In a recent assignment, we were instructed to read and critique Eula Biss' "The Pain Scale", a short, non-fiction narrative about one woman's experience of living with chronic pain. I immediately thought, 'Hey, I'm a trauma nurse; I give loads and loads of pain medication every day....I got this in the bag'. Eh, not so much. Let's discuss my biases about chronic pain as a nurse, and how it relates to the nursing profession. As well as the fact that she can't assign a number to her pain, how severe her pain really is to her, and some internet research that I compiled on The Pain Scale.
In nursing, when you hear in report about a patient, one of these things listed as a secondary diagnosis; chronic back pain, fibromyalgia, or chronic pain syndrome...you immediately think to yourself, 'oh boy, another pain issue'. However, after reading this essay my views have remained about the same and that is what I call "fuzzy”. For example, my grandmother has a chronic pain problem, in November she was diagnosed with a compression fracture in her back at the T5 level. A compression fracture is usually the result of a traumatic injury to the spine; however, my grandmother has osteoporosis. Her compression fracture has been a result of the force of gravity pushing on her, causing a thoracic spine vertebrae to compress and fracture. This has caused her excruciating pain, caused her to lose 40 pounds because the pain is making her depressed and have no appetite. There is a physical reason why she is experiencing pain, there is proof of pain. This is where things get fuzzy for me. Eula Biss experiences pain that does not have a physical reason. There is no proof of pain, there is just pain. In class we discussed that Biss even questions her sanity, because it is a type of pain that is inexplicable. She questions if this pain really exists, because there is no proof of it on x-ray or blood tests. As stated in the essay, a doctor once told Biss "We have reason to believe you are in pain, even if there is no physical evidence of your pain" (pp 39). The doctors at the Mayo Clinic even suggest that the pain she experiences is similar to the phantom pain phenomenon. A explainable phenomenon experienced by some amputees, in which they experience pain on the part of the extremity just amputated. In healthcare, we tend to not believe things, unless there is proof that thing does exist.
One of the first things that you learn in nursing school is "pain is what the patient says it is". What my teacher meant by that is that pain is subjective. The only person who knows what your pain feels like is you. No one else can feel your pain, even if they have had the exact same accident, and has the exact same injuries and fractures, only you can tell how that feels to you. Someone might think that breaking a toe is the most painful thing, and rates it 10/10. Others can literally have their legs crushed under a car, and only rate their pain a 7/10. Personally I have a hard time assigning a number to pain. I have never experienced anything that is close to the worst pain imaginable, so I have a hard time rating what would be even half of that. Is my broken heel that I stand on and work for 12 hours a day on 3 days a week, half of what it would feel like to be run over by a bus? I don't know what it feels like to be ran over by a bus, so I can't assign that pain a number, and as a result of that, I also can't assign my fractured heel pain a number. In the essay, Biss writes that the worst pain imaginable for her is "burning alive", so she assigns her pain "thirty percent of the pain she feels burning alive would feel like". Then her father says a three is nothing, just a "go home and take two Aspirin kind of pain" (pp.33). It seems like Biss and I have the same problem assigning a number to the pain. Biss also has a hard time understanding how to appropriately use the pain scale, it’s no wonder, if you can’t fathom to what extent your pain is; how can you use a number based scale? However, she also states that "I am comforted, oddly, by the possibility that you cannot compare my pain to yours. And, for that reason, cannot prove it insignificant" (pp.39).
When I Googled "Eula Biss, The Pain Scale" many, many results were returned. In this blog, the writer agrees with my ideas on pain by stating "who are we to judge the intensity of pain another person is feeling? Pain cannot be shared or transferred, so the only person who truly knows how bad the pain is the person who is experiencing it." (Easterling, B. 2011) In the essay Ms. Biss explains with very emphatic detail the way she experiences pain, comparing it to Hell and Dante's Inferno. I think Biss is trying to describe her pain as her own living hell. She refers to a wind strength scale used to measure hurricanes to measure her pain, but she never actually gives a number to her pain. As a reader, I do have empathy for her, as she states she would rather cut off her finger in exchange for the chronic pain she experiences on a daily basis, and even has a flitting thought about suicide.That puts into perspective just how severe she thinks her pain is. Isn’t it ironic how when people are in an extreme amount of pain, they will cause themselves more pain and problems just to end, or even decrease, that pain. Not only is Biss in physical pain, but also spiritual, mental and emotional pain. As I mentioned earlier my grandmother suffers from chronic pain and on countless occasions, I have heard my grandmother say to my grandfather, “just drop me off on the highway and I’ll step in front of a semi and end this pain. That is just selfish, in situations when people think suicide is the ‘only option left’, they are thinking of themselves and their pain. They are not thinking about their family and friends who would be devastated if they were suddenly and tragically taken from their lives. There is always ways to medicate and help to treat pain, there is no way to replace a family member or friend.
I don't like the style in which this essay was written, I find it hard to follow. It’s like there was no plan of action on how to organize this essay, just going from one idea to another. I found myself having to go back and re-read most of it, because I would lose focus. Then I came across this blog that states that “The quick thought changes, while seemingly ‘all over the place’ all correlate to one cohesive internal dilemma that fights within Biss.” (Bee, L. 2012). Thinking about it like that puts the way the story was written into a completely different picture, and I whole heartedly agree with the writer of that blog. Now that the 'bug has been put in my ear', it makes so much sense as to why it was written the way it was. It is actually very well organized into an argument between the author and herself. This is an article I thought I would breeze right through and it would be a really easy assignment to complete. Now that I have read “The Pain Scale” I have learned a bit more about how people with chronic pain feel. I am still “fuzzy” on chronic pain; as to the etiology of it, and the way it manifests without signs and symptoms. However, after reading this article, I can have far more empathy and even sympathy for the patient with chronic, unexplainable pain; as well as being able to understand a little more about how the patient is feeling on the inside. They may not verbalize their feelings about the way this pain is literally controlling their every move. I can have more compassion for the way my patients with chronic pain, or fibromyalgia feel, how much they actually do hurt, even if we can’t see it on an x-ray, or there is not pathophysiology for their pain. They may be having a lifelong internal battle, and be quietly suffering and not telling anyone, it’s no wonder a secondary diagnosis of chronic pain or fibromyalgia is accompanied with depression and anxiety.
References
References
Bee, L. (2012). On Eula Biss's "the Pain Scale". Literary Musings. Retrieved
from http://laneybranchlikeatree.wordpress.com/2012/02/21/on-eula-
bisss-the-pain-scale/
Biss, E. (2005). The Pain Scale. In Williford, L and Martrone, M (Eds.),
Touchstone anthology of contemporary and creative nonfiction: Work
from 1970 to present (pp.28-42). New York, NY: Simon & Schuster, Inc.
Easterling, B. (2011). Eula Biss' "The Pain Scale". ENC 1102. Retrieved from
http://brianna-easterling.blogspot.com/2011/09/eula-biss-pain-scale.html
Nice work, Jodi!
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