The worst pain of my life!

I named this blog 20 out of 10 in reference to the pain score most of my ER patients give me. This is especially frustrating because when I introduce the pain scale to them I tell them that a 10 is "the worst pain you can imagine".

Then they tell me that they are having 20/10.

So this is worse than the worst pain you can imagine? Please tell me how that is possible.

Invariably, these same patients are at the same time asking for something to eat, wanting to know why we don't have TVs in our ER, casually telling jokes to their friend who came along for the ride, and asking for the strongest narcotics they know of, because "it is the only thing that works."

Now I'm not one to deny that somebody is in pain just because they are laughing, and I know that hidden pain exists. I am always telling jokes and laughing, even when I'm in pain or tired or depressed or whatever, but if you are showing me absolutely no signs of pain and then tell me that you pain is so severe that the scale doesn't even contain it, then you are going to have an uphill battle to really convince me.

If you want my sympathy, then tell me that your pain is very severe, give it a realistic number on the pain scale and keep me up to date with how the medications and treatments are working. You be cool with me, and I'll be cool with you. Cool?