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:
- Isn’t this a lovely day? Sorry to bother you, but I need a Band-Aid.
- Eh… not so bad, but I thought this should be seen
- 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
- 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:
THE CHEMO NAUSEA PIZZA SCALE
From 1-10 How Opposed to Eating Pizza Are You Right Now?
- Pizza? Fantastic. I love this hospital. Another Yelp star for you!
- Sure, why not?
- Seems like an odd question, but I’ll have a couple of slices.
- Yes, but it better be really good.
- Well, I know I’m supposed to keep eating. Make it the thin crust stuff with a side of IV anti-nausea drugs going.
- Sure, if by “Pizza” you mean “Saltines.”
- You have some nerve asking that. Have you ever been nauseated? Force it on me if you must.
- Is your degree honorary?
- Awesome idea! Why don’t we get a make your own sundae bar and a moon bounce in here, too?
- No, and I will never eat again.