Last Friday, my surgeon called and asked me to come see him at 1:30 pm today so we could go over the recent biopsy results of the fluid removed from the mass in my chest. In early December, I had a huge cyst that spanned from my breast/collarbone to my sternum/underarm drained and biopsied. The interventionist radiologist removed 360cc of fluid. I IMMEDIATELY felt relief — all praise be to Asclepius.
The nurse came out to the waiting area and called my name. Someone new. “Where’s MY nurse . . . dammit, I have no time to train a new one,” I thought.
Into the room, we went. I could hear my doctor talking to another patient next door. He seemed in a good mood, but then he always seemed that way.
The nurse took my blood pressure and pulse. Then she asked, “Are you in pain today?”
If there is one question that raises my hackles, it is this one. “Can’t you read my chart? See right there where it says the patient has fibromyalgia, osteoarthritis, nerve pain, and is on narcotic pain management. Pay attention.”
For a brief snarky second, I wanted to say, “Praise Jesus, I went to a Benny Hinn Miracle Meeting® on Saturday, and God healed me of everything except the cyst that is growing again in my chest.” Instead, I said, “Yes, I am always in pain.”
Then the nurse asked me another question that I despise answering, “On a scale of one to ten, what’s your pain level?”
I replied, “I hate pain charts. Pain charts are subjective, a waste of time.”
I got the “look,” you know that look that says, “Give me a fucking number so I can enter it in the proper box on your chart.”
I replied, “six.”
Hell, it could have been ten or three or twelve. By what standard am I being asked to judge the level of my pain? Such a silly way to determine pain levels and what, if any, treatment is appropriate.
The surgeon entered the room with a medical student in tow. We traded a bit of chit chat and then moved to discussing the biopsy results and his recommended course of treatment. I told him the cyst had returned and was growing larger by the day. I stood up and had him feel the cyst. I turned to the medical student — a woman — and asked her if she would like to feel the cyst. She said, “yes,” and proceeded to put her hand above my right breast. The surgeon had her feel above the left breast too so she knew what normal felt and looked like.
The surgeon told me that removing the cyst could be a difficult operation due to its proximity and depth. His suggestion was for the radiologist to drain the cyst again and then inject it with a sclerosing agent. Hopefully, this procedure will stop the fluid from accumulating again.
The surgeon asked Polly and I if we had any questions. Both of us said, “no.” He then asked Polly how she was doing and if she was scheduled to see him soon (he is the doctor who will be reversing her colectomy). Polly answered in the affirmative. The surgeon and his student left, and my regular nurse came in to talk to me about scheduling the procedure. Hopefully, I will have it done in the next fourteen days.
The surgeon? He had left the office after seeing me and quickly made his way across the street to the hospital. Waiting for him was a young girl who needed emergency surgery.
What is your opinion of pain charts? Please share your thoughts in the comment section.
Bruce Gerencser, 67, lives in rural Northwest Ohio with his wife of 46 years. He and his wife have six grown children and thirteen grandchildren. Bruce pastored Evangelical churches for twenty-five years in Ohio, Texas, and Michigan. Bruce left the ministry in 2005, and in 2008 he left Christianity. Bruce is now a humanist and an atheist.
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I despise the pathological need they have to fill in all their little blanks and boxes. It’s aggravating and a waste of my time. And theirs, really. Imagine if they actually listened to your answers and cared about what you’re saying! If they actually SAW you.
Pain charts are utter garbage. I had an evaluation by a physical therapist today prior to getting some PT. She asked about pain on a pain scale. I’ve figured out what numbers to say to convey whether something is worrisome or not to the medical people, which means I often pull them out of my rear end. Gah.
In some ways, pain charts are useful. When my son was 7, he broke his arm. The pain chart helped him tell the doctor how much it hurt, in a language a child understood.
But like you, I find them frustrating. I just want to say “Where?” Today, for example. I had a really weird sinus headache this afternoon. Pain level was 3 but nausea level was 6. Tonight my back hurts from sitting too much, so that’s about a 4 — after a glass of wine. But telling pain levels by zones doesn’t fit on the charts.
Maybe the pain charts should be based on how many glasses of wine it takes to get relief. ?
I think pain charts serve the useful purpose only of comparing your own pain levels day by day. My number 6 would probably be your number nothing, but if the following day I was number 7 then that is perhaps telling.
I’m so sorry you have yet more health problems. This sounds weird, but I have a sort of self-diagnosed number dyslexia and numbers are tricky for me. I work hard to hide it and managed to teach maths to 5-7yos in my career but would soon been out of my depth much above that. I must be one of the few people in the world who can’t remember any phone numbers. I’ve not had to describe pain numerically in any illness I’ve had, but ponder what I’d say…as a language nerd, a proof reader for others, i could use some very accurate adjectives to describe my pain, but saying ‘6’ would be meaningless for me. Best wishes for successful treatment.
