Oh, the pain!

October 8, 2010

Physician recounts becoming a patient in addition to his doctor status, following an ice skating adventure that involved an arm injury.

Key Points

I rolled off the arm and looked at it with almost detached curiosity. It looked like a bayonet. It hurt a bit, but so many other thoughts competed for attention just then that pain was only a low-level part of the experience.

I pulled my arm out straight without hesitation, and then I felt faint. I had to lie flat for a couple of minutes, arguing with the bystanders, all of whom wanted to call an ambulance. My sweaty clothes started to freeze to the ice, so I gathered myself up and got to the exit. I felt swimmy again, however, and spent another 3 minutes fending off anxious do-gooders from flat on my back.

RATING THE PAIN

After the usual history-and-registration ice breakers, the very next question was "How would you rate your pain?" I said "4" (on a 0 to 10 scale.) Everyone there smiled or laughed out loud in disbelief, with innumerable examples in mind of whiny patients with hangnails rating their pain as 10 or 20. Here's a guy with a broken arm, and he says "4."

But I was not being facetious. The rating is supposed to be scaled from 0 being "no pain" to 10 being the worst pain you can imagine. My pain at that moment was unpleasant, and I didn't want it to linger much longer, but I could imagine much, much worse. As it turned out later, my imagination was not even close to being up to the task. Much, much worse was in store for me.

They started an IV after 1 missed attempt, required for all healthcare personnel. Ouch. Now that hurt, but just for a few seconds. Then a few more seconds of pain after the obligatory second effort. Then they asked the only question that mattered: "Do you want some pain relief?" Sure did. That "4" was no fun for the long haul.

The next shock was how little IV morphine did to relieve the pain. Twelve milligrams later, I couldn't tell any difference. I turn out to be not very sensitive to morphine, but a healthcare provider caring for me might wonder whether he didn't have a covert addict on his hands, considering how much of the drug I had on board, with such little relief achieved.

But the real aggravation was the persistent efforts of the nurses to put a number on it. What was up with that? I know damned well what was up with that-political correctness, written into a federal mandate by the Joint Commission.

Long ago it was recognized that we doctors do a lousy job of relieving pain, despite the availability of generally effective medications. Why is that? It should be axiomatic that the essence of doctoring is the relief of suffering. We have the tools, we have the knowledge and even the desire, but the patient feedback doesn't lie. We're not good at relieving pain. But why? What are the barriers?