One of my colleagues recently told me he doesn’t read fiction because he doesn’t see the point in wasting time on something that isn’t real and doesn’t matter. He learns more from non-fiction, he said.

Oh my.

The awarding of the 2010 Nobel Prize in literature yesterday to Mario Vargas Llosa of Peru for ten million Swedish Kronors—or, in our increasingly worthless American currency, 1.5 million dollars—is a powerful reminder that fiction, for society in general and for our little niche of narrative medicine in particular, does indeed matter.

To those who believe the reading of fiction to be of no practical value, like viewing an action movie or a cops-and-robbers TV show, we need look no further than Mr. Vargas Llosa’s oeuvre for rebuttal. In his youth a prototypical Latin American leftist, Vargas Llosa later became a powerful advocate of free-market capitalism and liberal democracy. His fiction concerns itself with the dehumanizing effects of autocracy and the virtues of individual empowerment. Born in 1936, he came of age in the 1950s, a period during which Peru suffered greatly from a corrupt dictatorship. His personal experience with tyranny and his enormous compassion for victims of statist oppression led him to become a controversial and vocal supporter of the American-led liberation of Iraq and the effort to depose Saddam Hussein. He was awarded the Nobel, in the words of the Swedish Academy, “for his cartography of the structures of power and his trenchant images of the individual’s resistance, revolt and defeat.”

So what does the literary success of an apostate Marxist have to do with a blog on literature and medicine?

Well, everything. Because, in the words of Vargas Llosa himself, as reported today by Emily Parker in the Opinion section of The Wall Street Journal, “Through writing, one can change history…Nothing better protects a human being against the stupidity of prejudice, racism, religious or political sectarianism, and exclusivist nationalism than this truth that invariably appears in great literature: that men and women of all nations and places are essentially equal.”

And so it is with literary fiction and medicine. Through stories, one can change lives. The meaning of illness is revealed and the suffering of others deeply and personally experienced. Reading, reflecting on, and discussing great fiction increases the empathy of caregivers (Anyone out there whose doctor seems cold and unemotional?) and helps patients understand the universal question: Why? Why me? What does my illness mean?

The answer is different for each that asks, but the journey (of understanding illness) is not—just as citizens in a free society share in common their quest for liberty, though their expression of it is individually unique.

For those who take the time to enjoy it, literary fiction, whether dealing with matters of tyranny and liberty, as do the novels of Nobel Prize winner Mario Varga Llosa, or in dealing with human illness, as does this blog and the field of narrative medicine, is transformative.

Sorry, my doctor’s lounge companion, but fiction matters.

Welcome to The Literary Doctor’s inaugural “prescription,” a moving short story by T. C. Boyle called Sin Dolor –Without Pain.

I can think of no finer writer to begin a narrative medicine blog with than T. C. Boyle, a luminary of American literature. He is a graduate of the University of Iowa Writers’ Workshop and a Distinguished Professor of English at USC. In 2009 he was inducted into The American Academy of Arts and Letters, considered the highest formal recognition of artistic merit in the United States. He is the author of twenty-one—and counting—works of fiction. Sin Dolor comes from a collection of short stories entitled Wild Child and Other Stories, published in 2009. If you are unfamiliar with this author, do yourself a favor and read one of his thirteen novels.

What would it be like to never experience pain? Sin Dolor is T.C. Boyle’s discomfiting exploration of this very question.

Mercedes Fumes brings her four-year-old son Dámaso to the town doctor—who is the first person narrator of the story—for burns on his hands. But these aren’t just any burns; these are black, oozing eschars on his palms that came, his mother insists, from snatching hot coals off the brazier she uses to cook the indigestible tacos she and her husband Francisco hawk on the street. The doctor doubts her story and wonders about child abuse.

No one, not even the fakirs of India (and they are fakers), could hold onto a burning coal long enough to suffer third-degree burns.

She answers his skepticism with the unlikeliest of explanations. “He’s not normal, Doctor. He doesn’t feel pain the way others do.”

She urges him to prick her son with a needle. The doctor doesn’t hesitate. He swabs Dámaso’s arm and takes a syringe from the cabinet.

The boy never flinched. Never gave any indication that anything was happening at all…

“We call him Sin Dolor, Doctor…The Painless One.”

