In nursing school we’re taught that pain is subjective; more specifically, we’re taught that the pain reported by the patient needs to be taken as the truth. No ifs, ands, or buts. I never really understood the importance of that until later. The phrase is said by every single nurse (relatively) the same, “How’s your pain? On a scale of 1-10, 10 being the worst pain you’ve ever felt?”. I’ve said this so many times. I feel as it’s the mantra for anyone pursuing a career in nursing – reminds me of when cops recite Miranda Rights. You ask once during each round, you get the number and you chart it. The number is valuable (to me), because it indicates the patients understanding of their pain.
I had a patient in my MedSurg rotation that would rate his pain at a constant 7 or 8 as soon as his pain medications were due. After receiving his medication, the rating would drop down to a 4 during my follow-up assessments. I enjoyed him, he was really down to earth and he allowed me to practice some skills I hadn’t been able to perform before. My nurse was great, best nurse I had ever gotten to shadow – but she was wary of his pain ratings. We left his room after taking a pain assessment, she turned to me and said, “Take the pain rating at face value. I know we’re supposed to believe the patient, but sometimes you think to yourself… is it really at an 8? He’s joking with us and laughing. I didn’t even see him wincing during our assessment”. I shook my head nervously in agreement, “But we believe them, and we treat it as reported. It’s normal to question it in your head – just to let you know. If he says it’s an 8, honey it’s an 8.”
I’ve had a few patients wince, flinch, and groan when I do my assessments. If I remember correctly, none of them rated their pain at an 8. It kind of got me thinking, we all have different perceptions on what’s painful and what’s not. We reach these conclusions based off of our past experiences – I mean we must, right? Also, we must have different opinions on how we let others know that we are in pain. Some people are open about their pain, and some people minimize or try to cover up their pain. Our professors and the clinical nursing staff put emphasis on how people will express their pain differently and it’s our job to be respectful and listen to them wholeheartedly and without judgement. Some people don’t want to be a bother, others don’t want to seem weak, others view pain and suffering as divine intervention, and others see pain as a vacation. It’s how we perceive, accept, and share our pain that outlines our treatment plan.
“Do you want to go through this alone? What’s your support system? Where did the pain come from? What makes it better? What makes it worse? What does this feel like to you? Have you ever experienced this pain before? How long has the pain lasted?”
Why rate your pain at an 8 when you’re smiling and happy? Why rate your pain at a 3 when it feels like I’m stabbing you whenever I palpate the area? Are their perceptions of pain different? Yes, obviously. But, what’s the goal they share? The goal is to get better. One wants medication and a lot of help to get through the pain, and the other is getting through the pain with minimal help from outside sources. They’re both valid, and both will work.
The follow-up question after a pain assessment is, “… Okay, and what’s an acceptable level of pain for you?”. I thought this question was hilarious, until I went in the field and heard every single number except the one number I’d expect all of my patients to say – 0. (Yes, 0 is not on the scale. But, I still expected that answer from everyone) I thought to myself, “Why are we going to ask people what’s an acceptable level of pain for them? Shouldn’t everyone want it at a 0? or a 1?”. I had answers that ranged from 2-6, and it always confused me – until I felt pain; more specifically pain that didn’t go away.
If someone were to ask me in the beginning of my bout with pain, “How’s your pain? On a scale of 1-10, 10 being the worst pain you’ve ever felt?” I’d probably say I was at a 5 on good days, and a solid 8 on my bad days. My acceptable level of pain? I’d say about a 5, because it was bearable and I still was able to enjoy myself.
I channeled my inner down-to-earth patient and I had thought by using quick fixes and things readily accessible, I’d be able to manage my pain. I yearned for some sort of connection; someone to make the pain go away. Someone to baby me, and tell me everything was going to be alright and that I was good enough. I was desperately gasping for air, waiting for someone to save me from drowning in my own pool of sorrow. To connect the story, I sought attention from someone when my pain was returning – like his pain medication schedule, I had this person on a “hit them up” schedule. It worked, but the conversations would only last so long; just as how the medications only last so long. The pain returned, and I would withstand the pain until this person had come around with my next dosage of attention. I had developed an addiction to the attention – I convinced myself that I needed it in order to make it through the day.
Eventually, just like medications, came the reality of waning off medications and trying to withstand the pain. I was a complete mess, and I began to get even more desperate for attention and reassurance. I sold my wellbeing to this person at a discounted price and I was worth so much more than he could ever afford. I had hit a new low, if rock bottom had a rock bottom – I was paying rent to sulk there. That feeling of drowning felt worse, like I couldn’t gauge the surface anymore – I didn’t see his silhouette trying to reach for me anymore. I accepted that I’d be stuck here forever until someone was going to pull me out.
Time seemed to slow down, and here I was back at square one – maybe square negative sixteen. I woke up one day and I felt every fiber in me screaming for help – but there was no help. No one was going to pull me out, and no one was going to save me. If anything, he let me sink deeper and deeper. I put my phone on Do Not Disturb, I blasted music, and I sat through my pain. I decided to write and read – I could feel the surface getting closer. I cleaned my room, I made plans with my friends – I felt like I was floating to the top, getting out of this slump. He didn’t talk to me the entire day, and I felt okay (it hurt but, I survived). I had made it. You see, at that point I realized all I had to do was stand. No one needed to save me, I just needed to stand. Metaphorically, I had breached the surface and I realized all of my family and friends were waiting for me to just stand. He, thankfully, was not there.
Today, I’m here standing. I don’t need him to compliment me, tell me good morning, send me a message, entertain me, or give me my scheduled dose of attention. Yes, I’m still in pain – but now my pain seems to be at a 5, and that’s acceptable for me. I need to accept this pain, really face it and not focus on it so much. I’ve relapsed a couple of times, and I’ve snuck a dose here and there, and that’s okay… but I’ve lived through the pain without him, and I know I can continue to do it. Baby steps Bran, baby steps.
If you are in pain right now, I want to let you know that it does suck – I understand that. But, the pain doesn’t last forever. You need to let go of the people that cause you pain, and you need to hold on tighter to the ones that sit with you through the pain. This will not be easy, but it’s going to be so worth it. Don’t give someone so much power over your healing, either. He/she will not save you from the pain, they’ll only make the pain worse – you are in charge of your healing, just as how a patient is in charge of their plan of care. Also, you cannot properly heal if you keep letting the person that hurt you open up the wound. Take care of yourself, love yourself, and grow.
“You not wanting me, was the beginning of me wanting myself. Thank you” – Nayyirah Waheed
“Right now, yes, things seem really shitty. Some days you will have no reason to get up, and other days you will feel empowered to change the world. Just remember, the storm doesn’t last forever. He will not save you, we can’t even save you. Just try to stand.”
Inhale, Exhale 