The pain scale.

Here I am contemplating at least, my last few shifts as an ER nurse.

Of course, all of this could fall through and I could have years and years of ER nursing ahead of me.  Hey, there are worse things.  But, if this is to be my last stint of ER duty, even for a while, I want to get a few things down and thought I would share.  For those of you here only for adventures and pretty pictures, come back soon.  They will return. 

Now...sit down with any ER nurse and ask them about the pain scale.  At the very least you will get a groan and an eye roll.  Some, like myself, will go off on a passionate rant about the misuse and abuse of the standard 1-10 pain scale.  This sounds like it isn't a big deal, but it might be more so than you think.

Let me tell you why.

First off, when you come in complaining of pain, we take you seriously.  You took the time out of your busy day to come all the way down to the ER and probably waited a pretty good amount of time in the waiting room to boot.  Obviously this is more than just a minor boo boo.  (Except when it isn't, but that is another rant.) I get that you are trying to convey to me the serious and urgent nature of your pain.  Again, you are here, that tells me something.  Telling me you have level 10 pain because your ankle hurts, or even your stomach hurts, doesn't do that.  The first thing that does, is prevent that pain from ever getting worse.

You see, the scale only goes to 10.  Yes, even if you insist your pain is 25.  So, when your migraine gets worse, or your back starts hurting from lying on the junky ER stretcher mattress for a couple of hours, there is no way to document that.  The computer will only allow an entry up to 10. 

Your pain got worse?  No it didn't.  10.

One guy I worked with, definitely of the ranting variety, would ask people who rated their pain a 10, "So, if I set you on fire right now, you wouldn't notice?"

It gets irritating.

Especially when you arrive and are texting your friend about OMG you are at the hospital and eating the bag of chips from the vending machine in the lobby while you tell me your belly pain is a 10 out of 10.  Look, if you won't take this seriously, why should I?  I have a guy next door with 6 out of 10 chest pain for the past hour.  Who do you think is getting my time?

But, the real reason is different.

The real reason is that I have seen people in level 10 pain.  Most ER personnel have and it can be quite the profound experience.  You see someone who is gravely hurt and fading in and out of consciousness.  Every moment they manage to stay awake they are crying and begging for medications maybe you can't give them because their blood pressure is too low from all the blood they lost.  Frequently, the pain overwhelms them and they fall into animal screams before they lose consciousness again. 

So, what was your pain level again?  Let me give you a clue, if you can tell me it is a 10, it isn't.

Please, respect the pain scale.  It can be useful if used properly.

For a good example of what I am talking about, look here:  Pain Scale