Dear Katelyn

The thing I don’t like about the 1-10 pain scale is when people say “10 being the worst pain you’ve ever felt in your entire life” …..then get upset when people say 10. 

I usually go with 10 is “the worst pain you could possibly imagine”. If they still go with 10, but appear to be laying there comfortably, HR WNL, BP not elevated, not guarding or grimacing (though some people are extremely stoic, so this isn’t always going to be a reliable indication of pain), etc, I’ll go on, “So, you couldn’t function or think about anything other than this pain? Like if someone ripped your arms off an started beating you with them… that’s probably 10/10.” (Note, this is not a common example I’d give because not everyone loves my sense of humor, although they should.) Usually at this point they’ll think about it and go with 9/10 or something slightly lower.

I think there are just patients who have completely unrealistic expectations about how their pain is going to be managed, and some of these are the ones who you have to get stern with. Like, sorry ma’am/dude, you just got hit by a fucking car/have traction or have an ex-fix on your leg which looks like a damn medieval torture device/had your stomach cut open from your crotch to your chest – it’s not that I want you to be in pain, but we can only do so much to manage your pain and do so safely. I can’t narc the hell out of you when you’re hypotensive and we can’t figure out why. I can’t narc the hell out of you when you’re slurring your words and are falling asleep mid-sentence.  I hate it when we end up having docs who are really stingy with the meds too, especially with a patient who clearly needs it. Had a burn patient recently boarding with us and both our ICU resident and our unit pharmacist thought 1 of dilaudid was appropriate for their daily huge dressing change where we’re freaking sloughing their skin off. I mean are you actually serious? How would you like it if I pulled off your skin layer by layer. What the hell!? Do you want to give this patient PTSD from these dressing changes? I had another doc the other day who took away my patient’s PCA because she didn’t think she needed it. Really? You’ve had this patient on your list for like 20 minutes, haven’t even examined her. You see her on paper, not in person. You haven’t had to deal with her screaming, moaning, crying, swearing, and begging for more pain medications. Give me back her PCA orders or so help me God I will be page you every five minutes for more pain medicine. And then I’ll go to your chief and your attending and make your life hell.