Off the charts

2 Apr

Pain scale

They say the Likert Scale is the “Universal Pain Assessment Tool.” I say, “Universal” needs a footnote appended to it. The footnote should say:

When assessing cyclists, add a “3” to whatever number they give you.

Cyclists have a unique (read: “highly dysfunctional”) relationship with pain:

* We get back on our bikes to finish races with 25cm splinters THROUGH our legs
(WARNING: Don’t click that link if you are squeamish)

* We complete 129 miles AFTER a being hit by car that launches us into a tangle of barbed wire
(WARNING: Don’t click that link if you are squeamish)

* We finish races even when we can’t remember finishing races and keep asking our friends if we finished and can’t remember / don’t “know” that we crashed, smashed our heads, broke our noses and ribs and -yes- ACTUALLY FINISHED and this non-memory loop keeps playing itself out as we’re being loaded into the ambulance and we keep aking “Did I crash? Did I finish?” over, and over, and over again
(WARNING: You can no longer find the incredibly disturbing video of Chris Horner’s 2011 Stage 7 ambulance-load amnesia episode because his handlers/sponsors apparently maintain an aggressive troop of link-scrubbers who have flawlessly eradicated all video evidence of Mr. Horner’s post-race “interview” — this L.A. Times story is the best link I could come up with, but it doesn’t do justice to the willful stupidity of Mr. Horner, his handlers, and, by proxy, ALL cyclists)

The “Universal Pain Assessment Tool” is utterly inapplicable to cyclists.

We are idiots. We are addicted to our bicycles and we will ride them regardless of pain. We have serious mental health challenges. We all likely deserve to be diagnosed with Delusional Disorder. Accordingly, medical professionals should view our self-reflective “pain assessments” with a great deal of skepticism.

* * *

It’s Sunday. It’s 75° and sunny. While you slept, it rained for a few hours, so the sky and landscape are exceptionally clear / beautiful. The winds have dissipated. It is, therefore, a 110% perfect day for a long, not-so-liesurely ride to the top of a mountain from whence one might survey and bask in the splendor of Los Angeles’ uniquely gorgeous, recently rain-washed terrain, but instead…

Instead, you have voluntarily presented yourself to the Emergency Room. No — scratch that. It’s worse: You had to ask a friend to present you to the ER because you were in no shape to drive yourself. No — scratch that. It’s even MORE worse: You actually had to call your ex-boss because he’s the only person who lives near you and would actually be awake (and not riding a bicycle) at 7-friggin’-30 in the morning on a Sunday.

When you elect to NOT RIDE YOUR BIKE on a 110% perfect day and instead have your ex-boss drive you to the ER, at your behest, at 7:30am on a gorgeous Sunday morning, things are very far from OK.

TIP FOR CYCLISTS: When the nurse asks you to rate your pain, don’t just say “8.” You need to share your internal chatter so that she understands that you are a cyclist:

  • Well, it’s not as bad a having someone saw a 4″-diameter hole into my skull and getting 47 staples in my head (i.e., a 10)
  • And it’s not as bad as getting hit by a bus and having my shoulder shattered (i.e., a 9)

If you had shared your head-chatter, then the medical staff might have be better able to calibrate, react to, and treat your “8.” But instead, you’ll be relegated to non-acute status and left to linger and wallow in pain for hours on end because the crack-head schizophrenics are more demanding and dramatic as they rant at the orderlies:

You want me to go Silence of the Lambs on you? I am a cannibal and I will chomp your head off like a Rolo candy, n*gger!

Yes, because you are cyclist and you have no idea how to relate your pain to the scale that Normal People use, you will spend hours curled up in fetal position waiting for tests to be run before anyone thinks to give you some Morphine.

Ahhh, Morphine. I ♥ love you! Thank you, nurse, my pain is now down to a “4” …. on the Normal People Likert (NPL) scale.

A couple of hours later, the doctor will finally make an appearance. You tell him that when you lie perfectly still, your pain is a “3.” When you move to adjust yourself on the gurney, it goes to a “4 or 5.” If you have to move your left leg, it goes up to a “6 or so” — that’s with the Morphine (and using the NPL).

He presses on your belly. Your eyes roll back into your head, you begin frothing at the mouth, and you nearly rip the guard-rails off of the bed.

He says: You said your pain was about a 3, right now, when you’re just sitting here?


And what about when I was pressing on your belly? What was it then?

Back up to maybe a 6.

Hmmm. And you just had your second dose of Morphine and you said it was worse when you move your left leg?


He raises his hand about 6″ above your legs and says: Can you lift your right leg and press against my hand?

Sure. You do this, no problem. Your pain remains around a “4” on the NPL.

OK, now, with your left….

You move your left leg maybe 1″ off of the bed and then crumple, moan, start panting like the women-in-labor you’ve seen on TV, and tell the doctor that you’d prefer to not have to complete the task.

And what was your pain level there?

Again, you flip through your mental Rolodex of cycling-related pain, and say: Mmmm, about a 6.

The doctor furrow his brow and says: You have an extraordinarily high pain threshold. I will be writing you the strongest possible Percoset prescription.

It’s only later — days later — that you realized that the NPL really DOES needs to be modified with the aforementioned Cyclist Footnote (CF).

If there had been a CF Likert scale at your hospital, then the nurse who noticed your RoadID bracelet (and sagely remarked: Oh, are you a cyclist? Looks like you’re missing a good riding day today…would have known to “add 3” to your self-assessment pain response and you could’ve been blissed out on Morphine right away rather than having to listen to the scary schizophrenic make good on his threat to punch a hole in the wall, and you could’ve ignored the rush of security guards who came to subdue him, and you would’ve better appreciated the fact that sometimes it’s more humane and necessary to prioritize treating those mental pains rather than your own physical ailments.

We do the best we can with the information and resources we’re given — but sometimes our resources really do need footnotes.


2 Responses to “Off the charts”

  1. Cheryl April 3, 2014 at 8:17 am #

    Recognize myself way too much in this post!

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