Editorial Assistant Will Brooks talks with David Rompf about his essay, “Pain Points,” featured in the Summer 2026 issue of Colorado Review.
David Rompf has contributed to The New Yorker, The New York Times, Harvard Review, The Common, The Missouri Review, and many other magazines and newspapers. Several of his essays have been selected as “Notable Essays and Literary Nonfiction” in Best American Essays and Best American Travel Writing.
Will Brooks: You open the essay with the familiar medical question: “How would you rate your pain today from zero to ten?” At what point did that question begin to feel like the center of an essay rather than just another frustrating part of a doctor’s visit?
David Rompf: I began thinking about an essay almost immediately because that question instantly led to other questions: How do I choose a static number when pain is erratically fluctuating even as I sat in the doctor’s office? Do I rate each of the bodily pains I’m experiencing separately? What does any number mean in the context of relative pain? Often my impulse to write begins with a question that triggers a cascade of more questions, creating momentum for the writing. In law school, I was exposed to heavy doses of the Socratic method, which uses persistent questioning to arrive at a deeper understanding of an issue and, as some would say, of the “truth.” Although I don’t practice law, the training has stayed with me. As soon as I was asked to rate my pain, which still strikes me as a strange proposition, I began taking mental notes and the written notes soon followed. I didn’t know what the shape of the essay would look like and where the writing would lead. Chekhov said that the role of a writer is to ask questions, not answer them. I think that’s a valuable insight, though often I want to quibble with him on this point. As an essayist and occasional journalist, I’m inclined to attempt some answers.
WB: Early in the essay you write: “We want numbers before narratives, scales before stories.” This idea seems to expand beyond medicine into a critique of modern culture. When you were writing, did you see the essay as primarily about pain, or did you see that connection about our broader cultural obsession with measurement beforehand?
DR: Physical pain was the impetus for writing but from the beginning I wanted to explore the tendrils connecting to the broader cultural context. Measurement, rankings, and ratings have interested me for a long time. On one level, there are obviously practical and important purposes for measurement. But we live in a world now saturated with compulsive measurement and rankings. I worry that we’ve acquiesced and have become numb to the phenomena and fail to question the validity and subjectivity of some forms of assessment. This is one reason why I don’t like the explosion of year-end “best of” lists that start coming out every November. Top ten books, top ten movies, top ten podcasts, and on and on. Media has seized on and compounded our craving for ranked assessments of nearly every aspect of our lives. We now see future-oriented rankings: the top twenty-five destinations to visit in the new year and the ten most anticipated books coming out this month. How does anyone measure anticipation, by the way? Surveys exist for just about everything now, so I can imagine one that asks responders to rank their anticipation. I confess to looking at many of those lists and rankings, but I also find myself arguing with them. Humans are often overwhelmed by the amount of information, data, choices, and inputs from the digital realm. Relying on highly distilled measurements might be the only way to cope with this bombardment. As an experiment to test my theory about the preference for numbers over narratives, I’ve answered several customer service surveys—the kind you receive in an email, text, or pop-up screen—by stating in the comments field that the company should contact me so that I can describe the specific reasons for my giving a one-star or otherwise low-ranked rating. I provided my phone number and email address and mentioned that there were a few small changes they could make in the way they’re doing business and that I’d be happy to spend some time speaking to someone about these. Naïve to think that anyone would respond? Absolutely. Not one of them did. They wanted that number. Or perhaps they were only equipped, technologically, to receive a numerical response. Even with AI’s ability to “read” narrative comments, I doubt there’s a corporate appetite for spending money to personally follow-up with every customer who wants to offer a story about their experience. I’d be happy to be proven wrong about that.
WB: At one point you describe the pain as “a mighty beast spitting fireballs through my flesh.” Throughout the essay there’s an interesting tension between this kind of visceral metaphor and the clinical language of pain scales and medical forms. How conscious were you of juxtaposing those two ways of describing pain?
DR: I was very conscious of the tension between the abutting languages of pain because, as a writer and as a patient, I was regularly thrust into the intersection of them. I think most people seeking medical treatment experience similar moments of expressive collision. A person who says, “it hurts like hell” or “this pain is torture”—vivid metaphors to describe a symptom—will be asked in the doctor’s office: “Can you rate the pain on a scale of zero to ten?” Which gets back to the preference, in some arenas, for a number over a narrative. On a daily basis, I never thought, “oh, my pain is a seven” or “this pain is now impacting my quality of life.” I thought instead, “that felt like a white-hot dagger stabbing my back.” There’s a fairly recent trend to train health care professionals in narrative medicine, a concept pioneered by Rita Charon at Columbia University’s School of Medicine. She’s a physician who also has a Ph.D. in English. With the help of a grant from the National Endowment for the Humanities, she launched a program in narrative medicine, which aims to help clinicians listen carefully to their patients’ stories and the language and metaphors used to tell them. It’s a meeting of medical and literary minds, and it promotes a holistic, expansive—rather than reductive—approach to understanding illness and suffering.
