John J. Bonica, 1917-1994 - Interview transcript
"I had made up my mind to be a champion....every, anything I want done, I would have to do it." (Tape I, Tape II)
As a young man in an Italian immigrant family, left fatherless at the age of 15, John Bonica learned to be tough, resourceful, and self-reliant, particularly from his redoubtable mother. As a teenager he worked in a grocery, had a paper route, and sold peanuts at ball games to help support his family. He became a carnival wrestler at 19 and supported himself throughout medical school, sometimes wrestling 36 bouts in one day. His fiancee, Emma, sold tickets to his matches, chaperoned by John's mother. They were married in 1942, the year he received his medical degree.
"I would touch the lady's face and almost fall in love with the lady to make her feel quiet....I wouldn't leave the patient unless I was satisfied that I couldn't do any more." (Tape II)
John Bonica's empathy with his patients and his passion for their comfort became apparent during his clinical clerkship. He devoted himself to relieving the suffering of women in labor, old people, and other patients whose pain was not a high priority for most doctors. Under the care of a conservative obstetrician and an inexperienced anesthetist, Emma experienced anesthesia complications during her first labor, and went into spasms. Although John, like other physicians, was enjoined from treating his own family, "I said to hell with this rule....I picked up the tube....and saved my wife and my baby." (Tape II)
I was very anxious to, first of all, sell the specialty and secondly, I wanted to sell obstetric analgesia and regional anesthesia." (Tape III)
As head of Anesthesia at the Madigan Army Hospital in Washington during World War II, Bonica was "ordered to handle pain control." He embarked on a personal intensive research program, including original dissections, extensive reading and
correspondence with other physicians, and the compilation of more than 2000 case histories, recorded on punch cards. He taught himself to do spinal and epidural nerve blocks and investigated new procedures and techniques. In 1953, he published "The Management of Pain.&quit;
The pain clinic was "a totally different thing, much more fruitful and efficient....the basis of my program is patient care; the frosting is the research." (Tape III, Tape IV)
At Madigan, Bonica had "cases that baffled me.&quit; He sent the patients for consultations with colleagues: an orthopedist, a neurosurgeon, a psychiatrist, but "they knew less than I did."
He proposed that the four meet twice a week at lunch for conversation and exchange of information on difficult pain problems. This was the genesis of the Multidisciplinary Pain Clinics which he developed at the Tacoma General Hospital (1947) and at the University of
Washington in Seattle, where he became Chair of Anesthesiology in 1960. By the 1960s, Bonica's work was known all over the world. His was one of only five Anesthesia Research Centers of Excellence funded by the National Institutes of Health. He served as president of
the American Society of Anesthesiologists and of the World Federation of Societies of Anaesthesiolgists.
"I was about to give up....I got good response but nothing happened. Everyone thought, pain is a simple disease, and that's it." (Tape III)
Despite his fame and success, Bonica became discouraged by the lack of enthusiasm for major research programs and clinical initiatives in pain control. He was somewhat heartened in 1965 when Melzack and Wall's gate control theory sparked interest in the problem. In the fall of 1972, the National Institute of General Medical Sciences promised funding for an international pain meeting. Bonica invited researchers and clinicians "from the periphery to the top" of the embryonic pain field. He enlisted 25 key supporters for his plan for an international pain organization. When budget cuts reduced his promised NIH funding from $100,000 to $10,000, he raised more than $90,000 in 3 weeks. Bonica opened the International Symposium on Pain, May 21, 1973, at Issaquah, Washington, with these words, which summed up his commitment and his passion: "Pain is a major human concern, influencing every
aspect of life."
"You know, it had come from my experience in the army. I said, 'you know, pain is not neurology.' The
neurologists think that pain is their domain. And it's not. And it's not psychiatry. And it's not.... It's everybody. And I said, 'what you need is, people could talk.'" (Tape IV)
In pain control, John Bonica recognized a clinical need -- one which engaged his intellect and his compassion. With tenacity, dedication, and drive, he sought out the scientific expertise in every field which could contribute to the solution of the great problem of pain and created the fora where that expertise could be developed and enriched through free exchange and debate. These -- and his great dream -- are his legacy to his "famiglia."