The Pain Scale

I've never understood the pain scale. My doctor wants to know how I'm feeling today (during our telehealth appointment), can I quantify my pain on a scale of 1 to 10, sometimes she asks in the form of percentages. What percentage of improvement did you feel on that medication? 10%? 20%? 50%? I make something up, 40-50% sounds good. But the relief from the injection has faded, so I can't quite remember how it felt just weeks ago. And if I can't handle the basic 1 to 10, then how in the world can I compute percentages?

It always feels so arbitrary to me. I know I'm supposed to base it on my own experiences with pain, but I can't ever seem to remember how bad it all felt all those times before. Am I worse? Am I better? I never know.

Over the years, I've resolved to write down my pain, to do a better job of tracking progress and symptoms. But my ambition always dies, I can't ever keep thinking in numbers and so my scientific approach turns into something poetic. My pain has always felt more manageable with stories and prayers. Of course, my doctor can't accept a diary to track my pain progress.

Ah, yes, the struggles of patient-reported outcomes, my smartest biostatistician friend says when I suggest we should all just be able to plug ourselves into a machine that spits out numbers of our pain.

Where does it hurt? Everywhere. (They never like this answer.)

But tell me, doctor, how do you know how much of the pain is my pain, and how much of it is the pain that I carry for the people I love? Some days the aches feel deep, weighty, like there's concrete poured through my veins. I don't think I intentionally add their pain to my pain, it just happens. Death, sickness, uncertainty, anxiety, exhaustion, fear, temptations, loss. Sure, come along, I'll carry that for you. Lately I've discovered I'm bad at even letting people know that I'm carrying their pain, too. I just quietly take it on.

And doctor, I'm not sure if you've heard, but we're in the middle of a global pandemic. Might that add to the pain?

I will try harder to notice, I promise. Today: a pulsing through my nerves in my arms and legs, pain in my knees, my hips, my ankles (always that broken right foot that's never broken). I'm tired. Our thermometer's broken, beeping that I'm 93 degrees which just feels wrong.

There's more to this pain that I should spell out for you, but I'd rather tell you about the sun that's trying so hard to shine. I'd rather go sit on the empty porch with a dusting of pollen and wonder, that red cardinal that lands on the fence post every day next to the field of yellow wildflowers, does he feel pain? Do any of the colors of nature feel the pain?

I make eye contact with my doctor through the screen. Her room is dimly lit and the connection blurry, the angle giving away no clues about her home life. I want to see inside her world, just a little bit, and flip the question to her, How are you feeling today on a scale of 1 to 10? Of course, I don't. She tells me to move up closer to the screen so she can see my face, to hold my hands up close and show her the movement in my joints.

Her voice is so soft in person that she now feels even further away. I turn up the volume, lean my ear in closer to hear everything that I should and shouldn't do. I tell her I'm fine, which seems like the best quantity I can offer.