For me, I’m a 10 every day but there is a difference between a 10 and a brutal 10. A brutal 10 is giving birth. When I reply, giving birth would be less pain, then we know I’m at brutal and above. I get some unsatisfactory looks when I respond: “I’d rather be giving birth right now than feel this pain.”
Pain scale was invented to put numbers to a subjective experience. It gets worse. Sometimes doctors are pressed to write pain med orders to match pain scale numbers. It’s never the doctor’s idea. So the patient said her pain was an 8. That calls for some Percocet. Except, she doesn’t want that right now. She’s going to PT. Right now she has orders for the Advil she wants if her pain is a 4-5. We ideally don’t lie, but in not lying I have to call the doctor for permission to give the Advil. I went to nursing school for what? Plus by the time I made that call the patient was already in PT and uncomfortable. Yay pain scale orders! after all that rigamarole she opted to finish the PT and take the Percocet after all.
My argument is that I should be able to choose, with my patient, among the pain control options ordered by the doctor. I do have a brain and I did go to nursing school!
I have a high pain tolerance but a low tolerance for irritation, so I don’t know how to answer.
I hope that your procedure helps with the cyst.
I don’t think they are completely useless. They could also be used to see if your pain has increased or decreased.
Yeaah. Pain charts are not useless, but don’t give a complete picture. Sometimes I’m okay overall, maybe a 3, when parts of my body may be 5 or 6. Sometimes when overall body pain recedes areas of pain feel worse. I hate filling out pictures to show where I have pain, because I have to shade everything!
PS–I have a WordPress account through Facebook. But I’m not seeing where I can check to get new comments without commenting.
When asked if I’m in pain I say, Yes, but that’s not why I’m here. Of course, they push for a number so I give them one. It doesn’t matter. It never comes up with the doctor. At least they’ve stopped with the paperwork that asks if I’m depressed or if I’m safe at home. They must have figured out that wasn’t working. Such invasive bullshit. And I always lie about drinking. None of their gd business.
If I go to emerg with chest discomfort (I have heart stents) and am asked for a level of pain I am feeling, I gauge that of course by my own standards of pain, one to ten. Generally, it is said that women tolerate pain better than men, so I guess a woman’s 6 might be my 8 but my point is that we are giving ourselves ratings from our own understanding of the scale, our own experience. Two men will probably also assess their pain levels in completely disparate fashion. Christians who deserve to suffer as rotten sinners who continue to sin, might feel a 6 pain and state it as a 2 because they are afraid that God might get more angry and really whack them if they are not quick to repent and accept a good spanking from Him. It’s all a personal translation and a unique transaction between the pro and client.
If I was an emerg nurse and somebody barked at me when queried, I would assume that might be part of some evidence of a pain level that has reduced a client’s tolerance but it could be that the asshole is a personality disorder who has been trained to be a jerk with others. Who knows at first, two strangers suddenly together to figure out a crisis?
Now if I saw Gerencser coming in again with pain complaints and I was the nurse (maybe a nurse with a personality disorder!) then the exchange might be jagged when it came to 1 to 10. “What is your pain TODAY, Gerencser?”
Gerencser: “Sigh”
Nurse: “High?”
Gerencser: “SSSSigh!”
Nurse: “I need a number, Gerencser.”
(and so forth…)
For me, I don’t mind being asked for a number from one to ten. It beats the hell out of: Does it hurt or really sort-of hurt or what? Triage is a place where expedited assessment is necessary and I think the pain-scale helps in moving the patient along to the doc. What bothers me more than the pain-scale is lack of empathy. I know how hard it is to work in an emerg with one crisis after another and so much pain in the room. A bit of human caring, a smile or a nod… some sign of connection and caring makes all the difference to me.
I found the pain charts very helpful when my husband was in the ICU following his triple bypass. The number isn’t one size fits all, but if he said he was at a 4, they knew HE was able to tolerate it at that time. If he said 8, it was time for meds. For myself, when I presented to the ER and told them I had stomach pain at 9.5, they immediately did an ultrasound that diagnosed gallstones. Without the scale, I’d have had to somehow convey to them some other way that it fucking hurt a lot!!
I have a high pain tolerance; I’ve learned to work with it. But my 3 might be somebody else’s 8. Unfortunately, until the Vulcans come and teach us to mind meld, the pain chart is all we got.
I too have fibromyalgia and I have had disc surgery on my back at L5/S1. I am also in pain every. Single. Day. I never feel like the questions they ask about pain in reference to the number scale are enough. It is all subjective. My pain compared to what? I don’ t remember what it feels like to have no pain. Today might be a good day, that doesn’t mean that when I wake up tomorrow I won’t feel like I have been hit by a bus. Besides, even if I have had worse pain, the pain I am dealing with now can seem just as bad because it is affecting me in the present. I also hate it because I feel like it is used as a judgement tool. Say a number that they think is too high and you are a drug seeker. Say a number too low and they brush it off completely and feel treatment isn’t necessary.