The First Noble Truth of Buddhism declares that pain and suffering exist for everyone, everywhere.

Cicero, in On the Ends in Good and Evil, writes that Epicurus deemed pain to be the greatest evil, a sentiment often misattributed to St. Augustine, who considered pain a test and a teacher compelling us to acknowledge the frailty of human nature.

Under glaring white light, a courteous medical assistant asks, “How would you rate your pain today from zero to ten?”

“A four this morning when I woke up, an eight in the waiting room, a three while sitting here,” I say. “So, make that a five.”

With no-nonsense efficiency, she taps her keyboard, recording my answer in the medical ether.

The question began to wear on me, becoming a test in its own right as it gnawed at my patience. My pain often oscillated, spiking and subsiding within seconds, and while the capital of pain was located in my spine’s lumbar region, its mercurial intensity revealed itself as a mighty beast spitting fireballs through my flesh, simmering in retreat for brief periods before rising again with renewed aggression. At other scattershot times it marshalled foot soldiers to attack my hinterlands, from the buttocks to the legs and feet, from the lower left quadrant of my body to the right. “On average, it’s a six,” I said in another appointment. I figured an average bore the illusion of mathematical validity and proved I was attentive to my pain’s erratic nature, inviting it to teach me something about myself, but one skeptical nurse asked me to revise my answer to reflect how I was feeling right now. Yet over the course of five years I found it increasingly difficult to pin a number to a timestamp of the occurrence.

The well-intentioned request to rate the pain shooting through me seemed coldly impersonal, anti-humanistic, and also very familiar. This is America, I thought, a country and culture that prefers quick and easy assessments of the world around us. We want numbers before narratives, scales before stories. Make it short and sweet, brief and bitter. We relish the speedy ranking of almost every aspect of life. Five-star scales on Amazon purchases, Yelp rankings for everything from handymen to lawyers to tacos. Three stars for the best Michelin-reviewed restaurants. Stars, or lack thereof, for our doctors. In casual conversations we ask how you would rate your plumber, your professor, your gym, your mobile service, your flight, your date. It should have been no surprise I was asked to rate a phenomenon as individual and universal as pain, and though it is subjectively experienced, a number transforms pain into a relatable concept. Two empathetic individuals will understand that a nine signifies terrible pain even if they could never know how each other feels such pain.

Still, choosing a numerical rating as a snap summary of volatile and nuanced sensations seemed an endeavor empty of meaning and utility. I could not reduce the vexing wild ride of my pain to a static, pared-down, one-dimensional number excised from the intricacies of the human condition, a number divested of my body. And just as we are more than our afflictions, I was certainly more than the sum—or average—of any reported levels of my pain. Repeatedly confronted with the question, I could not help thinking about the extent to which numbers are affixed to all of us, and for entire lifetimes. Our date of birth, social security number, driver’s license number, passport number. Our teeth, our vertebrae, our days are all numbered. Mobile phone numbers confirm our identities and bestow permission, access, confirmation. When you call your insurance company, you will likely be asked, as I was ad nauseam, to first provide your member number to an automated system. We are numbers before we are patients.

“Pick a number for this moment,” another flummoxed medical assistant implored.

“You can choose for me,” I said, channeling the frustration with my pain into deference for the professional. “Whatever you decide will be accurate at some point during this appointment.”

She typed something into her computer, but I did not ask what number she chose.

A secular ignoble truth: We cannot detach ourselves from the tyranny of numbers, which cleave to us long after the end.

I had reached the severe stages of spinal stenosis, with ligaments clogging the canal within the dorsal bony arches of my vertebrae. Nerves were being squeezed and pressured, triggering sharp pain and spasms, often with swift and dramatic fluctuation. A prestigious clinic describes the condition with a layperson’s metaphor: It’s like a door being slammed on an electrical cord, wedging it against the frame. Eventually the pressure damages the cord, affecting its conductivity. The door was closing at my vertebrae numbered L4 and L5. Scientific studies have identified a variant on chromosome 2 associated with a genetic predisposition for stenosis, and the variant itself has a number. Aging is another likely cause—those numbers that have only one way of being halted.

