This time last year I published Breaking through the pain barrier. The extraordinary life of Dr Michael J. Cousins—the biography of Dr Michael Cousins AO, a trailblazing Australian pain medicine pioneer who played a pivotal role in shaping modern pain medicine.
Michael grew up on Sydney’s North Shore in the 1940s, studied medicine at Sydney University, did his residency at St George Hospital in southern Sydney, and trained as an anaesthetist at Royal North Shore Hospital.
On Cracker Night in 1964 when he was a junior doctor, Michael treated two little boys whose bonfire had run rampant, leaving them with life-threatening burns.
He kept a forty-eight-hour vigil by the boys’ bedsides, fighting to save their lives. Thankfully, the boys survived, but Michael couldn’t control their agonising pain because pain medicine was poorly understood, and there were few options for managing severe pain back then.
Haunted by the children’s suffering, he resolved to learn more about pain and its management. At the end of that weekend, Michael Cousins made a decision that would define his future and profoundly influence the field of pain medicine—he dedicated his life to reducing suffering by improving the treatment of pain.
The following year, he started training at Royal North Shore Hospital to become an anaesthetist because in the 1960s it was anaesthetists who managed severe pain.
Three years later, he headed to McGill University in Montreal, then Stanford University in California to study epidural pain relief.
The makings of a life-long dedication
For the next fifty years, Michael’s quest dominated his life, driving his research, treatment of patients, reform agenda and political advocacy. During that time, he led the pain world, and he established the field of pain medicine in Australia.
Michael became my pain specialist in 2005 and for twelve years, he tried every possible treatment to reduce the impact of chronic migraine in my life. The condition developed in the 1980s after some thugs pushed me off my bicycle from their speeding car. The force of the impact was so strong it propelled me into the air, and I landed on my head before rolling headfirst down the road. That day, my twenty-fourth birthday, heralded the onset of daily migraine attacks.
As Michael’s patient, I appreciated his empathy and kindness. I also sensed his determination in the way he persevered, even when I didn’t respond to the treatments he trialled. But he never gave up on me.
It was this gritty determination, combined with his commitment to advancing the field of pain medicine, that inspired me to write Breaking through the pain barrier.
The choice conundrum of biography writing
While writing the biography, I faced countless choices and I’ll explore some of them in this blog. Each involved one or more questions and by viewing them as a whole, I formed the research question for my doctoral dissertation: How does one write the biography of a living scientist? This question was inspired by one that Virginia Woolf voiced, ‘My God, how does one write a biography?’ in a letter to Vita Sackville West while she struggled to write the biography of her friend, the artist Roger Fry.
Richard Holmes, who wrote the biography of scientists from the Romantic age of science in the 18th century, suggests today’s readers want to read about scientific work as part of a life story, and that biographies of scientists can be suspenseful and electrifying. ‘A detective story, perhaps; a mystery story…but always a story of human lives’.
Holmes encourages biographers to bring the story of a scientist or doctor to life by sharing with readers ‘what makes the person tick, and what set them ticking’. Also vital is capturing scientific passion, the essence of wonder and its centrality in the life of a researcher because it’s what drives so much scientific endeavour. Grasping the significance of the ‘Eureka moment’, that ‘intuitive inspired instant of invention or discovery,’ is also an essential component of science and medical biography.
The fascinating story of scientific discovery
Readers of science biographies long to experience ‘adventures of the human spirit’ that show what drives scientists to make discoveries. Also, how they deal with uncertainty, dead-ends and mistakes. Contemporary readers are also curious about psychological and social interpretations of scientists’ lives and non-scientific aspects such as love, religion and politics.’
Richard Holmes believes there’s ‘a fresh hunger to understand the making of science through the making of scientists,’ and that we can write science biographies as gripping adventure stories.
This is the approach I adopted in Breaking through the pain barrier by sharing Michael’s struggles, successes and failures, and portraying his ambitions, passions, disappointments and moral choices.
