COMMUNICATION

Wong-Baker Scale with emojis from Wikimedia Commons

You’ve arrived at the doctor’s office, and after adding to your pain by putting your phone away and reading through two magazines in which you have no interest, you’ve made it to an examination room. Someone other than the doctor has come to see you. Staring at the computer screen instead of looking compassionately into your eyes, the automaton asks, “What is your pain level?” The finger points to the chart on the wall.

The chart is an attempt at quantifying one’s pain. In ten steps, Smiley goes from a cheerful upturned mouth to a deep frown, augmented by a tear. “Pick one.”

This selection is a multi-level problem. Experience tells us that the intensity of pain does not match up well with this linear scale. Somewhere in between happy and awful is a point where intolerability factors in. While there are levels both before and after this point, that the point exists suggests an exponential scale.

There is also a comparative problem. Since pain tolerance varies greatly from person to person, how does one know what to select so that the proper level is communicated? One does not want to be shortchanged in treatment because softies continually overstate their pain.

Conjoined with personal tolerance is social judgement. Should one say just what level he or she (or whatever pronoun) is feeling, or will that result in an improper value judgement by the medical staff? If one selects number eight, will that be deemed something that only a wimp would admit to? And if one selects number two, will the resulting stare from the automaton say, “What are you doing here? We have other patients with real problems.”

Can’t we do better?

Submitted for your and Rod Serling’s approval, a scale with new and improved descriptions of the intensity of pain for each level, so others can feel your pain.

0 “Right after you pass that doobie, you can go get us another beer. I’ll wait right here and sing along with the Dead.” OR “This ice cream is the best, isn’t it, Grandma?”

1You are victimized by a surprise in-service training course with mandatory attendance. It is sprung upon you on a day when you almost called in sick. Now you are both annoyed and definitely sick.

2 You are itching from multiple bites by mosquitoes, augmented by the annoyance of killing one just as it lands. Your previously sucked blood splatters all over your arm. You shout, “You selfish vampire! One drink of my blood wasn’t enough?!”

3 Walking barefoot through the house in semi-darkness, you slam your little toe into the leg of a recently moved table. The localized pain is intense, but not so great that you can’t stifle your scream so as not to wake others, even though your toe will never be the same.

4 Jerking your hand away from the suddenly bloody workpiece, you shout, “Who put the long nails in the nail gun?”

Photo by Author after the fact

5 Hiking in the spring, you walk straight into a swarm of Adirondack black flies. Welts rise on your face and neck as you thrash in a violent futile effort to disperse them. Though you know the water will be cold, you contemplate diving into the nearest stream and staying completely under for at least 30 minutes.

5+5≠10 — An instructive example: You reach deep into the partially melted ice to search the bottom of the large and ancient metal cooler. The remaining bit of feeling in your frozen hand determines that the last beer is gone (any dedicated beer drinker will confirm that the absence of beer is at least a 5-level pain). As you turn your head and shout to your peers, “Hey, who took the last one?” the cooler lid dislodges and smashes your head into the latching mechanism (second 5-level pain). Painful, yes. 10-level, not even close.

6 You are jerked into wide-awakeness by cramping of your right leg adductors, the muscles that pull your leg toward your midline. As you quickly move out of bed to stretch and relieve the pain, the left leg adductors join the right in cramping. There is nothing that will relieve the pain on one side without exacerbating it on the other. The only solution is to attempt to relax while breathing heavily and waiting for the pain to subside. Crying is recommended. A kind spouse will bring you water without laughing.

7 The window sash you are working on becomes suddenly unstuck while 2 of your fingers are directly below, at the bottom inside the sill. It is an aged building, and the cords connecting the counterweights to the sash have long since disintegrated. Children are nearby. What words do you scream after your fingers stop the downward motion?

7and 1/2 — An electrical connection must be re-soldered while working in the cramped space under the dashboard of an antique car. The only position which allows you to both see the connection and the flow of solder puts your head directly under the workpiece. Just a tad too much solder melts to be absorbed by the connection, and a drip of molten metal disengages and plummets directly into your right nostril. Your convulsive reaction directs your head into the steering column, nearly knocking you unconscious. (A deduction of 3 pain levels if you succeed at blacking out.)

Well worth the pain, wouldn’t you say? Photo of Author’s auto by Author.

8 (Male pain) The misguided soccer ball leaps off the insole of a forward with a cannon-foot and is blocked by your groin. The successive sensations of surprise, shock, and nausea overwhelm you. But they pass quickly as you fall to the ground, writhing as you wish you would pass out. The initial time-lapse can be the worst part for repeat victims who know what is coming.

8 and 1/2 — One’s big toe has been afflicted by gout. This pain is so acute that sufferers seriously consider amputation in favor of recurrence. This level of pain dispels any misconceptions of how high one’s tolerance for pain may be.

9The momentum imparted to you by a recently cut and moving tree trunk has propelled you off the roof. Fortunately, you were able to orient yourself for a feet-first landing. Unfortunately, the drop is more than 10 feet. Upon landing, pain travels up the back of the legs to the spine and terminates just below the (lack of) brains. A full-body functionality survey will be necessary but must wait for the intensity of excruciating sensations to subside.

(Note that 10-level pain provides the benefit of indeterminate ending. While enduring 10-level pain, the sufferer’s misfortune is magnified by doubt that it will ever end.)

10 The screaming agony of passing a kidney stone - Most often experienced by males. As one sufferer says, “It’s pain that makes you sweat, pain that makes you puke, pain that makes the risk of a lifetime hooked on OxyContin seem like a small price to pay JUST TO MAKE IT STOP!”

10 The screaming agony of prolonged childbirth — — Most often experienced by females. As you do your damnedest to control breathing, you realize it is all a bunch of BS and scream, “GET THIS THING OUT OF ME!!!”

So that men could understand, Moms Mabley once described the pain of childbirth in the following fashion. “I want you to put your hand on the back of your neck. Then push it up over the top of your head and down your face. Now grab your upper lip and pull it all the way back over your head to where your hand started. Doing that, Sir, will give you just a small idea of the pain of childbirth.”

10+++ Passing a kidney stone while giving birth. This is so much pain that one cannot even form the words to say, “JUST KILL ME NOW!”

Thanks to Roland of Rochester for kidney stone insight.