"I heard it break," Sylvia says today of his arm. "But during the fight it didn't hurt at all." The first real pain came when he high-fived a fan on the way out of the arena. Later, as he sat alone on a gurney waiting to go to the hospital, the pain rushed in. Sylvia's arm was found to have multiple fractures that required three titanium plates to fix. "[The ref] probably saved my career," he says.
Circumstances play a big role in how people experience pain. At the Anzio beachhead in Italy during World War II, anesthesiologist Henry Beecher realized that he could not always predict the degree of pain a soldier would feel from a wound. Men came in after bullets had passed clear through them, or with arms dangling and legs missing, and some of the most grotesquely injured among them would smile and express relief that they were alive and out of harm's way. Often they declined morphine.
It was not that these soldiers were suddenly immune to pain or unaware of their injuries. When medics gave them IVs, they complained just as bitterly as other patients about an ineptly placed needle. It was that they were not feeling the specific pain of the wound that had gotten them out of the crossfire. And this experience could not be explained by shock. Some of the soldiers were fully aware of what had happened, able to calmly analyze the situation in the battlefield and to carry on conversations. When Beecher later treated civilians with similar injuries, he found that they usually experienced far more pain than had the soldiers. The battlefield itself, it turns out, was the painkiller.
Part of the explanation is probably the body's ancient fight-or-flight mechanism. It can cause immunity to pain—so-called "stress-induced analgesia"—in life-threatening situations. According to Jeffrey Mogil, head of the Pain Genetics Lab at McGill University in Montreal, part of the evolutionary purpose of the pain from, say, a sprained ankle is to facilitate healing. "Humans didn't have casts in the situation in which we evolved," he says, "but you know to keep your leg still because it hurts if you move it." In battle, however, immobility could be deadly. Sudden immunity to pain offers the injured person a chance to flee first and deal with the injury second. The theory is backed up by studies of mice in which, when two are pitted against each other, only the losing mouse, the one that needs to flee, experiences stress-induced pain relief.
The brain has distinct pathways for feeling pain and producing the emotions that cause distress from pain. It appears that alterations in one pathway can change how a person is affected by the other. Battle can cause that sort of alteration, as can mental distraction. In the 1950s, working at a clinic in Portland, Canadian psychologist Ronald Melzack documented a phenomenon in civilians similar to what Sylvia went through. A machine-shop foreman who had just lost a foot felt no pain as he focused on the worry that his fellow workers would think he was stupid. A young woman with a severed leg felt fine but cried because she believed that now no man would want to marry her. The main power of some painkillers lies not in dampening the physical quality of pain but in softening the emotional response to it. "Morphine doesn't so much decrease the pain intensity," Mogil says. "It decreases how badly I feel about it." That pain is in the head is incontrovertible.
The Atlanta Olympics were John Register's dream. A four-time All-America sprinter and jumper at Arkansas, Register joined the Army's World Class Athlete Program in 1988 and competed at that year's U.S. trials in the 110-meter hurdles, though he failed to make the team. In '92, having served in the gulf war and switched to the 400-meter hurdles, he again qualified for the trials but finished 17th. By the spring of '94, two years before the Atlanta Games, he had run a sub-50-second 400-meter hurdles and had hopes of making the trials finals. But his Olympic dream came crashing down in a single hurdle.
On May 17, 1994, Register was warming up at Fort Hays in Kansas for a competition the next day. The conditions were windy and he was having trouble getting his 13 steps down between each hurdle. On the third hurdle Register knew that his 13th step would be too far from the barrier. Rather than stutter-step, he attempted an extralong jump off his right leg. Register cleared the hurdle but landed hard on his left foot and collapsed to the track. He knew he'd been hurt badly. His left leg was lying at a right angle, like an L, across his right. But for a moment there was no pain, only heartache. Man, I just lost my shot at the Olympics. He took another look at his leg and the pain surged.
Over the next few days, Register's pain grew worse. He had severed the popliteal artery, the extension of the femoral artery that brings blood through the knee to the lower leg. Gangrene began to set in. Five days after the accident, he had a choice: have the lower leg cleaned out and keep it but lose so much function that he would have to rely on a walker or wheelchair for the rest of his life, or amputate the leg above the knee and use a prosthetic lower limb. At that point all Register could think about was getting rid of the constant and immense pain. "I just wanted the pain gone," he says. "I thought, shoot, if you cut [the leg] off, the pain has got to go."
Except that sometimes the rope is not pulled, and the bell rings just the same.
At some point in their lives, most people who have lost a leg will feel that leg as if it were still flesh and blood. Many of them will feel pain in it. Others who were born without a leg or arm will nonetheless sense pain in the limb that has never existed.