Pain Scales Are Tools of The Devil!

“Pain level of 15/10”

For those who did not know, sometime in the eighties, The Powers That Be ([T]PTB), in their unlimited wisdom, determined that Pain Was Undertreated!, and, of course, Something Must Be Done! This, as is usual in these initiatives,  meant that the untermenschen must be thrown beneath the proverbial bus, and, not surprisingly, we were.

We Peons were instructed that “Pain is the fifth vital sign”, and that “Pain must be adequately treated!” And so, “Pain Scales” were inflicted upon us. (I leave as an exercise for the student, what the connection between the foregoing and the present PANDEMIC! ZOMG! Of DEATH! BY! OPOIDS! Happens to be.) (Of course, it is the EVIL! Drug companies, and EVIL! Physicians who are at fault. Therefore, let the Benevolent PTB ride to our collective rescue with The Answer, right?)

So, TINS©, there I was, in the emergency department at this time in my life, Nursing away, FDASL©. I was in triage one shift, and, of course, interviewing and vital signing and pain assessing the teeming millions seeking cures (and work notes) (and narcotic scripts).

Pain assessment involves asking the patient how severe his/her pain is, with zero being no pain at all, and 10 being “the worst pain in the world”. Folks are asked to scale their pain against this imaginary yardstick. Mostly, people try to be fairly straightforward, and generally rate their, say, sprained ankle, at the time of assessment as something like a “4/10”. or maybe a “7/10”. Then, there are those creative souls who try to game the system. This is my shocked face.

One night, one soul arrived, reporting back pain, or some other malarkey. Strolling into the triage room, said soul sat, and I cataloged allergies, medications, medical history, pulse, blood pressure, respiratory rate, temperature. I asked about pain, with my usual spiel.

“Sir/Madam, if zero is no pain, and 10 is the worst pain in the entire world, what is your pain level at right now?”

This person, appearing for all the world to completely nondistressed, looked me steadily in the eye, and replied “15”.

I blinked. “So, if zero is no pain whatsoever, and 10 is the worst pain ever, your pain is 15 on that scale?”

My correspondent paused to take a handful of chips from the bag on his/her lap, chewed thoughtfully for a moment, and responded, “Yep.”

Again, I blinked. “And, 10, T-E-N, is the worst pain in the entire world, right?”

“Yep.”

“And, your pain is 15, F-I-F-T-E-E-N, correct?”

Again, with the chips. “Yep.”

“So, you’re telling me that your pain is one-and-a-half times as severe, as the worst pain ever, anywhere, in the whole world, right?”

“Yep.”

“So, that would make your (chip eating, non screaming, non writhing, non weeping, non wringing-wet-sweating) pain, the worst pain in the world, am I hearing you correctly?”

Rumination, in both senses of the word. “Yep.”

“So, if ’10’ is the worst pain in the world, and you, right now, have the worst pain in the world, and your pain is ’15’ out of ’10’, then you’re telling me that your pain, right now, is half again as severe, as the pain that you are having right now, am I hearing you right?”

More cud chewing. “Yep”.

What could I say? “I’ll make certain that the doctor learns all of this. Please have a seat in the waiting room, we’ll call you as soon as we can.”

 

 

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Medic Six: Medic in Trouble.

So, TINS©, TIWFDASL© in Da City. So, in the course of EMS in, really, any city, you occasionally encounter folks who fail to realize just how wonderful you and your partner truly are. Some of these folks, at a loss for words to articulate their world view, act out. Indeed, from time to time they seek to act out upon members of the uniformed city services, which is why cops have sidearms, firefighters travel in groups of 5 or more, and medics….well, we generally rely on good fortune. And the antipathy police officers most everywhere demonstrate, kinetically, upon those folks who lay hands on medics.

So, having taken note of the above cited occasional dilemma of the tactical variety, The Powers That Be in Da City administration, had established a radio code, to indicate that the crew employing it, was either in trouble, RIGHT NOW!, or anticipated things to get sporty, REALLY FREAKING SOON!. Since we were, by department rule, forbidden arms, we relied upon our friends at TBCPD to extract our bacon from the fire, when the occasion demanded it. In return, we paid very, very close attention to the calls of “officer (insert injury here)”. While nominally all our responses were “Code 1” (red lights and siren), there were varieties of “Code 1”. For instance, there was a “Code 1” response to the call, “man has cough, for two weeks”, and there was the “code 1” response to “Officer shot”. For only one of these, would the ambulance require brake replacement after the call, and other motorists wonder what was that orange streak that had passed them by at “Warp 8”.

Generally, EMS Dispatch was on the ball. They kept track of where you were, how long you had been there, and, if you had not cleared the scene after a suitable interval, they would radio you and check that you were alright. On (thankfully!) rare occasions, they were not. Whether this was to be laid at the feet of dispatch, or the elderly radio system we employed, is not clear.

So, this one time, several crews were hanging out at TBTCIDC, telling tall tales, conversing, and generally waiting for dispatch to decide that it was Our Time To Save Lives. Our handie talkies were on, because dispatch might NOT assume we were still hanging out at TBTCIDC. Our radios, at that time, were open, meaning that any traffic on the frequency was heard on our HT. Therefore, when Medic 6 called “Medic in Trouble”, well, the room went silent. We waited for Dispatch to respond, and heard nothing. One guy phoned dispatch, asking “Did you hear Medic Six call that they were in trouble?”

When answered negatively, he said, “Well, they just did so. What is the address of their scene?” Writing it down, he hung up. “Hey, partner! Wanna take a little drive?”

“Sure. Where to?”

“Medic Six’s scene.”

Abruptly, four ambulances called on the air from TBTCIDC. We sped over to Six’s scene, and (thankfully) beheld the crew strolling out of the house there. And, no police.

“You guys alright?”, one of us asked. 

“Yeah, but it go a little tense there, for a minute!”

Everybody drove away, and the rest of that shift passed, without making any more memories.

Thank Ghawd!