Michael’s biography takes readers on a sometimes-rocky roller coaster ride from the moment he dedicated his life to improving the treatment of pain, through the many trials and tribulations he faced in realising his dream, to the end of his career when he retired at the age of eighty.
Knowing that the testimony of multiple observers enables a biographer to emphasise the diversity of truths about a person, I set out to interview all of Michael’s Australian and overseas colleagues who were still alive.
Sitting opposite Michael during two years of interviews and looking at photographs of pain medicine pioneers enabled me to describe him and his early mentors with physical and psychological specificity. I was delighted when some of my readers told me the way I’d described Michael’s early mentors helped them to perceive the pioneers in their ‘mind’s eye’. When they saw the photos in the middle of the book, they knew instantly who the mentors were, even before they read the captions underneath.
Interview question selection
In selecting interview questions, I often asked interviewees what they could see, hear, smell and feel in various situations, to help me reconstruct scenes and dramatic episodes in Michael’s life.
I wanted the reader to see each scene, imagining what Michael might have been experiencing and what else was happening around him. I also wanted readers to feel his desperation to improve pain management and his frustration when obstacles littered his path.
To give you an idea of this approach, I’ve pasted below a scene from 1979 that captures a Eureka moment in the history of pain medicine. The setting is the surgical recovery ward at Flinders Medical Centre in Adelaide where Michael and the pain team treated patients and conducted research studies because they didn’t have their own space until years later when enough funding was secured.
The Flinders team kicked off a series of studies on epidural pain relief. In a break from standard practice, they injected pethidine rather than local anaesthetic into the epidural space—the space surrounding the outer membrane of the spinal cord.
The first patient they tested with this technique was a middle-aged woman named Dora who suffered from severe lower back pain. Early one evening, Dora lay on a bed in the recovery ward where Michael had prepared her to receive an epidural injection. Two nurses scurried around tidying up before they left for the day while the head scientist, Laurie Mather, stood beside Dora’s right shoulder chatting with her about the procedure. Two researchers dressed in crisp white lab coats hovered at the end of the bed.
Michael hooked up a thermometer to Dora’s right big toe to measure any changes in her body temperature triggered by pethidine’s local anaesthetic action. Then he injected pethidine into the epidural space in her lower back. After a few minutes, he asked Dora to describe her pain on a scale of one to ten.
‘I don’t have any pain,’ she said.
‘Do your legs feel numb?’ Michael asked.
‘No. They feel normal.’
Michael instructed Dora to wiggle her legs. She did.
These results astounded the Flinders’ team because it meant the pethidine hadn’t caused the loss of feeling or movement in the legs that occurred whenever they injected local anaesthetic into a patient’s epidural space.
During the following weeks, Michael and his colleagues repeated the procedure on several more patients. The results were the same. The Flinders team was ecstatic. An improved method of pain relief was seemingly within grasp!”
This discovery stimulated intense excitement among researchers who were feverishly trying to find ways of delivering pain-relieving drugs via the epidural space.
Michael recalls ‘there was a bit of a race on between different research groups around the world to be the first to publish new methods of spinal pain relief. ‘I think it happens every time something new and exciting appears on the horizon,’ he said.
It was an exhilarating time to be researching epidural pain relief. ‘Our team became euphoric,’ Michael said, adding that, at first, they asked, ‘Can it be true?’ Then they became convinced it was right, quivering in disbelief. Michael believes part of the reward of research is publishing and communicating the findings. ‘It’s a signal you’ve contributed to better understanding an illness,’ he said, ‘and it eggs you on to do more to see if you can improve the way we treat medical conditions.’
Theme and structure
One of my early choices was deciding on the book’s themes and structure. At first, this was daunting because of the sheer volume of material Michael and other pain scholars wrote.
After doing over 200 interviews with a range of individuals, reading most of Michael’s 300 journal articles and textbooks, and studying the pain medicine literature and archival sources, I assembled an enormous mountain of material. But I wasn’t sure how to focus it.
Biography scholars insist that a good biographical portrait requires ‘the greatest kind of economy’ and they warn biographers against being too comprehensive because it risks boring the reader.
