The Chemo Nausea Pizza Scale, by Steve Safran

How much pain are you in right now? On a scale from 1-10? Probably none, right? Now– and this is for the sake of science and also my amusement– put yourself in some pain. Any pain. Pinch yourself. Bend your finger back a little too much. Stub a toe. Now how would you rate your pain? A one or a two? What if someone stepped on your foot really hard? Bet that’s a four or five. Step on broken glass? A six.

What if you had a tumor in your back?

I don’t want to get all heavy here. I’m just trying to illustrate how relative pain is. Suddenly getting your foot stepped on is, at most, a two. That’s the problem with that smiley-to-full-agony face pain scale that’s ubiquitous in hospitals. They ask you to rate your pain on a scale from 1-10 without any words that describe what a four, six or ten feel like. During my first admission to the hospital for what turned out to be testicular cancer, I was in the worst pain in my life. It was a full 10 on the Steve Scale of Experience. But… I didn’t have a compound fracture or gunshot wound. I imagine those are worse. They sure look worse. Are they two agony faces worse? I bet they’re four agony faces worse. But my pain was more than a four, right?

The numbers needed descriptors like:

  1. Isn’t this a lovely day? Sorry to bother you, but I need a Band-Aid.
  2. Eh… not so bad, but I thought this should be seen

and maybe

  1. This is worse than the time in preschool Kim threw a rock at my head, but not as bad as when she threw the second one because the first one didn’t bounce to her liking


  1. That’s not enough morphine and I question your training that you’re only giving me that dosage

I need a scale that is more relatable. During chemo, you have to keep eating. You need to eat so that your stomach stays full and you don’t get sicker. It’s pretty cruel. I’ve shed tears at the thought of having another meal. So with cancer treatment, pain isn’t really the problem. Cancer is a nausea experience. And so every day at the chemo lab, this question: “From 1-10, how nauseous are you today?”

I have designed a system I feel is more precise than the smile-to-agony face sliding scale of misery. It’s the Chemo Nausea Pizza Chart. In essence, “Given the way you feel right now, how opposed would you be to eating some pizza?”

Why pizza? It’s pretty universally loved. And there’s precedent. You eat pizza when you’re drunk, so we’ve established you’ll have it when you don’t feel great. Also, it’s mostly bread, which is pretty easy to digest. You can make it through a slice if you really have to. Here’s the scale:


From 1-10 How Opposed to Eating Pizza Are You Right Now?

  1. Pizza? Fantastic. I love this hospital. Another Yelp star for you!
  2. Sure, why not?
  3. Seems like an odd question, but I’ll have a couple of slices.
  4. Yes, but it better be really good.
  5. Well, I know I’m supposed to keep eating. Make it the thin crust stuff with a side of IV anti-nausea drugs going.
  6. Sure, if by “Pizza” you mean “Saltines.”
  7. You have some nerve asking that. Have you ever been nauseated? Force it on me if you must.
  8. Is your degree honorary?
  9. Awesome idea! Why don’t we get a make your own sundae bar and a moon bounce in here, too?
  10. No, and I will never eat again.


From the always awesome Hyperbole and a Half

Cartoon credit to the always awesome Hyperbole and a Half 

8 responses

    • I agree, pretty girl. In fact, the last time this little site was FP’ed was when Stevie and I did a back-and-forth! I love having his writing over here.

      • As a medical-based speech therapists, I work with patients who have impaired swallow functioning/difficulty chewing and swallowing safely. People who are fighting head/neck cancer really get it from all sides. They have the raging nausea as you so well describe, but they also lose some ability yo swallow from the radiation and surgery. Oh, and the radiation also jacks up their sense of taste. It must be the worst. God bless…

  1. I love Hyperbole and a Half! But I don’t love the sound of constant nausea. I imagine it’s hard to focus on anything, but at the same time you’re utterly bored and fed up. Sending you a non-nauseating virtual bunch of flowers 💐

  2. Well said Steve. I found alcohol helped too (depending on your chemo cocktail – I had 5FU ) and the radonc suggested it. 😀 Not being one to disobey the doctor, I followed his suggestion. So, for when you can stomache it – here’s a shot: |_| To go along with the flowers that sandyfaithking gave you. May the force be with you and keep smiling (when you can). 😀

  3. Lovely. Highly scientific; enjoyably reminiscent of the Schmidt Sting Pain Index.

    Although “Is your degree honorary?” would be funnier if I hadn’t seriously wondered that about so many of the doctors I’ve seen over the years.

  4. Dear Steve,
    Thank you for explaining what you are now experiencing. That chemo trip must be Torture, but I pray that when it is over, you will have a roaring appetite, along with the availability of delicious foods at hand.

    Thing only time in my life I have felt fairly that way, for an extended period was when I was pregnant an morning sick. The thought of my favorite foods, even coffee, made me want to heave. I know that was not far up the scale which you so perfectly described!!
    But that experience was misery.

    The amazing fact that you have not lost your sense of humor gives me some idea of what a resilient guy you are.

    God bless you as you ride this one out. you have my prayers that all will soon be well with you.


  5. Pingback: I got cancer… and fat! By Steve Safran | Blooms and Bubbles

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