Wednesday, January 21, 2009

Take Me To Your Pain-O-Meter.

First of all, if you notice any contradiction between this post and one a few days ago, you are cordially invited to shut the hell up about it. Anything you read on my blog is correct at the moment you’re reading it. (Yeah, you heard that right! This blog’s accuracy is fully dependent on the moment when you are reading it, not the moment when it was written. Live with it.)

I got my first pair of eyeglasses when I was three or four years old. (Why, yes, I was adorable, thank you very much.) At that appointment and at every other optometrist's appointment since then, I’ve gone through the portion of the exam where they keep flipping back and forth between two lenses and asking “Is this one better…or this one”? And I’m always sure I’m going to get it wrong. I mean, they’re the ones who went to Eye-Doctor School. Who the hell am I to tell them when they’ve got it right?

I complained a few days ago about doctors who, more or less, ignored my presence in the room so they could discuss me like a specimen under a slide. Today, I’m going to complain about the ones who care too much about my opinion in the whole thing. (I’m contrary that way. Live with it.)

Let’s start with the part where they’re pressing and patting and prodding different parts of you and asking, “Does it hurt here?” Well, everything is fine as long as you keep expressing pain where they expect you to. Then, all of a sudden, you rebound and cringe from one particular prod and they say “It hurt there?” And their look utterly screams, “OMG, OMG, OMG, it’s not supposed to hurt there and there…is it?” And you’re left lying there thinking, “Oh, crap. I failed the test.”

It’s my understanding that during my first few days in the hospital, they just kept me doped up on morphine and I may have missed a lot of what was going on. Then, they switched me to another pain medication and the instruction was that I could have it as often as once every four hours, but only if I asked for it. These were both fine situations as far as I was concerned. Then they switched me to yet a different pain-killer, but the new wrinkle was that when I requested it, I was asked to rate my pain on a “one-to-ten” scale. WTF? I was supposed to study?

The truth is, I had a whole lot of difficulty rating my pain on a “one-to-ten” scale. I mean, just think about it! That’s an awful lot of pressure for some schmuck whose gut hurts and all he wants is to get back to sleep.

Well, as a public service, I’m going to advise you on how to react to these questions if you find yourself in a similar situation sometime down the road.

First, and most importantly, you need to be aware that it’s totally a trick question. Let’s dispense with the top of the pain chart.

TEN is reserved for situations in which someone with access to heavy-duty painkillers takes one look at you, says, “Oooh gross! I don’t think that really belongs there”, and decides that anyone with their parts rearranged thusly, is probably in pain. You will receive painkillers with nobody's request or explanation required.

NINE is reserved for people screaming incoherently. Once again, it's likely you have some parts in places or positions not usually considered correct. The major difference here is that someone in charge requests enough pain-killer to quiet you down. Altruism is not the major consideration here, but once again, your own expressed wishes are not required.

EIGHT is reserved for people similar to William Wallace at the end of Braveheart, being shown his own entrails. In a modern version of the movie, he would have screamed “Morphine”, not “Freedom”. (Note: This is the only Mel Gibson movie where he scores a solid Eight. In the Lethal Weapon movies, I doubt he ever gets higher than a Six.) This is the lowest level of pain where you can express a need for the the heavy artillery and be believed without question.

Note that in each of the above cases, standing with a nurse and contemplating your pain level is neither an option, nor anything that might be expected of you. You’ve made it clear that you are in great pain, and the pros just want to alleviate it. Yay, pros.

At the other end of the scale, is what I’ll call, S.I.U.A.Y.G.A, or Suck It Up Asshole. You Get Aleve. This is what happens if you respond that your pain should be rated a One, Two, or Three. I won’t describe One and Two, but Three is pretty much Homer Simpson hitting his thumb with a hammer. No Percocet for you!

Which leaves us with Four through Seven. These are the only answers available to you when you’re asked about your pain level. Use too low a number, and you get an Advil…too high a number, and you’re clearly faking.

SEVEN is the most important one to be aware of. Think Dustin Hoffman in Marathon Man. Laurence Olivier has been drilling your teeth without any anesthetic and asking you questions to which you don’t know any answers. This is a pain you can imagine. You can also imagine looking pleadingly at the nurse while begging for morphine. I think she'll believe you.

FOUR, FIVE AND SIX are actually variations on the same theme and somewhat interchangeable. Any Looney-Tunes cartoon in which one of the following occurs, rates one of these numbers:

a.) Daffy Duck’s bill ends up spinning around his head and or lands at his feet.
b.) Any character is hit in the face with a cast-iron pan which takes on the shape of his face.
c.) Any character is fired from a cannon and leaves a perfect silhouette-shape of their body in the wall. (Note: Only counts when fired from cannon. Purposeful escapes through a wall that leave the same shape do not inflict the same pain.)