“It’s really tight in there,” the orthopedist said as he viewed the MRI scans of my back.

A ten on the pain scale was presumably reserved for the most excruciating pain imaginable: an amputation without anesthesia comes to mind, as do the ferocious migraines that have banished my friend Julie to bed for days. (“Sometimes it was so bad,” she once told me, “I feared I was having an aneurysm or some other brain event that would explain the pressure I felt, like a steel band tightening around my forehead.”) A ten seemed beyond me and beyond the raging beast, a status for encounters with a colossally surreal form of suffering, a pain so intense, as one scale suggests, you will shortly go unconscious. I could not utter a ten for myself, at least not yet. I feared being seen as the confirmed kvetcher, the dreaded drama queen on the patient schedule. Many of the medical professionals who had asked me to rate my pain were women who had given birth—in my mind, an inconceivable ten. How could I claim the pinnacle of pain in their presence? As a person who strives for integrity through words, I recoil at the possibility of being disbelieved.

Elaine Scarry, in The Body in Pain, a cultural and philosophical study of physical suffering, said that “to have great pain is to have certainty; to hear that another person has pain is to have doubt.” She goes on to write that the doubt of others “amplifies the suffering of those already in pain,” an effect that seemed, to me, especially pertinent in a doctor’s office. If your healthcare professional doesn’t believe you, who will? I suppose, above all, I was afraid of being doubted. As I wrestled with rating my pain on demand, the potential doubt of others led me to mistrust the very existence of the problem that was causing pain.

Other factors compounded my troubled stance. Throughout most of my life, I’ve benefited from a freakishly high threshold for pain. I’ve had cavities filled without Novocain, to the dismay of nervous dentists. While dealing with back pain, I had two epidurals without general anesthesia, whereas my sister, who also suffers from stenosis, could not bear the injections into her spine without being knocked out. My self-perception—as someone who could withstand pain more than others—naturally and perhaps subconsciously steered me away from the top of the pain scale. I also descend from sturdy Upper Midwestern stock and immigrants who labored in boarding houses and copper mines with hardly a whimper. Through years of cancer, dialysis, and heart failure, my father never muttered a word about the assaults on his body. For better or worse, whether by choice or conditioning, our people, with few exceptions, have maintained a stoic grit in the face of woe. If they suffered, they did so in silence. Bellyaching about pain, about anything, was a frivolous appeal for attention that distracted from earning a dime and shoveling massive heaps of snow. Which isn’t to say I come from an unsympathetic lot; rather, we are subdued and forbearing in our worldly struggles. Perhaps, in earlier eras, such steadfast stoicism was an acquiescent front for the futility of complaint when complaining got you nowhere—or in trouble, when silence was the safest course of action.

Cicero himself admired the Stoics, for whom pain was merely a sensation to be endured, not an evil per se. (The infliction of pain is another matter.) No one in my family had formal education in philosophy, but everyone understood endurance as a buttress for precarious survival. For the religious among them, endurance was a God-given blessing. If their quiet strength was ever a charade, it was one born of dignity as a foil to pain.

Or perhaps our fortitude could be traced, like stenosis itself, to hereditary links. Studies have shown a significant genetic basis for pain sensitivity and tolerance. Maybe we are a long line of characters who feel less pain and withstand it longer than others, and maybe my backbone became the test for the limits of this biological advantage.

As a prevalent evaluation tool in medicine, the pain scale seems to involve a simple task without controversy, but the simplicity of the assignment—pick a number—belies the difficulty for patients in choosing between a four and a six, or an eight and a ten. Without a point of comparison, how do we gauge our discomfort to a hypothetical common denominator of discomfort? Does my long-lingering backache deserve a ten while migraines incapacitate my friend Julie?

