eighteenth-century setting, crucial to this exploration of the consequences, particularly for the practice of medicine, of the Enlightenment's (and our own) tendency to privilege reason over feeling.


This novel won the Impac Dublin Literary Award (May, 1999).


Harcourt Brace

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