Medscapades, Vol. II
I work in hospital settings. Sometimes wacky stuff happens. Names and details have been altered to respect privacy.
Volume II: Pain Management
The vast majority of patients who come in the doors of a hospital have some sort of pain that needs to be addressed. Whether it be traumatic, surgical, or insidious in nature, pain, and the desire to improve on it, is pretty much everywhere. But really, other than for routine checks, why else would someone be consulting a healthcare provider? Something is wrong with my body. Please fix it.
They tell us time and time again in our schooling and competencies that the most accurate indicator of a patient’s pain is what they self-report. Over time, I’ve come to accept that this is probably a true statement, but I’ve done so begrudgingly, as it in no way addresses a bigger issue – a surprising amount of people have a surprising amount of trouble accurately self-reporting pain.
At some point in your life, you’ve probably been instructed by a doctor or some other professional in a similar realm, “On a scale from 0 to 10, rate your level of pain.” You may have come across a written scale as well; a smiley face on one end and a frowning one on the other. It seems pretty self-explanatory. And yet, the volume of people I encounter on a weekly basis who have no clue how to use it is remarkable.
I’ve asked and explained the question so many times that my spiel is pretty much burned into my subconscious at this juncture. It generally goes something like this:
“Now I’m going to ask you to rate the pain in your [body part/area]. On a scale from 0 to 10, where 0 means no pain at all and 10 means the most pain you’ve ever had in your entire life, what number would you give your [body part/area] right now?”
And then they give me a number. Sometimes it happens like this:
Me: So using that scale I just described, what would you say the pain in your shoulder is?
Patient [dramatically]: OH MY GOD FIFTEEN!!!
[Pause]
Me: Okay. Let’s try that again, except this time I want you to try to use a number that’s actually on the scale.
Or this:
Me: Using that scale, what would you say your knee pain is?
Patient [crossing legs, calmly]: Ten.
Me: So you would say that right now, you are experiencing the worst pain that you’ve ever had?
Patient: No.
Me: Okay, because you seem to be pretty relaxed. In that case, what would you rate the pain as right this moment, just sitting here and talking with me?
Patient: Ten.
[Facepalm]
Or this:
Me: Do you understand the scale I just described?
Patient: Yes.
Me: Great. Can you rate the pain in your hip right now?
Patient [reclining in bed, intently watching Maury]: Eleven!
Me: The scale only goes from zero to ten.
Patient: Well, it’s an eleven, but I guess I’ll say ten.
Me: So it’s the worst pain you’ve ever had, ever?
Patient: Yes.
Me: You’ve never had more pain than at this very moment?
Patient [annoyed]: Yes.
Me: Worse than childbirth?
Patient: BOY, what do you know about childbirth?
Me: I know it hurts.
Patient: Well, it’s not worse than childbirth.
Me: Okay so then what should I put your pain level as?
Patient: Ten!
I wouldn’t be such a stickler for accurately interpreting the scale, except that oftentimes there are protocols in place based on that misguided numerical response. Choosing between 5 or 7 can mean the difference between an alleviating, appropriate dose of narcotics or a double-Vicodin, snowed-out slumber. At 9 or 10, we’re frequently told to call the attending physician since this would indicate the patient is having a medical emergency. You know, the same patient who is now peacefully napping as I’m waiting for an answer to the page I just sent. These cases are obviously not the norm, yet they occur at a high enough frequency that I keep thinking there must be some sort of acceptable alternative. But there never is.
And then, there are moments like this.
I walked into a middle-aged man’s room on the post-surgical floor. A rod had been placed in his femur a couple days prior to stabilize the bone he had broken from falling off of something. He had yet to get out of bed since the surgery, and it was my job to get him up to the recliner sitting nearby. We went through a basic assessment, and then it was time to get to the edge of the bed in preparation for the transfer.
“Okay, I know you don’t have enough strength to lift your leg on your own, so I’m going to put my hands underneath it and help guide it in the direction we’re going. You worry about everything else; I’ll worry about your leg. Got it?”
“Yes.”
“All right, so I’m just going to slide this hand under your knee, and – ”
“BAAAAAAHHHHHHHHH!!!!!!!!”
“Sir, I haven’t actually touched your leg yet.”
“Oh. Okay.”
“So what I was saying was that I’m going to put my hand under your knee like this and then – ”
“
At this juncture, a crowd of nurses had gathered at the door of the room, likely assuming the patient was actively experiencing stigmata. When they saw me, their objective presumably shifted to locating the murder weapon. I explained the situation to them and instructed them that I was going to shut the door, and no matter what they heard, to not open it. This probably sounded like I was going to emerge from the room as the Green Goblin or Captain America or something, but really, I just wanted the guy to get out of bed. I told his primary nurse that I’d hit the call light when we were done so she could come in and give him something for pain, since he was due for more medication shortly anyway.
The cursing, screaming, and threats to my family continued, in addition to wild flailing and faces reminiscent of an Edward Munch painting. But through it all, we managed to make it to the recliner. I helped him to get comfortable, and pushed the call button to summon his nurse. She arrived and asked if he would like any medication for his pain.
“Oh I’m not having any pain right now.”
…
o_O
…
So…a ten?