The Numerical Rating Scale, the NRS, is the most widely used pain scale, but there are at least eleven others. Visual analog scales (VAS), such as the Wong-Baker FACES Pain Rating Scale, ask patients to describe their pain by selecting from a display of pictures: happy faces (for “no hurt”) to a frowning face with tears streaming down the cheeks (“hurts worst”). A third variety, called categorical scales, uses words and preformulated descriptions of pain, and sometimes colors and numbers. One day, I began wondering how pain could be rated for infants and, sure enough, I came across the CRIES scale, most often used in neonatal intensive care units. Health care professionals monitor and score a baby’s crying (from zero for no crying or a cry that is not high-pitched to two, a high-pitched cry indicating the child is inconsolable), facial expressions (such as a grimace with eyes squeezed shut), sleeplessness, oxygen levels (babies in pain have decreased levels of oxygenation), increased high blood pressure and heart rate. Each of these areas has a zero-to-two scale associated with it. Several years ago, the U.S. Department of Defense introduced its own protocol for measuring pain in active soldiers and veterans. The Defense and Veterans Pain Rating Scale employs the typical zero-to-ten scale along with colors and images of facial expressions, but it also includes questions to determine pain’s impact on a patient’s daily activity, sleep, mood, and stress. An Air Force press release stated that the DVPRS represented a “cultural change” for patients and physicians.

Although pain scales, regardless of the type, don’t pretend to proffer verifiable facts, the use of numbers comes with a sheen of objectivity, a ring of truth. Numbers, it is said, don’t lie. A classmate in graduate school once whispered to me, during a student presentation, “Reciting numbers makes a person seem smart.” The doctor’s office, however, is one place where numbers can lose their grip on quantitative rigor, slipping from the realm of science to art, from aspirational exactitude to fickle approximation. Or succumbing to spheres of sugarcoated avoidance: Eula Biss, in her essay “The Pain Scale,” writes that her father, a physician, explained how one of the pain scale’s functions “is to protect doctors—to spare them some emotional pain. Hearing someone describe their pain as a ten is much easier than hearing them describe it as a hot poker driven through their eyeball into their brain.”

Trying to rate pain with numbers is not like measuring an earthquake’s magnitude on the Richter scale, a logarithmic formulation. Whether it’s a jolt along the San Andreas Fault or the rumblings of an active volcano, sizing earthly convulsions results in a number universally understood by geologists, even if laymen experiencing the same motion will describe it in varying subjective terms. A 6.0 earthquake is not twice as powerful as one measuring 3.0 but rather one thousand times more powerful. A 9.0 earthquake is always—always—one hundred million times the magnitude of a 1.0 tremor. These are airtight axioms carved in scientific stone. The pain scale, on the other hand, is no such calculus. No one can be hooked up to an apparatus for measuring and recording pain in the way people are monitored for heart rhythms, blood pressure, and nerve conductivity. The pain scale distills a complex story of pain to a hazy, unsatisfying sketch of suffering.

At times it seemed a trick question: How would you rate your pain today? How would I if I could, if I wanted to?

Or an existential question suggesting I had the freedom to define my pain and decide on its meaning in my life—here, right now.

The numbers themselves posed an inherently existential quandary. After all, what did a six mean? Greater than five and less than seven: That much is indisputable but also, ultimately, unhelpful. What was my expertise for choosing? In the cool, still air of my medical appointments hovered an unspoken implication that patients possess an innate proficiency for pegging their pain on a commonly known scale.

That a self-determined appraisal, this act of free will, would be reviewed and considered and digested by authorities—those empowered by specialized education and training—who would come up with a holistic treatment of the patient.

That this number was a pivot point for rallying ideas, resources, medications, decisions, and solutions (because wasn’t pain a problem that needed to be solved?).

That without this number—whatever number was chosen—my medical profile would be rendered deficient, that I would be disadvantaged without it.

But what happened to all the numbers I did report, whether averaged or modestly low? Who, if anyone, was looking at them? No one—not once—followed up with questions about a trend line for my numbers. Were they being dumped into the cloud and crunched for some greater scientific purpose—greater, that is, than attempting to treat my ever-narrowing spinal canal?

I envisioned those numerical morsels as a code for my pain’s pattern, an encryption only I could decipher and translate into nonlinear narratives no one wanted to hear, at least not in full, even if time permitted the luxury of listening.

