Garth Greenwell: ‘Physical pain is as universal as a human experience can get, but very little has been written about it’

In 2020, in the middle of the pandemic, writer Garth Greenwell, 47, experienced a serious illness that led to him being hospitalized for several days. The same thing happens to the protagonist of his latest novel Small Rain, who is of the same age as and closely resembles the author.

But with first-person memoirs now proliferating and often treated as inherently truthful, Greenwell warns that Small Rain is a fictional account. His real-life experience is not the point — it’s really about what happens in the pages.

“The necessary condition for conceiving of a book is bewilderment,” he explains. “And even though this book is not memoir, it is not an autobiography, because it’s full of invention and made up things, I did go through and experience something like what the narrator does, an unexpected medical crisis, and found myself utterly bewildered by it.”

That bewilderment, at first, overwhelms the reader as well. The opening pages are a descent into hell. The vascular disease that the protagonist suffers is terrifying. Greenwell describes in detail every test, every symptom, every moment of panic. But at the least expected moment, in the middle of a medical examination, the text — claustrophobic and dense — begins to soar, to fill with light.

And the magic isn’t due to tired life lessons, but to a literary technique that shows care, precision, talent, and a love of the craft as a way of understanding life. Understanding life, ultimately, is what matters most to Greenwell.

“The reason we have art is that there are questions or situations that are so complicated that they defeat all our other tools for thinking. We can’t logic or argue our way out of them,” he says. “I need the formal resources of art, the pressure of syntax, the possibilities of scene, the possibility of invention. All of those things are the tools I need to try to think about a question that is too big to think about. Like the question of our mortality, of our finitude, having to confront not just the possibility, but at a certain point, the likelihood of death much earlier than one had expected.”

Small Rain is a cathartic book, but not for the obvious reasons. It won the 2025 PEN/Faulkner Award for fiction and has been applauded by critics as the crowning achievement of an author who already had a healthy number of readers. It could also be said to mark a shift in subject matter. In 2016, Greenwell published What Belongs to You, a story of a relationship between an American and a sex work in Bulgaria. In 2020, he released Cleanness. The New York Times wrote that no one writes about sex better than he does — but now, he’s shifting his focus to physical pain.

“Unlike psychological pain, spiritual pain, romantic pain, which has this incredibly rich literature, about physical pain, there’s actually very little,” says the author, who cites Virginia Woolf’s essay On Being Ill as a rare exception. “It is as universal as a human experience can get. People often say that pain is impossible to write, in the same way that they say sex is impossible to write.”

He continues: “I just see that as a challenge, something that interests me as a writer, I’ve always been interested in the body in crisis. Desire, sex is one kind of crisis. Illness and pain are another kind of crisis. When I was in the hospital, I was fascinated by the kinds of asymmetrical relationships that form between the patient who is undergoing something utterly unique and life-changing, and the doctors and nurses who are keeping him alive, for whom he’s part of their job.”

In Small Rain, those relationships, the daily existence of a man who can barely get up to go to the bathroom on his own during his stay in the intensive care unit, also shed light on the everyday reality of the hospital. Beyond the walls of his room, there is a pandemic, and the first news of the Black Lives Matter protests begins to arrive. Within a healthcare system hanging by a thread, there are kind doctors and distant nurses, some of whom embody the “Midwestern nice”— marked by small talk and trivial conversations as an intuitive way of avoiding conflict. The narrator, a poet who has just bought a house with his boyfriend, a Spanish poet working at the University of Iowa, senses that many of them vote for Trump or hold views opposed to his own. The hospital is not a microcosm, but its walls are porous. And nothing depends on him.

“I would never write a novel with a political intention, although I believe art can meaningfully engage with political questions,” says Greenwell. “This book is like a Russian doll, this broken body in a broken house, in a broken country on a broken planet. I’m interested in how we respond to brokenness. The narrator has just bought a house that has been a complete disaster, and suddenly, they have neighbors in a way that they haven’t really had neighbors before. He lives in a very conservative state, he knows that some of his neighbors are Trump voters, but they’re still his neighbors. I feel very intensely that my country is on a precipice. The United States has always been a violent country, but right now there is a societal-level violence that utterly terrifies me.”

The story of Small Rain takes place during the peak of the COVID-19 pandemic, but it is not a pandemic novel. Apparently, after the health crisis ended, the fiction industry brushed aside the experiences of the past few years, as if they were poison for the box office. That, to Greenwell, says something.

“It is fascinating to me, this resistance to thinking about this huge thing that transformed our world, the consequences of which we’re only beginning to see,” he says. “People don’t want to talk about it. What is it that the pandemic showed us that we can’t bear to see? It simply — and this is the big question of this book — where does the meaning or the value of a life come from? In the United States, and I would say in the West more broadly, we have organized our society around the principle of refusing to acknowledge death. The great American writer James Baldwin argues that death is the only fact we have.”

Greenwell says that the state of alarm in which the majority of the planet lived from 2020 to 2022 is the perfect frame for a story like Small Rain. “What interests me about these particular weird, out-of-the-ordinary situations is that they reveal truths that are universal to humanness. In this book, those truths include our absolute vulnerability, the fact that at any moment anything can happen to us and that our will, our desires barely register. We are helpless in front of contingency — and also, our absolute dependence on other people. I think, certainly in my country, those ideas are horrifying.”

Greenwell’s writing is engaging, but it doesn’t grab you instantly. His themes are neither simple nor, seemingly, commercially appealing. “My first novel is about a guy who goes to Bulgaria, has a relationship with a sex worker and gets syphilis. Nobody would think that’s a great idea. Like, that’s going to sell like hotcakes,” he jokes.

But he does contest the idea that his books are for a limited audience. “Physical pain is as universal as a human experience can get,” says Greenwell.

The same goes for writing from a gay perspective. “From the beginning of my career, I’ve always been asked whether I worry that by writing about gay experience, I am putting myself in a ghetto or you’re cutting myself off from mainstream readers. I think that those questions come from a fundamental mistake about art. Yes, I am a gay writer. Yes, I’m working from gay traditions. Queer traditions of writing are not at the margin of literature, but are right at the center, with Baldwin, Woolf, Thomas Mann and Shakespeare. They are all at the center of tradition, not the margin. These particular stories are for everybody, because of that devotion to the particular. And that’s just how art works. Cezanne paints a particular apple in all of its particular-ness, and it’s because of that, that somehow he shows us something true about all of reality.”

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