Rate Your Pain

Pain is the 5th vital sign (after BP, pulse, respirations, and temp), according to what I was told in nursing school. Pain is an indicator of things gone wrong, and it's also ethically wrong to leave a patient in pain if it can be avoided.

At one of my jobs (head and neck), pain is taken very seriously, and strong drugs are prescribed on a fairly regular basis, because a lot of what we treat is cancer, which is very painful. At my other job, however, pain is often ignored, because some (not all) psych patients desperately want the high that pain meds can give.

Last night, we happened to have a patient with compartment syndrome. Of the four of us working, none of us knew what this was, so we looked it up. Compartment syndrome is a condition in which an area of the leg will be injured (possibly by having circulation cut off), and this results in chronic, long-term pain which is much worse than the condition seems to warrant...yet the psychiatrist had only prescribed Tylenol, and nothing stronger, so I had to make a middle of the night call to get her a stronger medication.

So we nurses started talking about pain, and pain ratings. Normally, we ask patients to rate pain on a scale of 0-10, with 0 being "none" and 10 being the "worst imaginable".

Most cancer patients rarely rate their pain as high as 10. Most psych patients rarely rate their pain as less than 10, perhaps because they are afraid they will not be taken seriously...or perhaps because they are desperate for the brief relief from reality that enough morphine or demerol will give them. And many psych nurses have no patience with people displaying med-seeking behaviors (and sometimes, they are mistaken, like with the compartment syndrome lady).

One of the long-time psych nurses said, "When they rate their pain as a 10, I always want to say, 'if someone stuck a dagger in your heart, would that hurt worse? Yes? Then it's not a 10, IS IT?'" While none of us would ever say this, even to a patient who appeared to be drug seeking, it struck us as very funny. Of course, at 4:30am, with my 3 coworkers each nearing the end of a double shift, everything is funny.

When I came home, Gavin happened to be awake, savoring the last of his weekend and already dreading Monday.

Gavin, groaning: "Oh, Mom, it's school tomorrow. Monday is like Tuesday, only it's evil. It's awful. Mondays HURT."

So, I asked him to rate his pain on a scale of 0-10, and when he rated it as 10, I asked, "If someone stuck a dagger in your heart, would that hurt worse?"

Gavin: "If someone stuck a dagger in my heart, I wouldn't have to go to school! I could join the circus and be the 'Dagger in the Heart Boy' and everyone would pay to see me! And no school again, ever!"

Why is it that my conversations with Gavin always seem to veer off into weirdness? (I have to admit, though, I take a lot of joy in it...)