But they admit: ‘Biography—like fiction feeds on detail.’
Biography is much more than an inventory of facts, figures and achievements and it’s ‘crucial to have little details, especially human details that bring the story alive and enable the reader to enter it.
I questioned how to provide vivid descriptions to bring people, places and events to life, but to do this sparingly, to ensure I didn’t write a dull, bloated book.
After much deliberation, I prioritised material that represented turning points and pivotal moments in the history of pain medicine and Michael’s life, rather than trying to represent the entire arc of his life.
The challenge of understanding the science
When I started writing, I faced several choices about how much of the science of pain medicine I needed to understand, how much I should include in the narrative, and how to balance Michael’s scientific and professional life with his private life.
An aspect of the material’s scientific complexity that concerned me was making it accessible to a general audience. Catherine Reef, who wrote a biography of Florence Nightingale, advises science biographers to ask themselves what readers might already know or not know, and what they need to know to follow the story of a scientist or doctor.
I couldn’t assume readers would know the meaning of epidural space, regional anaesthesia or multidisciplinary pain management, so I defined each term within the narrative, aiming to make its meaning clear without interrupting the narrative flow.
At the same time, I didn’t want to dumb down descriptions because I knew members of the pain medicine community would read the book.
Mary Jo Nye faced these issues while writing the biography of the early 20th-century physicist Patrick Blackett. One way she addressed it was by exploring how Blackett made choices: ‘What scientific problems he would study, how he would organise his laboratory, what administrative responsibilities he would take on, what political issues he would address publicly, and how much open controversy he was willing to endure in science and politics.’
I did the same, exploring why Michael studied epidural pain relief, spinal cord injury pain, and multidisciplinary pain management.
Exploring the personal journey
In Breaking through the pain barrier, I show how Michael had to beg, borrow and steal to cobble together enough funds to buy laboratory equipment and finance research studies, and how he twisted the arms of empathetic colleagues who provided pain services pro bono on their days off.
I also examine why he was so willing to continue his quest when faced with so much resistance and hostility, and why and how he took on so many administrative and leadership roles when it took him away from his patients, his pain research and his beloved family.
I particularly wanted to understand how he navigated the transition from junior doctor and benchtop researcher to the leader of teams of talented individuals who shared his vision.
Given Michael’s relentless advocacy, I also probe his reasons for pursuing a radical reform agenda when he faced systemic inertia and strident opposition.
I was intrigued by how Michael as a doctor who didn’t have the advantage of management, media and political training, could become an accomplished media performer and outspoken campaigner for people living with chronic pain.
And I wondered how he convinced governments around the world to accept access to pain management as a universal human right.
Breaking through the barrier sheds light on these aspects of Michael’s character and behaviour and shows what it takes for an individual to move mountains to improve the human condition. I hope it inspires others to follow in Michael’s footsteps, no matter what field of endeavour they pursue.
Balancing private life vs career
One of my key challenges was striking a balance in portraying Michael’s career and private life and crafting a nuanced portrait of him as a scientist, doctor, reformer, advocate, husband, father and friend.
Biography is a life story first and foremost, and a science biographer’s role is to understand the individual and present them as a whole person rather than focusing on the scientific life at the expense of the personal.
Charlotte Jacobs, who wrote the biography of Jonas Salk, the scientist who created the polio vaccine, suggests this involves finding the vital speaker.
Jacobs insists life is not a chronicle of events and a biographer must capture the intellectual, spiritual and moral makeup of a person and how it evolves with time. Jacobs likened writing Jonas Salk’s biography to sculpting a piece of clay: ‘My task was to sculpt the perfect likeness of Jonas Salk,’ she said. ‘I used to call it “Seeking Salk.”’
I set out to do the same.
Reflecting on the personal, political and philosophical dimensions of a scientist can humanise them, helping a biographer to view them as a whole person, rather than their public image as a hero wearing a white coat and looking down a laboratory microscope.
