Pain Scale (Paul Hostovsky)

Summary: A patient, in excruciating pain, awaits his doctor’s arrival in the examination room. As he looks at the pain scale on the wall, decorated with cartoon happy and sad faces, he muses on the inability of words to express pain.

I’m waiting for my doctor in this little room,
all alone with my body and nothing to read
except for the anatomy chart and the Lipitor ad,
and tacked to the wall near the blood pressure cuff
this other small piece of paper with six
progressively withering smiley faces
numbered zero to five. How do I know it’s a pain scale
for the non-verbal, or the non-English-speaking,
or maybe the deaf? It’s gotten my attention
as only pain can. I imagine my doctor asking,
How much does it hurt?” then pointing to each
corroding happy face in turn with a trembling
index. The first face boasts a smile a hundred
and eighty degrees wide, labelled zero for zero pain.
The last face is wringing tears from the scrunched up
lines that make up its face, labelled five for crushing
pain. And the faces in between, one through four,
might be mild, annoying, pounding, wrenching
pain. That is if there were words for what is all
vowels anyway. I mean, what can you say about pain
when ouch says it all; when words at their best
are merely true—or merely due, like the blessing
after achoo; when the complete works of Shakespeare
couldn’t budge one kidney stone, nor all the Bibles
in all the hotel rooms piled on top of each other reach
the big toe of the suicide hanging in I4B … I mean
you’d think we’d have figured it out by now, what to do
with all the pain, what to make of it, this natural
resource everywhere abundantly fallow, in every
corner of the world, every corner of the body. You’d think
by now we’d have invented a formula for converting it
into energy or food, or cancelling it out completely,
dividing it by itself or the farthest star, or else some
denominator we have yet to imagine. But no, when it comes
to pain, we’re still in kindergarten. When it comes,
we can only hunch over it, try to draw from memory
the irretrievable face of happiness. The language
of pain is wind in a field, it’s wind howling past a useless
tongue, past lips and teeth like disused rails and ties
abandoned in a field, where once the excellent trains ran
all day and into the night, the well-timed, smart arrivals.

Source:
Hostovsky, Paul. “Pain Scale.” Body & Soul: Narratives of Healing from Ars Medica. Eds. Crawford, Allison, et al. Toronto: University of Toronto Press, 2012. 61-62. Print.

Discussion Questions:

1. This poem hints at the limitations of language in the clinical encounter: “The language/of pain is a wind in the field, it’s wind howling past a useless/ tongue.” To what extent can we truly understand another’s pain especially when the clinical interview relies on words as a primary medium of communication? What are some alternative strategies we might use to better understand what our patients are going through?

2. The speaker is hyper-aware of his immediate environment as he waits in the exam room, making note of the anatomy chart, Lipitor ad, and the pain chart posted on the wall. How do the physical surroundings play a role in the speaker’s (or more generally a patient’s) perception of pain?

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One thought on “Pain Scale (Paul Hostovsky)

  1. I really enjoyed this poem and how it questioned the way we interpret and understand a patient’s pain.

    1) I’ve encountered this problem in my own HPI interview. I think the most valuable thing to do is to give the patient the opportunity to expand on pain outside of a number, or a quantifier. Pain can be abstract, all-encompassing, or indescribable – and we should be respectful of the massive impact it can have on people’s lives. I think it’s valuable to allow the patient to characterize it the best that they can. Following, we can do our best to reflect it back to them in a way that allows translation through the case report structure but more importantly values their experience. I think it’s a lot more difficult in practice, but as with all parts of the interview, I believe it’s important to hear the patient in their own meaning.

    2) I really enjoyed the 2nd line of this poem: “all alone with my body and nothing to read” and I think it points to how pain can consume the entirety of one’s body in a very debilitating way. What I think the speaker is getting to, with the almost desperate focus on environmental minutiae, is the desire to create distance from this sensation, entwined wholly with the experience of the body.

    Liked by 2 people

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