So, basically, when a nurse asks you to rate your pain before giving you your meds, you’re limited to Four through Seven…and only use Seven if you’re having trouble articulating it.

P.S. Kindly refrain from sending me rabid comments about how I don’t know pain and I shouldn’t be making fun of people who might have chronic or acute pain. That’s kind of the point, after all. If I want to know how firm of a bed I should be sleeping on, I can check out that “Sleep Number” bed that Lindsay Wagner’s always hawking and figure out what my sleep number is. (And who doesn’t want a bed sold by the Bionic Woman?)

I’m not aware of (nor would I want to participate in), some test at the hospital that lets me more accurately rate my pain so that my charts can be filled in more accurately. "You say, that level of slamming a door on my foot rates a Six? OK, put me down for 5.75."


Jeff Hentosz said...

Well done, sir. I nominate it for Polybloggimous Post of the Year! Ah, what the hell -- Winner! (You could very well be doped the next 10 days.)

Here is a pain chart I've been handed a few times. You may find its scale doesn't entirely sync with yours. I'd love to see a graphic of yours.

Random Michelle K said...

I was actually pondering that for the past couple weeks.

Pain is completely subjective and will be different for different people.

For instance for me, a 9 would be the migraines I got in college--the ones where I was quite certain I was dying because something exploded in my brain. Nothing has come even close to that since then (thankfully), but because of that I'm always shocked when someone who is coherent and capable of movement claims their pain is an 8.

Really? Are you kidding me?

So when asked that, I want to say, well, if nine is a migraine and four is that-time-of-the-month cramps, then this is definitely a five or something like that. A number without context for the individual doesn't make much sense to me.

Maybe they need a chart like, one is a splinter and ten is having your skull broken open or an appendage ripped off. Compare and contrast.

Some dude stuck in the Midwest said...

Can you describe the pain in images to the medical staff?

You know that feeling the Martian gets when he burns himself to a crisp with his own ray gun after failing to kill the pesky rabbit or destroy earth? - 8

You know that feeling Scratchy gets at the end of every itchy and Scratchy episode? - 10

That's it.

vince said...

Jeff, I've been handed that pain chart. I've never found it very useful.

Michelle, I agree. Context is all.

Konstantin, I am totally using that scale if I ever have to describe my level of pain again.

Tania said...

I'm always amused (and I shouldn't be) by the faces on the pain chart. I know they're there for use by people with limited communication and/or literacy skills, but they still make me snort.

Janiece said...

And it's Nathan FTW! I'm using the "William Wallace" scale the next time I'm asked this question.

Steve Buchheit said...

When I shattered my fibula and displaced my ankle three inches, the doctor couldn't believe I walked up stairs to my house with it that way. Until all the witnesses said I did. Then I said that it wasn't a steady walk and that I didn't lean on the railings pretty hard.

I said I was at 7-8, until the doctor that became my orthopedic surgeon use a 3" needle to inject three shots of novocain deep in my ankle to reset it. That was a 10, you know, until the novocain took hold.

MWT said...

Here's a function impairment version of the pain scale, as described by a friend of mine who does have chronic pain:

1 = no pain
2 = that headache you don't realize you have till you take an aspirin
3, 4 = sprains, a stubbed toe will bop up into six to eight for one instant and then immediately dull to a throb. Ice cream headache.

Pain level six. I'm starting to get a bit impaired but can function pretty well.

Pain level seven there are mistakes in things, and I'm not really able to handle remembering numbers at all or things like that.

Pain level eight is pretty severe impairment. That's a day when I'm not doing anything but playing Diablo.

Pain Level Nine: Extreme impairment, involuntary tears. Needle up the nose will do it.

Pain Level Ten: Total impairment, suicidal ideation, I would only do anything if I had some overwhelming (survival) reason to do it

Pain 11 = Total hypnotic disorientation. Thats a point you can feel your mind crumbling.
whole parts of the self sloughing off
dying inside
mind you that was specifically under that kind of pain plus psychological attack
Because you would do anything to make the pain stop. Or nearly anything.
That is when you find "the last inch" [of self] ... that won't crumble under that onslaught

neurondoc said...

I was one of those annoying doctors on a regular basis, to be honest. And I would give only moderately useful directions. "0 is no pain. 10 is the pain you'd feel if a passing bear rips your arm off (and eats it...)." Helpful, eh?

Jim Wright said...

The last VA doctor I saw asked me, "how would you rate your pain?" My answer was, "All the time." Of course, that wasn't the on stupid scale.

I only have two settings on the Pain-O-Meter: functional and non-functional.

mattw said...

The hospital by us uses a chart similar to Jeff's but ours is all colorful and stuff. I can't remember though if the face by 10 was deep red or purple.