Wednesday, December 05, 2007

Maid Of The River

Now that Mo'vember has passed, I've slackened off a bit. Sorry. I continue to find it difficult to find stuff to blog about; some days I'm pretty much too lazy to sleep, if you can credit it.

Today has found me on just such a day. A day off, after a late; slept late, then mooched about. I did have good intentions to get some work done... I guess it'll have to keep.

So tonight finds me immersed in my favourite pastime - watching old episodes of ER. This one is one of my especial favourites. Its called Exodus, and features Carter stepping to the fore in the face of a major incident. A benzene spill, with contamination of the ER. High melodrama at its finest.

In real life, shit continues to flow downhill. I am forever fascinated by people's reactions to our enquiries about their pain. Most if not all, places use a 0 - 10 point scale. 0 is no pain, 10 the worst imaginable. Yet people insist on telling me their pain is '12', or '20'. Now I recognise that your pain may be bad, but when I offer you a scale that tops out at 'the worst imaginable', there is no point telling me it's worse than that. It's childish. It's like saying 'infinity plus one'. Particularly when you then flinch as I put a venflon in.

I'm thinking we should tell people the scale is "0 for no pain, 10 for worst imaginable, and more than 10 means you're making it up.". I was once confronted by an angry young woman, who had come back from the waiting room, to ask when she would seen for her headache. Her pain, she said, was '20 out of 10'. I was amazed that she was able to converse with pain twice as bad as, for example, being cut in half with a rusty lemon. Interestingly, it always seems to be these people who insist they have a very high pain threshold. Never the people with horrendous compound fractures sitting quietly. Why do they never feel the need to brag about their pain threshold?

Something else that seems to confuse people is the pointing out of inconsistencies in their stories. I recently saw a patient, whose final diagnosis appears to have been cholecystitis (inflammation of the gall bladder), who assured me she had a very high pain threshold. Despite this, she was unmanageable with pain, despite morphine and enough entonox to sedate an elephant. The pain, she insisted was markedly worse on movement. 'But you're moving all the time', I offered. 'Your breathing, in fact, is using all your abdominal muscles, and you're rolling all over the bed (I know what you're thinking, it's colic; and it was), so is it really worse on movement?'

Patient just looked blankly at me. I mean, I know we sometimes blind people with science, but...

Well, it could be worse. I could be mopping up benzene...


Faith Walker said...

At my trust we ask people post op on a 0-3 basis for pain. Gives them less room for lies.

0 no pain.
1 minor
2 moderate
3 severe.

I like it like that.

Baby Blue Pyjamas said...

i know a man in stores who can get all kninds of chemicals..... Gamma-hydroxybutyric acid, [1R-(exo,exo)]-3-(Benzoyloxy)-8-methyl-8-azabicyclo[3.2.1]octane-2-carboxylic acid methyl ester, he may be able to get benzine too. do you smoke or inject it?

Baby Blue Pyjamas said...

or the fall proof test. (While holding a size 20 catheter or piece of garden hose) say "To treat you we need to insert this into you bladder.

If they let you, find a med student to do it. If they don't they can't be in that much pain.

A consultant told me that.

Anonymous said...

haha! good post. But Shroom, don't you get annoyed with the glamourisation or emergency med in ER?

Kate said...

We use the 10 point scale at my hospital. I don't know about you, but if they are on the cell phone, playing Gameboy, or listening to their iPod while telling me that the pain is at a 10, I tend to divide their reported number by 10 and pass out the acetaminophen (it helps to not call it tylenol).