Where would the numbers go after I was no longer a patient? Or no longer alive?

Were they erased from the outer limits of big data, discharged upon death?

Maybe the query was part and parcel of the Augustinian notion of pain as a teacher: Contemplate the question, answer it—or don’t—and see if you can learn anything profound about yourself or the world or pain itself.

Aggravating the challenge of choosing a number are the many manifestations of pain and the speed at which they travel through us. The McGill Pain Index consists of seventy-eight words patients can choose from to describe their type of pain. Among them: flickering, drilling, tugging, crushing, burning, wretched, nauseating, dreadful, terrifying. Pain pounds and throbs, spikes and spreads. It can prick at a pinpoint or radiate in rampages through muscles and bones, piercing, it seems, our very soul, despite what any Stoic said about the soul being untouched by pain. St. Augustine, believing physical pain imposed its greatest suffering on the soul, wrote: “Pain is a suffering of the soul arising from the body. The wounds of the soul are more hidden yet they cry out more loudly.”

The body’s nerve-pain signals travel between half a meter to forty meters or more per second, depending on the type of pain. Light blazes at 186,000 miles per second; seismic waves, on average, tear through the earth at two to eight miles per second; a bullet from an AK-47 rips at 2,350 feet per second; and sound waddles through air at 1,100 feet per second. Despite its leisurely rate, pain is fast enough to zip from the spine to the feet in less than a second. A level four pang in the back can become ancient bodily history as it sets off for the toes, creating a newborn universe of agony piercing the outer limits of pain for nanoseconds, months, or years—it’s anyone’s guess. This is one of the paradoxes of pain: Its intensity cannot be truly measured, but its velocity can be clocked with relative precision.

What have I learned as a participatory student of pain? As a patient in America? Perhaps most alarming of all: The pain scale carried no weight in my insurance company’s approval of a steroid injection that could deliver relief. After my doctor submitted an authorization request, a reviewing physician took several days to respond with follow-up questions, none of which addressed my self-reported extent of pain. After submitting her answers, my doctor asked for an expedited review. She had studied my MRI. She saw me flinch as she examined me. I had already been waiting a week for the approval, each long day now marked by a fresh penetrating pain in the joints connecting my lower spine to the pelvic bone. At times, searing spasms stopped me in my tracks. One evening, while carrying a dish from the kitchen, a convulsion sent dinner to the floor. But since my condition was not life-threatening, the insurance company said it could not accelerate its review. Instead, at least another three full days were needed to consider my doctor’s additional information, which had been submitted on a Wednesday morning. By Friday afternoon, still no response. Another weekend would pass without knowing when I might be treated. Angry and desperate, I called my insurance company and tapped my member number, birth date, and telephone number into the phone before I was allowed to speak with anyone. “This delay is frustrating,” I told the person whose title was patient liaison. “I’m at a ten on the pain scale.”

Finally, I had said it. A ten. I would no longer shrink from the possibility of being doubted. I did not use an average; the liaison would have no interest in my finespun calibrations. I cast aside my diminishing threshold for pain and shed all traces of my virtuous ancestors. Begging for an immediate decision—from the entity I was paying more than five hundred dollars in premiums every month—was not beyond me.

“It’s not a delay, because we have no guaranteed time frame for approvals,” the liaison said. I could hear the practiced script in her response.

“I’m talking about delay from the patient’s perspective,” I said. “From a patient who is in extreme pain. The delay seems inhumane.”

For this she had no response and our conversation ended abruptly. Sometime later I received an email asking me to rate my satisfaction with the phone call, with ten being the most satisfied. I had no issue with choosing zero, but I knew it was just another number that would vanish into the void. No one would inquire why I had given the low rating or whether anything could be done to improve services.

Clearly a patient’s input on his pain wielded no influence in the insurance review, a process that seemed predicated on doubt and shaped by corporate self-preservation. And it was clear the pain scale would not bolster a diligent doctor’s advocacy for her patient. In the insurance industry’s so-called criteria and coverage limitations, nowhere is the pain scale mentioned. “I can report your level of pain in my notes for the insurance company,” my doctor told me, “but it’s not a requirement or qualification.” In other words, the degree of pain seems to play no role in the determination of insurance coverage or how quickly authorizations are issued.

