My Wednesday reflection on service and my recent experience in the ER (from both sides of the curtain) got me thinking about pain.
Simply put my job as a physician can be boiled down to two primary objectives – 1. To treat treat/cure disease, and 2. To alleviate suffering. And, of course, in the application of each of these there is the ever present imperative to “benefit and yet not to harm.” Based on my observations thus far, there are three primary reasons people come to the ER – 1. They come for treatment, 2. They come for reassurance, 3. They come for pain pills.
PAIN PILLS: THE BANE OF AN ER PHYSICIAN’S EXISTENCE
It sucks to feel used, it is no fun to be lied to. It sucks to be in pain, it is no fun to be ignored. And thus the conflict that gets played out hundreds, nay thousands of times in American emergency rooms each day. The classic dilemma of distinguishing between those who are “drug seeking” and those who are in “real pain,” begs any number of questions. Who is to say they are different people? Whose right is it to determine or judge the level of pain another individual is experiencing? Is all pain bad? Does pain always need to be treated? Are narcotics over-used? Are narcotics under-used? Is it a doctor’s job to relieve patients of all pain and at what cost?
These questions and more have led me to a broader reflection on the meaning of pain in our culture. What follows is a collection of scenarios, quotes, and common sayings related to or inspired by pain. I am curious to hear what the topic brings up for you.
- “No pain, no gain.”
- Narcotics: Illegal, Prescribed, Controlled, Addictive, Pain-alleviating, Sleep-inducing, Potentially-lethal, Expected.
- The brand name of prescription narcotics and muscle relaxants are also household names: Vicodin, Percocet, Flexeril.
- Most people I know have been prescribed a narcotic for one reason or another at one point on their life.
- The juxtaposition of a sweating writhing man passing a kidney stone rating his pain at a 6-7/10 and a young woman with a sprained ankle resting comfortably in bed rating it at a 10/10 and demanding narcotics.
- “A lot of people run a race to see who is fastest. I run to see who has the most guts, who can punish himself into an exhausting pace, and then at the end, punish himself even more.” -Prefontaine
- An elderly woman is dying. Her disease causes her severe pain even at rest and makes her feel as though she is suffocating. Morphine could help alleviate both, but she refusing saying, “I don’t want to get addicted.”
- The husband of a young woman with chronic headaches threatens to kill an ER physician for not giving his wife more Dilaudid stating,”You are obligated to treat her pain.”
- “Cutters” – inflicting physical pain on themselves to relieve existential, emotional, psychological distress.
Merely the body’s messenger of injury and imbalance?
Perhaps a villian to be slayed at all costs?
Or is it a virtue to be endured and even relished?