The next time the doctor sees the boy, now eight, he is with his father, Francisco. Dámaso comes in limping, favoring his right leg, which the doctor discovers is broken, a fractured tibia. That he walked in on. Without the slightest whimper. The doctor again suspects child abuse, but Francisco Fumes tells him Dámaso did it by jumping off the roof of a shed. The doctor realizes he has stumbled onto an unprecedented medical marvel.

I felt the boy’s gaze on me. He was absolutely calm, his eyes like the motionless pools of the rill that brought water down out of the mountains…For the first time it occurred to me that something extraordinary was going on here, a kind of medical miracle…

He is seized by ambition, an intense desire to claim credit for discovering what must be…a mutation in his genes, a positive mutation, superior, progressive…He befriends Dámaso in hopes of spectacular medical fame.

If that mutation could be isolated—if the genetic sequence could be discovered—then the boon for our poor suffering species would be immeasurable. Imagine a pain-free old age. Painless childbirth, surgery, dentistry…What an insuperable coup over the afflictions that twist and maim us and haunt us to the grave!

He encourages Dámaso to spend time at his clinic and to come to his home for dinner. At the same time, he contacts a geneticist he knows from medical school in Guadalajara, who implores him to send scrapings from the inside of Dámaso’s mouth for analysis. But Francisco Fumes becomes jealous of the attention lavished on his son—and of Dámaso’s response to the attention. He forbids all contact between Dámaso and the doctor, destroying the doctor’s ambitions and his son’s only chance to escape his circumstances…the stew of misinformation and illiteracy into which he’d been born…

Five or six years pass before the doctor sees Dámaso again…Though I heard the rumors—we all did—that his father was forcing him to travel from town to town like a freak in a sideshow, shamelessly exploiting his gift for the benefit of every gaping rube with a peso in his pocket.

Finally they meet again, Dámaso now thirteen or so, no longer in school and supporting his family by performing cheap carnival tricks that weren’t tricks, burning and slicing and maiming himself for the crowd without a hint of pain. After witnessing one such performance, the doctor observes that Dámaso has changed.

He seemed to walk more deliberately than he had in the past, as if the years had weighed on him in some unfathomable way…

Later, he learns the price Dámaso has paid for being a medical freak.

“I have no friends, Doctor, not a single one. Even my brothers and sisters look at me like I’m a stranger. And the boys all over the district, in the smallest towns, they try to imitate me.”

He tells the doctor that he does what his family asks of him—exploiting his painlessness, profiting from his miracle in the most vulgar of ways—out of a sense of duty to them.

“But what they’ll never understand, what you don’t understand, is that I do hurt, I do feel it, I do.” And then he taps himself over his heart. “Here,” he says. “Here’s where I hurt.”

He dies a week later, after leaping off a three-story building to satisfy the little sycophants who idolize him. “Jump!” they shout. “Sin Dolor! Sin Dolor!” He dies without a twinge of pain.

The story concludes with the doctor treating a small girl who has stepped on a sea urchin.

As delicately as I could, I held her miniature heel in my hand, took hold of the slick black fragment with the grip of my forceps and pulled it cleanly from the flesh, and I have to tell you, that little girl shrieked till the very glass in the windows rattled, shrieked as if there were no other pain in the world.

The last twenty years have seen the rise of an entirely new medical field: the specialty of Pain Medicine, or Algiatry, a discipline devoted to the prevention of pain. At first blush a noble endeavor, relief from the myriad cancers, fractures, nerve impingements, torsions, and infarctions we human beings suffer long overdue. But having practiced medicine during this time, I have witnessed firsthand a troubling and proportional surge in prescription drug addiction, patient after patient hooked on Vicodin, Norco, Percocet, Xanax, Oxycontin and countless other “mother’s little helpers,” as the eponymous song by the Rolling Stones goes. Perhaps, as T.C. Boyle so poignantly suggests, a certain amount of pain—I know, not childbirth and Oh God, please not kidney stones—is necessary to the human condition. Perhaps the complete elimination of pain is not without consequences.

Tell us what you think about the quest to eliminate pain, both from the perspective of a doctor seeking to relieve it, and from the perspective of a patient—of a human being—who suffers from it.