After ten days, the request was approved. While the initial epidural brought some relief, my doctor believed I needed a second injection, and I agreed. When she sought approval for the additional procedure, the insurance company wanted to know the extent of any improvement in my pain, expressed as a percentage change after the first injection. But the company hadn’t taken into consideration my level ten pain to begin with, and now the reviewer was asking for—demanding—a number to judge the progress of my pain, a number that would be received in the context of doubt and could, in theory, be manipulated or downright fabricated for the goal of securing approval. My savvy, strategic doctor told the reviewer my pain had improved by fifty percent and a second injection would surely build on that success, moving me closer to total pain relief, even if temporary. Who could deny me that?

The pain of fighting for relief within a bureaucratic, profit-centric—rather than patient-centric—establishment? I consulted the McGill Index: exhausting, suffocating, miserable, sickening. If this wasn’t a ten, what was?

What else does a ten feel like? Cruel, vicious, suffocating, punishing, torturing, killing—the traits of tormentors and persecutors, villains and criminals: pain personified. Pain as an alien enemy battling the body and the mind from the inside out.

But what does a ten look like?

On the subway one day, a young woman sitting alone suddenly cried out in pain and grasped her neck with both hands. Her eyes bulged and terror contorted her face, which turned bright red. It was one of the most disturbing scenes I’ve seen on New York subways. No one offered to help or console her. I don’t believe this inaction came from a lack of compassion—I’ve observed kind and compassionate acts throughout the city—but rather from the potent shock of witnessing pain, which is usually invisible, become exposed and embodied. The woman’s sudden look of horror, the reddened face, the scream: There was little room for doubt. Her public pain stunned our collective nerve. I felt a disconcerting paralysis in myself and sensed it in those around me. Later, I was awash in regret—and shame—over my hobbled inclination to help. When the episode had passed, the woman’s hands fell away from her neck and she relaxed into her seat. From ten to some lesser number: It happens more than we realize, these unpredictable, often inconspicuous flares of pain in our compatriots. At the next subway stop, she exited the train and disappeared into the throng.

Going about my business in New York, or wherever I traveled, I became overwhelmed by the probability that I was surrounded by people who had some degree of pain. On the bustling city streets, we walk among those who, if they were asked, are feeling a ten—or an eight, or a four, or an always-morphing average of pain that skips around like a ball on a roulette wheel.Who in the market, at the barber shop, on the bus, in the post office, at the ramen counter—who among us is in pain, and how much? Was the man on the escalator a ten? The elderly woman in the coffee line: Did she have a five in her hip, and if so, would it spiral without warning to a ten throughout her thin body? An eight for the taxi driver whose gloomy frown did not seem caused by traffic? The police officer on horseback, the museum guard, the wailing infant (definitely a two on the CRIES scale), the young woman weeping on a street corner at noon, the other patients sitting in my doctor’s office—who would report a one, who a ten?

Walking along Manhattan’s pulsing avenues, passing through Grand Central Station, riding a packed elevator: Each step in the public domain became a curious and daunting submission to the First Noble Truth, big time. Pain for everyone, everywhere. A constant density of human suffering. Strangers became less strange; they became extended family, with pain binding us in our lineage. Pain was our stifled dialect. One morning I saw a woman trip from the steps of a crosstown bus and tumble to the pavement. I ran to her, knowing the fall must have hurt badly. I helped her get up and asked if she was all right. Straightening herself, she smiled and said she was fine and thanked me for my concern. She walked away with a slight limp, stoic in expression but not in bearing.

The pain scale had sparked my rebellion against numbers and now, as I gazed upon my fellow denizens, pondering their pain, I loathed any further numerization of human beings, lamented the urge to attach yet another digit to individuals whose names I would never know but whose pain I might be familiar with, if only we could share our stories.