One way of portraying the complex, three-dimensional personality of a scientist is to include their words and thoughts as quotes. Michael delivered dozens of orations, did hundreds of media interviews, and spent countless hours in conversation with me, so I often quoted him directly rather than paraphrasing, because his expression, language, intonation, use of metaphors and vivid images, and the pace and rhythm of his speech reveal so much about him.
Rayvon Fouché, who wrote a biography of three African American inventors of the early 20th century, believes a subject’s relationships reveal crucial evidence about their character. In Fouché’s biography, Black Inventors in the Age of Segregation, he explores connections in their broadest sense because they shed light on who each subject was as an individual.
The role of colleagues
Michael had close relationships with several of the early pioneers of pain medicine and I was eager to interview them to discover their perceptions of Michael as a young doctor and researcher.
Two colleagues I longed to interview were psychologist Ronald Melzack, who, along with neuroscientist Patrick Wall, proposed the revolutionary Gate Control Theory of Pain in 1965.
The pair set the pain medicine world on fire with this theory, triggering decades of research and the development of new treatments for chronic pain. They inspired Michael when he spent 1969 at McGill University working with them, and they remained lifelong mentors and friends.
I also longed to interview John J. Bonica, the formidable ‘Grand Man’ of pain medicine who used the force of his personality to raise enough funds to launch a pioneering pain centre at the University of Washington. He also drove the creation of a global pain medicine community and was Michael’s earliest and most influential mentor.
In establishing the field of pain medicine in Australia, Michael modelled his research, patient care, advocacy and reform agenda on that of John Bonica, who guided him throughout his career. He also never forgot Bonica’s advice to ‘always get your facts right, son. And never, never give up.’
Interacting with the giants of pain medicine reinforced Michael’s drive to pursue excellence and learn from the very best—two of his lifelong traits. He found several distinguished role models to guide him, and he took every opportunity to learn from them. The standards Melzack, Wall and Bonica set naturally came to be the standards Michael embraced. ‘It was a fortunate convergence of three extraordinary individuals,’ he said. ‘My years in North America were like nothing else I’ve experienced throughout the rest of my life.’
I was keen to get a glimpse of the young Michael Cousins through the eyes of his mentors, but sadly, they are no longer with us. However, their correspondence with him and other vital archival material that reflects on his character and behaviour are stored in pain medicine archives at the University of California, Stanford and McGill universities.
COVID lockdowns and border closures meant I couldn’t travel to these archives before the biography was published, but I’m visiting them next May and will incorporate them into the updated version of the biography I’m submitting for my doctoral dissertation.
The Sydney Uni historian Barbara Caine suggests for today’s readers, ‘It’s not the light shed on the lives of powerful individuals which is most important, but rather what can be learned from the lives of less exalted and ordinary people.’
A patient’s view
Knowing today’s readers are more interested in how a subject’s journey affects ordinary people rather than how ‘prominent people shaped events,’ I interviewed several of Michael’s patients because the vision driving him was reducing their suffering by improving the treatment of pain. I wanted to understand how his patients experienced him, hoping it would shed light on his values, motivations and behaviour, and why he drove himself so hard despite the toll it took on him.
To give you a sense of the way Michael’s patients experienced him I’ve pasted below the closing scene of Breaking through the pain barrier. It involves Symantha Liu, one of Michael’s many patients who live with chronic migraine:
Symantha Liu’s most vivid memory of Michael involves a hospital ward and a tuxedo. She’d been suffering from a cluster migraine for several days when the pain became unbearable. Michael admitted her to Royal North Shore Hospital, and at one point, the pain was so bad Sam begged the nursing staff to knock her out.
‘The migraine was impacting my vision,’ Sam said, ‘and I’d never felt so vulnerable. I thought death would be better.’
A little while later, Sam felt a gentle hand on her shoulder and heard a soft voice say: ‘Sam, it’s me, Michael Cousins.’
Through her tear-stained eyes and blotchy vision, she struggled to make him out. Slowly, a man wearing a dashing dinner jacket and with dapper silver hair came into view. He was almost luminous, and in her state, one thought came to mind.