WB: The essay moves through Buddhist philosophy, Stoicism, and writers like Augustine and Cicero. How did those philosophical traditions shape your thinking while writing the essay? Did those references enter the piece early in the drafting process, or did they emerge later as a way to widen the essay’s frame?
DR: Since I was already familiar with Buddhism through study and meditation, and from living in the blend of Buddhist and Shinto culture of Japan, its teachings about suffering were always top-of-mind, from the onslaught of pain to the first notes. Before and during the writing, I was obsessed with the notion that I was surrounded by people suffering from some type of pain, and that obsession became integral to the essay early on. The other references soon followed. The frame kept widening and the length stretched on. Augustine’s ideas about pain as a teacher and as a test shaped my thinking and experience all along. Contending with my insurance company was a test. The pain scale itself seemed a test, as did the bureaucracies surrounding the core medical interactions. But I wanted to test the test itself, in my own way, and to challenge any system, including the insurance industry, that threatened to degrade humanity. Kafka’s The Trial is about two trials: the nightmarish, inexplicable prosecution against Joseph K., and his attempt to put the system on trial by protesting and resisting the absurdity of it all. We all need to be a little like Joseph K. in opposing the bureaucracies that often seem to be our adversaries rather than our allies.
WB: You write about the difficulty of choosing a number for pain, noting that the scale asks patients to compress a complex experience into a single digit. Did writing about that tension change the way you think about the role of measurement in medicine or in other parts of life?
DR: My thinking about pervasive measurement mania intensified and deepened, and I would even say that my impulse to rebel against it grew stronger. I’ve always been aware of the extent to which humans have become subject to numerization, a word used in my essay that hasn’t appeared yet in standard dictionaries, but I predict it will. I found myself objecting to all kinds of measurements and ratings in culture and society. Recently I saw a list of supposedly the best 100 books of the 21st century. My first thought was: it’s a little early in the century for that. As a writer who worked in corporate America, I was always intrigued by the power and centrality of data science and measurement juxtaposed with their limits. I don’t think it’s an exaggeration to say that measurement in most environments is nothing without the human wisdom and insight to discern the nuances behind the numbers and the need to constantly question them.
WB: There’s a striking moment in the essay when you realize the pain scale doesn’t actually affect the insurance company’s decision about your treatment. What was it like discovering that the number you were being asked to produce so often didn’t ultimately matter in the system making decisions about your care?
DR: Like many of my dealings with health insurance companies, it was infuriating, but not entirely surprising. As we know, those companies are not as patient centric as their marketing materials would like us to believe. For me, the experience shined a spotlight on the chasm between medical professionals and the profit-focused insurance system, and therefore between that system and the patient. The telegraphed message suggested that a patient’s input ultimately didn’t carry any weight with the insurance company—that the patient’s expression of pain could not be trusted and carried no validity, a stance that can make it difficult to be one’s own best advocate.
WB: You write about inheriting a kind of stoic endurance from your family, people who suffered quietly and rarely complained. How did reflecting on that cultural inheritance shape the moment when you finally told the insurance representative you were at a “ten”?
DR: On the one hand, that moment presented an opportunity for liberation, for breaking from a pattern of stoic endurance, reserve, and moderation, and on the other, there were flashes of self-doubt—was it really a ten?—and of feeling that I was about to betray a familial inheritance. That said, a prolonged pattern of quiet endurance had built up to an occasion for reckoning, a moment when I would show my ancestors that I could be a kind of pioneer. That probably sounds dramatic, but in fact it felt like pivotal moment when there’s a shift away from a family’s tradition, away from a history of expressive styles.
WB: Later in the essay you begin imagining the invisible pain of strangers around you, people on the subway, in the street, in everyday life. And later, we get that moment on the subway with the woman in severe pain while people tried to ignore her. Did living with chronic pain permanently change the way you move through public spaces or perceive other people?
My perceptions were first changed, radically and permanently, more than twenty years ago when I was diagnosed with Guillain-Barre Syndrome, an autoimmune neurological disorder that affects the peripheral nerves, preventing them from transmitting signals to the brain and causing numbness and episodic paralysis—in my case, in the feet and legs. Except when I was walking unsteadily or occasionally falling on my face, the illness was largely invisible. One day, I was with a colleague, and we needed to go to the second floor of a building. He started to take the stairs, but I told him I would ride the elevator. He made a snide comment about being too lazy to walk up. I had to correct him and remind him that my legs were too weak and unstable to handle even one flight of stairs. From that point on, I became more keenly aware of living among people who suffered from illnesses and pain that remained invisible and impeded their ability to move through public spaces. Nearly half of the American adult population has some form of cardiovascular disease, which can cause, among other things, fatigue, weakness, and shortness of breath. That’s a mind-boggling number of people. On the streets of New York, in the subway system, or wherever I find myself, I’ve become much more patient with those who move slowly. With spinal stenosis, I was reminded of the prevalence of chronic back pain in others. I assume a degree of suffering, physical or otherwise, in my fellow humans, and maybe that comes from Buddhism in addition to having to proceed more slowly up the subway stairs. Regardless of the source, defaulting to an initial assumption of suffering strikes me as a humanistic ideal.