Pain bolted downward and sideways but never upward to my brain. Or rather I never felt the physical pain of stenosis in my head and brain, although that is where bodily pain is processed, whether it originates from a sprained ankle or a fractured shoulder. An elaborate causeway of chemical and electrical interactions sends neurotransmitters from the injury site up through the spinal cord to the thalamus and other parts of the brain where, in a feat of neural wizardry, pain is registered and interpreted. In short, the brain determines how we feel pain depending on the injury or stimulus. The conscious, thinking, perceiving I—the I who chooses salad over steak—has no say in the matter. My brain, in stealth mode, decides for me, without checking in. It is an astonishing authority for an organ that cannot feel pain itself.

My mental health did not escape unscathed by stenosis. Cramping and stabbing pain often thwarted a good night’s rest. In the fog of lost sleep, I could not read, write, or think with adequate focus and acuity. My energy waned and my mood, despite the hand-me-downs of Midwestern vigor, teetered. I was not depressed, exactly. I had become demoralized by the unyielding nuisance of pain. I mourned the loss of an undervalued normalcy of life, of the unthinking carefree liberty in having no pain. I worried that the pain would never subside, that it would deepen and permeate, become chronic and disabling; that yoga was ineffective; that acetaminophen and naproxen were destroying my liver and kidneys; that surgery, with no guarantees and myriad risks, might be the only way out. The beast in my back became an infuriating, full-time occupant of my mind.

How would I rate my mental health during this time?

To help their patients describe distress or anxiety, cognitive behavioral therapists use the Subjective Units of Distress Scale. SUDS: an apt label for my brain’s murkiest moments under pain’s influence. Fuzzy-sudsy-headed instead of clearly, sharply alert. SUDS spans a whopping scale of zero to one hundred, and I was there for it, mentally floundering, slowed by the whiplike vagaries of pain. If I had to provide a woozy-headed guess, I wobbled in the cloudy midlands of SUDS, sometimes drifting, briefly, to the perilous northern cliffs.

Let us catalog the tools for appraising mental anguish: SUDS, the PHQ-9, the GAD-7, the Beck Depression Inventory, the Hamilton Rating Scales for depression and anxiety. Need there be so many options for estimating Darkness Visible, as William Styron called his book about a long battle with clinical depression? So many pain scales for mind and body? “Mysteriously and in ways that are totally remote from normal experience,” Styron wrote, “the gray drizzle of horror induced by depression takes on the quality of physical pain.” Could there be—should there be—one grand, unified, scrupulous approach for evaluating the totality of pain, with or without numbers? Or maybe we need to admit that the size of pain, like the size of the entire universe, is unknowable.

My problem with the pain scale extended beyond the solipsistic, beyond its bearing on my medical care and the (mostly) gentle nudging to concede an integer to the numerisphere.

Despite its accepted legitimacy, the pain scale has fallen victim to flagrant abuse, as my upstanding pain physician confirmed. People involved in litigation over their injuries might be prone to exaggerating their pain as they—advised and prompted by their lawyers—eye hefty payouts from settlements and court-awarded damages. The greater the pain, the juicier the financial judgment. In lawsuits, everyone should be fairly compensated for the suffering caused by others, but the temptation and lawyerly pressure to overstate pain for a windfall is not uncommon; some studies have suggested that thirty percent of personal injury claims show exaggerated pain, and one study of litigants in particular found that more than eighty percent of plaintiffs had “nongenuine abnormalities.” Malingering and magnified pain in legal claims has led to the development of several “symptom validity tests” to detect overblown self-reported symptoms. This, the Greek chorus chants, is the unvirtuous America, where money warps and sensationalizes pain, fueling a financial euphoria that does not erase, as Buddhists say, the persistent suffering caused by ceaseless desire.

Or some patients might merely desire some paid time off from work.

And others, as I heard from more than one doctor, exaggerate pain in an attempt to secure prescriptions for opioids, a practice known as narcotic-seeking behavior.

Whose ten should be doubted? Though I had blurted mine—with conviction—at the patient liaison, any doubt or disbelief she might have held wasn’t open to persuasion because doubt or disbelief about my pain did not exist for her at all. For her purposes, a number was irrelevant. Her singular bias was for protecting her company’s wealth. The outcome I sought would have been beneficial for me (less pain) and detrimental to her employer (a dent to the profit line). Any ethical reckoning on her part would be far less consequential than opioids prescribed for a questionable ten.