‘Am I dead, Michael? Is it really you?’
Michael chuckled quietly and told Sam he was still beside her and not to worry. She asked him why the hospital had disturbed him if he’d somewhere important to be.
‘Whenever I feel one of my patients has reached a migraine crisis,’ he said, ‘I can only feel better if I lay eyes on them for my own peace of mind’
Symantha says this is the measure of the man. ‘For me, forever, a saint on earth.’
Michael’s two great loves are his family and medicine, and he is happiest when his family is together at home in Palm Beach. Throughout his career, he loved the thrill of a new medical discovery, but most of all, he loved helping people better manage their pain and reduce its impact on their life.
In closing, the choices I’ve explored with you are just the tip of the iceberg and there are countless more that time prevents us from looking at today. But what I can say is that my questions and choices fall into four key categories:
Biography Choice # 1
The first was deciding how to write Michael’s biography so that it captured his passion for science, pain medicine, his patients, and his family. I also needed to portray the essence of scientific wonder and its centrality in his life.
To some biographers, unlocking the Eureka moment is so important they focus on it exclusively rather than writing a three-dimensional portrait of a whole person. But I wanted to strike a balance between portraying Michael’s public and private lives, the second category of choice.
Biography Choice # 2
Patrick White’s biographer, David Marr, believes the ‘potency of biography is its compelling intimacy’. To achieve this intimacy, the Oxford scholar and Virginia Woolf biographer, Hermione Lee, urges biographers ‘to get behind the public performance and show us the real person at home in his undress’. But is this possible? Virginia Woolf claimed: ‘biographers pretend they know people,’ and several scholars argue biographies create an illusion of intimacy, rather than real intimacy.
So to what extent can biographers truly get to know their subject and how should they balance all aspects of a person’s life? This question lies at the heart of contemporary biography and would fill a library, so time doesn’t permit us to explore it, but it does take us to the third category of choice.
Biography Choice # 3
The third category of choice involves the many challenges faced by biographers of the living, particularly issues around privacy and security, ethical choices about disclosure, and potential legal disputes, to name a few. Some scholars argue that biographies of the living are not ‘true biographies’ because history, by definition, is concerned with the past and so the concept of writing about a living subject who is ‘not yet a part of history,’ is contradictory. These ‘purists’ insist it’s not possible to attain proper scholarly distance or rigorous historical analysis with a living scientist.
However, when a living subject trusts a biographer and opens up to them about their innermost thoughts and feelings, their biography has the potential to reflect a much deeper, nuanced philosophical and psychological portrait than would otherwise be possible.
Living subjects also open doors for biographers and provide vital historical documents that might not be stored in an archive. Interviewing a living subject enables a biographer to observe their gestures, mode of speaking, body language and mannerisms, providing a glimpse into the subtle things that ‘make up an individual’.
Biography Choice #4
This takes us to narrative strategy, the fourth category of choice, because it’s key to how a biographer translates observations into a captivating narrative. Choosing a narrative strategy involves decisions about structure, narrative voice, pace, rhythm, word choice, interpretation and the use of fiction techniques.
The power of storytelling depends on how a biographer chooses to capture a subject’s distinctive characteristics and sculpt a perfect likeness, bringing a subject to life and keeping the reader sitting on the edge of their seat, wondering what happens next.
While choosing the ‘right’ narrative strategy can involve years of trial and error, I learned that it’s fine to try one approach, assess it, then discard or rewrite it, no matter how many drafts it takes.
I took comfort from Virginia Woolf’s admission that one of her letters to The Times went through 27 drafts! So did Kate Grenville’s biography of her mother, Nance Russell.
As I end, I want to reassure budding science and medical biographers that while these choices might seem overwhelming at first, making them is tremendously exciting.
Please don’t let them put you off, because biography enables the biographer and reader to better understand themself and the human condition.
It’s also exhilarating, especially when you uncover the missing gold nuggets that unlock the meaning of a life.