WB: The essay unfolds in numbered sections, which echoes the numerical pain scale that the essay questions. When did that structural choice emerge, and how did the segmented form shape the way the essay developed?
DR: The first few drafts did not have any numbered sections, and the form wasn’t segmented at all. In early versions, I wanted to capture, with some immediacy, the experience of pain and of the journey through medical appointments, along with observations and questions about the global, sprawling subjects of insurance bureaucracies, pain assessment, treatment options, the idea of ambient pain, and so on. In those drafts, there wasn’t a clear narrative arc from the cause of pain to surgery for spinal decompression. At some point after the fourth or fifth revision, while going through a massive reorganization, I decided to explicitly compartmentalize the essay into numbered sections. I thought doing so would help manage the complexities—containing them coherently—and also providing some movement forward, while referencing the numerical pain scale but also riffing off it and, in a way, blowing it apart. Section one begins with the Buddhist idea of universal suffering—a big idea that can be seen as a primary, fundamental concept for talking about pain—and section ten ends on that concept as I consider the ambient pain in my surroundings. The progression is very different from the sequencing and hierarchy of the pain scale. In the essay, the tenth section circles back to the first, reinforcing it with elaboration on the idea of universal suffering. There’s still a kind of escalation, from the general concept—everyone suffers—to a heightened awareness of an ambient pain that can be perceived, if you look for it. And there’s a progression from the idea of assessing pain on a scale to the proposition that there is a collective and shared pain that cannot be measured or rated.
WB: Many nonfiction writers eventually find themselves writing about the body—through illness, injury, or aging. Did this experience change how you think about the body as material for nonfiction?
DR: This particular passage through pain reminded me that the body, this entity that is closer to us than anything else, is very fertile ground for writing. As a subject, or as a springboard for other subjects, it offers limitless material. The body is always changing, always morphing, and our attitudes and perceptions shift along with those changes. Thinking about the prevalence of pain reinforced my awareness of the body as possessing unique and universal qualities that, to state the obvious, translate into a high relatability factor in writing. The body is inspiring, even, or especially, when it’s under attack or not functioning properly or failing.
WB: The essay balances memoir, philosophy, neuroscience, and cultural commentary. What did the revision process look like for this piece? Were there moments where the essay changed direction significantly?
DR: My digital folder for this essay has seventeen drafts in various stages of revision occurring over eighteen months. I also have miscellaneous notes that go back farther than the first draft. The revision process is always, for me, one of continual expansion leading to some contraction. I tend to write long, as one editor has pointed out, and this essay was no exception. The piece changed most significantly after the first couple of drafts, when I thought I’d take a journalistic approach—essentially, a reported piece about the attempt to measure pain in the medical establishment and how patients struggle with describing their pain in the context of ratings and scales. Those early versions were much less I-centric and used my own experience with pain only as a grounding anecdote. As I continued to write and read, and the longer I lived with my spinal condition, the more those initial drafts started moving in the direction of a memoir-driven essay, with detours into the insurance industry and quirky meanderings into the attributes of pain, neuroscience, and the cultural and societal dimensions.
WB: At one point in the essay, you reference Eula Biss’s essay “The Pain Scale,” particularly her observation that pain scales can function as a way to protect doctors from the emotional weight of patients’ suffering. Your essay seems to both echo and complicate that idea. How did Biss’s essay influence your thinking, and did you see “Pain Points” as entering into conversation with that earlier piece?
DR: Although I was familiar with many of Biss’s essays, I hadn’t read “The Pain Scale” before starting to write. I only became aware of her piece in the midst of my research, while reading a book about illness narratives. My very first and, I believe, correct thought was to not read her piece until I was nearly done with mine, so I waited to look at her essay until I was about twelve drafts into my own. I was wildly curious about her essay, of course, but I didn’t want to be influenced by it in any way. I suppose I was initially worried that what I was writing had already been done, leaving nothing new to say. Although we had some similar reactions to being subject to the pain scale, my essay takes a unique trajectory, with different divergences. I think both essays are now in conversation with the vast, ever-growing narratives about pain.
WB: Now that some time has passed since the experience that sparked this essay, do you feel any distance from the version of yourself who was living through that pain while writing it?
DR: Since the body, like the mind, is a receptacle of memory, I often feel close to that self who had pain from a particular condition and who was concurrently writing about it. I now have a scar about two inches long on my lower back. I can only see it when I look in a mirror but it’s there as a reminder—a historical record, if you will. A fellow swimmer at my gym asked me about the scar and I told him what had happened. I gave him an updated narrative from a perspective of relief, yes, but with clear memory of the pain. And I think the memory of pain should remain clear and present in order to fully appreciate the reprieve from pain. As a deep well of stories, the body keeps on giving! And my scar is like the essay itself in a surprising way. The essay is done, published, final and, like the scar, it is a permanent imprint of experience.
Will Brooks is an MFA candidate in nonfiction and an associate editor for Colorado Review.