Five years had passed since an initial MRI showed a moderate but manageable stenosis. Now my spinal canal was being choked, the nerve endings compressed. The condition has no remission; the constriction and the pain would only worsen. I was nearly two thousand days older and tens of thousands of dollars lighter—a zero-sum game in which appointments, expenses, opinions, prescriptions, and yoga sessions of bird dogs and modified cat/cows had not alleviated the pain. There was one path left. Or two, counting the alternative of taking no action and accepting the likelihood of lifelong reduced mobility, permanent nerve damage, and pain soaring to the highest echelons of every pain scale in the land.

Like St. Augustine, I have my own compendium of confessions: While searching for a surgeon, I devoured the copious online ratings that are now ubiquitous for doctors. Ratings everywhere, ratings for everyone. I filtered and sorted profiles with at least four stars on a five-star scale. I read hundreds of patient reviews for dozens of spine specialists, and I cross-checked the ratings of their medical schools and assessed the prestige of their surgical fellowships. In a notebook I kept a short list of candidates, with averaged rankings inked next to their names. I had surrendered, in the end, to rating mania.

But this is America, I told myself, and this was spine surgery.

In the OR, I was put to sleep in seconds with propofol, which blocks the nerve endings for pain perception. In this state of induced unconsciousness, I could not feel the scalpel slicing into my back or the instrument tunneling through my spine. All pain, mine and everyone’s, became suspended in ephemeral nothingness. Afterward, the worst of the postsurgical soreness was blunted for five days by oxycodone, and then by heavy-duty muscle relaxers and super-charged Tylenol. During this time, if someone had asked me to rate my pain I would have answered: What pain?

In the months following my surgery, the stenosis symptoms faded. The incalculable achievement of modern medicine had landed one of its miracles squarely on my back. The beast, for now, had been evicted from mind and body.

Only days after walking out of the hospital, I began receiving regular automated follow-up questionnaires about my level of discomfort. How was I feeling at three, six, nine, and twelve weeks after surgery? A year later? I answered only one such survey because I wanted to be done with thinking about pain, finished with guesstimating its depths and range. I did send an email to my doctor, who now, more than ever, dwelled in the stratosphere of rankings. I thanked him for his care and for the surgery’s success. Knowing he would want to quantify that success—for his own esteem, for the record, or for a narrative he could pass on to the next patient—I told him the pain had been reduced by at least ninety percent. In an online review, I sang his praises and awarded him five gold stars.

Ninety percent less than what rating on the pain scale? Although my back and whole body now felt better, my psyche remained stubbornly resistant to stamping a number on pain. Yes, I had pronounced a ten to the patient liaison, but was it the worst imaginable pain? An imagination is more expansive than our bodies, more galvanizing than any neurotransmitter; I had imagined, wrongly, that my ten would hasten a decision. And if it had been a ten, how long had it lasted? Long enough to say it, long enough to square off with bureaucratic lunacy?

A year after my surgery, an email survey asked me to “think about your pain level and what you can do each day. Is the current state of your condition acceptable?” I could have chosen only yes or no before clicking Submit. There was no space for an explanation. The word itself—acceptable—struck me as another oversimplification, another egregious attempt to obscure and circumvent. Eight or ten. Acceptable or not. Is any pain, any decline in the quality of life, acceptable? Answering the survey would mean I had become complicit in reductive forces. I didn’t want any part of it. In any case, responding would have been pointless—if I’d said, no, this is not acceptable, who would have called?—and so I deleted the email.

Now, despite minor residual pain, I can walk unhindered, swim smoothly, bend backward and forward, and toss a ball for the dogs, meanwhile perceiving the ambient and eternal pain that marches ahead of me on the sidewalk, lingers on the stoops of a brownstone, trembles beside me on the subway, and though proof and measurement are impossible, this confluence of pain, this infinite and enveloping pain, belongs to all of us.