The Night in the Hospital; or The Pain Richter Scale

“How would you rate your pain on a scale of 0 to 10, zero being no pain and 10 pain the worst pain you have ever felt?” This is what I was asked, ever couple of hours after I was admitted to the hospital on the fateful night of December 5, 2009, with a right foot Lisfranc Fracture / Dislocation. By the time I was admitted from the ER for overnight stay, my pain had indeed increased. But, really, how do you measure pain? It is so subjective. I have had clients rate their back pain at 8 or 9 after a moderate impact accident. I suspect that I would have rated the same pain as a 4 or 5, because the scale is uniquely based on personal experience.

So what was my personal “10” on the pain scale? My patellas (knee caps), from time to time, dislocate from where they should be. It usually tends to be at very inconvenient times, like the time I was hiking down from Mount Timpanogos. When one of them dislocates, I scream uncontrollably, usually fly up into the air, flailing about like a fish out of water and shouting obscenities, in an attempt to get pressure off of my leg, which will allow the patella to return to where it should be. Then I land in a crumpled heap on the ground. I then cry between hyperventilating breaths, because it hurts so bad. Fortunately, once the patella is back in place, the intense pain begins to subsides, and then it just hurts “a lot.” It makes my pain level spike just thinking about it. So when the nurse at the hospital asks me what my foot pain level was, I never even approached a 10. I think it would peak at a 7 or maybe even 8, and I determined that a 5 was a tolerable pain level that I could live with and even get some sporadic sleep. I can’t help but think that my 7 would have been other peoples’ 10. Then again, I am sure there are others who would think I was simply a wimp when I said my pain was at a 7 and would say that I simply didn’t know what true pain was. But should I have used my patella dislocating pain as my basis of comparison? The knee-cap pain is extremely intense but quickly subsides, whereas the foot pain, that night, rated from 5-7 or 8, was constant, but less intense, so maybe I wasn’t comparing apples to apples. Again, it’s just so subjective.

Pictured: My foot X-ray after the first surgery

I was able to get through the night by sleeping for up to 90 minutes or so, then calling in the nurse to ask for either oral pain meds or the intravenous Dilaudid (hydromorphone) along with an anti-emetic. I alternated the between the two throughout the night. Then came morning, and Dr. Richards, who was the orthopedist on call that night, came back to see me. He was extremely concerned about the swelling, and the resulting internal pressure. He opted to located some testing equipment to measure the pressure in order to determine whether my foot needed to be opened up just to relieve the pressure. The testing equipment consisted of a really long and fat syringe thingy with a pressure gauge on it. It looked real nasty to me, so I tried not to look at it too much. I was also on mind-altering pain medication, so I can’t recall exactly what it looked like. So Dr. Richards numbs up my foot with local anesthetic and then starts probing. I recall he put those long needle probes into three places on my foot. Two were essentially non-painful entries, but one of them really hurt. (Pain scale rating: a lot). The test results were positive, which in medical lingo means: not good for me. However, the literature on the subject states that the inflamation pressure should be correlated with my blood pressure, and if my blood pressure is around normal, my foot would not have to be opened up. I think they checked my blood pressure three or four times within a ten minutes span to get a good average. Thank goodness for not having high blood pressure. Based on the combined result, Dr. Richards opined that I could forego the “pressure letting” (my terminology, not his) and be discharged for home.

I was so happy to be out of the hospital. Based upon the limited experience overnight in two different hospitals (I know, I know; not enough information to form a statistically sound opinion), I found that the nurses working the graveyard shift simply care about their patients more than the daytime nurses. Trying to get home, however, even though we live less than 10 miles from the hospital, was not fun. I felt every bump in the road, and the anti-emetic was wearing off, with the emetic effect of the pain medication taking its effect.

Now every time I go to physical therapy, I have to rate my current pain, my pain over the last week, and over the last 24 hours. I told the PT assistant that the pain scale is very subjective, so I question is true viability as a diagnostic tool, and that now I view it as being more similar to the Richter scale, where a 4 is ten times worse than a 3, a 5 is ten times worse that a 4, and so on. I guess it should be called the Pain Richter Scale.