In Seriously Doc, I shared some of my thoughts on the practice of medicine. At the time, I was focused on the subjective pain rating system used universally by the medical profession.
You know what I mean. The ambulance crew rolls you in on a gurney in obvious pain, and someone will ask, “On a scale of 1 to 10, with ten being the worst pain you’ve ever felt, what is your pain level now?”
Over the years, I’ve been asked that question on numerous occasions. Two days ago, I was again asked the question, and my response left the nurse wondering if I might have slipped into some alternate universe or was in cognitive decline. Honestly, I was trying to make a point, but I did not make it very well.
Also, the situation was not a normal pain-related scenario. I was in the Cardiac Rehab facility doing my exercises related to helping strengthen my heart. These are relatively low-level cardio exercises such as walking on the treadmill, riding a stationary bike, and new torture devices designed to give you a cardio workout with your arms.
So, in the middle of my treadmill time, a pain hit me. It was not a new pain, but exercise had never triggered it. Also, it was worse than any of my previous encounters with this little demon. The only way I can describe it is that it is like a combination of the discomfort you might feel if angina and acid reflux hit you simultaneously. I had both in the past. Thankfully, never at the same time.
I shut the treadmill down, carefully dismounted, and walked to the nurse’s station. They thought I was ready to move on to the next exercise until I told them what was happening. Then, it was “sit over there,” “go get the EKG,” and “where does it hurt” time.
One of the nurses immediately asked me the “on a scale” question about my pain. I told the nurse how much I disliked the question because of the subjective nature of the rating system. I also shared; this was not a usual kind of pain. Of course, she had nowhere else to go with this, so I told her it was at twelve.
Wide-eyed, she repeated, “A twelve?” At that point, I tried to explain I had experienced this pain or discomfort before but never at this level. Also, I attempted to help her understand this pain was not the same as other pains I experienced in the past.
For instance, during a rugby match, I once ripped my Achilles tendon loose from the heel bone. That is my “10” pain standard. That kind of pain can cause you to blackout, and then you are in pain until everything is repaired and healed.
The pain I experienced the other day needs its’ own scale. It comes on relatively slowly, has you wondering how bad it will get, and then is gone in under fifteen minutes. Then, everything is fine until it pays another visit. After it subsided and my blood pressure went down, I was allowed to complete my therapy routine with no sweat and no pain.
So what is my point in sharing this little story? Well, one reason is to vent a little. Another reason is to point out something a friend of mine in the medical profession told me not long ago. Never feel bad about asking for a second or even third opinion. I will not feel the least bit bad about taking such action if my cardiac team responds to this incident as it responded when I reported earlier incidents of this nature.
I have a state-of-the-art device implanted in my upper chest. It can help regulate my heart, shock it back into action should it fail, and send all my cardiac data to my doctors and the manufacturer if something serious happens. Still, no one can explain these stupid attacks like the one above.
After the nurses share my feedback and thoughts on this incident, I will be very interested to see what my cardiac team says.
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Yikes. Heart issues. Not fun. I have irregular heart beats but, no pain involved. I’m so sorry…
We’re not certain where the pain is coming from. My cardiologist says it is unrelated to my heart, except the pain drives up my blood pressure when one of these episodes occurs. They only last 10-15 minutes and are very irregular. There’s a bit of a finger-pointing game going on between my heart doc and my gastroenterologist concerning the cause of the episodes, events, whatever they should be called.
Ulcer?
Who knows? Just had a complete G.I. exam in January, no sign of anything wrong in my digestive system.
I’ll be bugging my PCP about it soon to see if he can get some movement out the locals or recommend someone to take another look.
Any MRI?
In January when I was hemorrhaging. Nothing suspicious. A couple CT’s last year nothing nothing suspicious there either.
Hmmm…
I think you’re being a bit unfair here, S.E. I’m retired from a career in the medical field and I want to say here that using subjective terms in evaluating pain is the only effective way to document it, my friend. Because pain IS subjective. Didn’t that Cardiac Rehab nurse go on to ask more questions about the characteristics of the pain you were experiencing? Questions such as: was the pain constant or intermittent, sharp or dull, throbbing or aching? Did it occur suddenly or did it creep up on you? Best practice guidelines are such that you should have been helped to qualify your pain more if possible. Did those staffers get to hear your rugby story?
So I’m offering some defense here for healthcare workers; I was one of them during my career, including running a Pulmonary Rehab program (sister to Cardiac Rehab). It was a helluva great job.
Jim, thanks for taking the time to comment and provide your input based on your background. For the record, the medical team running the cardiac rehab center did a great job of responding to the situation and asked all the right questions to document what was happening. The problem is that the scale of 1-10 question made little sense in this situation, but that is all they had to document or rate the pain.
The sensations I felt during this episode or event were not those I felt at other times when I felt “pain.” This pain was negligible compared to ripping my Achilles tendon loose from the heel. Yet, compared to the pain I felt the last time I had an episode like this, it was greater. That is why I said it was a “12” and then went on to try to explain what I meant and the difference between sensations related to this pain. As for pain being subjective, I understand that is the traditional way of defining or labeling pain. Thanks to your feedback, I did some research and discovered I am not the only one who feels that is a problem.
I will probably write about what I found after doing more research. Thanks again for the comment, and please know I did not mean to slam medical personnel in general. Rather, I am concerned about how medicine has been affected by changes in society, politics, and educational systems. Some great doctors keep me upright and moving, but they work within a system I have trouble trusting.
Thanks again,
Eric