This Pain Goes to 11

Actually, More Like 23

Welcome to all of the new faces!

And apologies because this isn’t a hermit crab essay. I wrote this numbered essay in the summer of 2022, and I’ve been sitting on it since. Which is a shame because I really love it. Rather than letting it languish in a folder for all eternity, I decided it was high time to edit it and get up here.

(Didn’t hurt that I’ve been going through some recent medical stuff that put me in mind of it, either)

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I.  “How would you rate your pain from 0 to 10?”

The most dreaded words uttered by medical professionals. Worse than, “You have fibromyalgia.” Even more soul-sucking than, “We didn’t find anything wrong.” Nope, it’s the monotonous drone of a nurse entering a number into my medical record that kills you, the Wong-Baker FACES scale perched somewhere over their shoulder.

I despise the FACES. They stare down with varying expressions meant to mimic my facial state of mind.

I never know if my eyes and mouth crinkle into those approved grimaces despite the hours I waste practicing the motions in the mirror. I lack any sense of control when consigned to a hard plastic chair in the ER.

Am I squinting?

Has a tear slipped down my cheek? (As if I’d ever give those people the satisfaction of seeing me cry)

Who decided Wong and Baker knew everything about the state of pain?

As if a basic scale of 0 to 10 could capture all the shades and nuances the human body can produce; from a stubbed toe up to an arm mutilated in a car wreck.

Whose stubbed toe, though?

The five-year-old screaming in the waiting room, who will enact a miraculous recovery at the sight of an ice cream cone? (Plenty of tears on that face)

Or the screeching nerves in my foot assuring my spinal cord the digit is no longer attached, regardless of any tactile or visual input I try to shove into my brain? If I attempt to cry over such a minor injury—despite the enormity of pain flooding my nervous system—I’ll earn a jaded eyebrow arch of skepticism. (And no ice cream)

So much for the FACES.

It’s an open-ended question, supposedly without a wrong answer. Except there’s always a right answer. And a suspicious answer.

Give the appropriate number, and you slide forward into a line receiving medical attention, including blessed analgesia.

Guess wrong, and the hammer comes down on hypochondria. They shuffle you into the Fast Track, where you wait for hours before a brief dismissal of “You’re fine.” Maybe you’ll hear a recommendation for Tylenol or Advil (both if you manage to behave).

Am I fine, Wong? Baker? Does my lack of sobs automatically translate to good health?

“How do you rate your pain from 0 to 10?”

I’m left with no choice but to close my eyes and fumble for a number that equates to what I believe is malfunctioning in my body.

Throw a dart at the FACES and hope my guess comes close.

More people will ask, giving me more opportunities to get things right.

More chances to practice my FACES.

II. Something cleaved my head into neat quarters: Once down the middle (I could see the hemispheres of my brain bisecting) and once through an arbitrary line somewhere above my ears. Every breath scraped through my trachea with the sound of sandpaper.

I hated the sound of my body, contemplated how long my most impressive breath-hold record was, and wondered if the middle of the workday might be an appropriate time to challenge it. Every ambient light in the cave of our office blazed with the intensity of an unprotected eclipse, slicing my retinas into strips.

“Sunglasses at Night” rolled through the back of my brain on an insane repeat.

I didn’t need to touch my chest to confirm my heartbeat. My pulse jumped in the artery in my wrist, threatening to leap out of my arm with each surge. The dance of sinew under flesh provided momentary distractions from the corresponding pounding throughout my head. Rhythmic, unhurried, but carried with the force of a tsunami.

“Can I see the Kardia?” I asked.

“Do you have a demonstration?” Marie asked, retrieving the heart monitor from its sacred space in the cabinet.

“No.”

I watched the ECG trace across the screen of my phone. The lines soared higher than my meager pulse usually managed, sketching a perfect heartbeat. Nothing special or out of the ordinary; the rate no higher than my body’s typical 60 beats per minute despite the waves of anxiety turning my stomach to knots. I scrolled through the entire run, determined to spot something out of place, a wobble from the baseline to explain why my heart slammed the underside of my sternum.

Black lines stared back.

Migraine?

Headache?

Imagination?

I swallowed the words along with the unease pushing pain through my blood vessels.

No medical professionals accepted “not right” as a reason for presentation to the Emergency Room.

I drove to my parents’ house, fingers probing the lines of my skull at every red light. Were the bones separating? Had my brain finally declared war on my body, resigning from the minutiae of running a system imperfectly crafted?

“Dad has a blood pressure monitor, right?” I asked, dropping my workbag on the couch.

“Of course. Why?” (Mom-Alert always jumps to 11 the moment I ask suspicious questions)

“Something feels wrong,” I said, extending my wrist for Dad to strap the cuff around my hammering pulse. He bent my arm against my chest, launching into a recitation of everything he did to keep his hypertension under control. I wanted to roll my eyes at the subtle bragging—the man lived on diet soda while I slugged water—but pressure behind my ocular rims suggested the orbits might roll free and tumble across the kitchen counter if I moved them.

Dad frowned, staring at the monitor as it beeped repeatedly. “230 over 120.”

“That doesn’t sound normal.” I knew animal normals, not humans. But I’d never heard anyone read values that high before.

“Let’s try one more time, just to be sure.” He repositioned the cuff, checked that my feet were flat on the floor. (As if hearing an absurdly high number hadn’t elevated my blood pressure further) “240 over 130. I think we need to go to the ER. This is stroke zone.”

Groaning and rubbing my eyes, I had no choice but to resign myself to the inevitable. “Right. Do you mind driving me? My head feels like it’s separating from my body.”

“How would you rate your pain from 0 to 10?” the nurse prompted me in her cubicle.

I stared at her, numb.

Had she not heard the blood pressure values I’d recited a moment before—or seen the flashing numbers of her machine? Did I not resemble a hypertensive patient? (Damn my inability to lose those five pounds) Was I supposed to walk in clutching my chest? Hold a hand to my head? (What did stroke patients look like before the drooping face took over?)

Red numbers flashed repeatedly on the monitor. Systolic: high. Diastolic: high. Pulse: normal. Was the normal throwing her off? Tumbling me into a category of patient unhealthy enough to justify the visit but still quantifiably healthy to waste the final moments of her shift?

My eyes swept the pain scale, searching for unwanted, unneeded, but necessary guidance.

“Five,” I mumbled.

The Fast Track doctor diagnosed hypertension. (They give medical degrees for this?) A nurse plastered lidocaine across my chest to thwart my body’s vasoconstriction. No one preemptively warned me the pain slicing through my head would worsen as vessels opened to accommodate the lidocaine-induced increased blood flow.

Then again, I was in minor discomfort; a little extra pain meant nothing.

I sent Dad home, confident I could crawl the few blocks home alone.

The midnight hour covered my sheer embarrassment.

III. “Well, your ECG is normal,” the nurse told me.

I wondered if she expected me to cheer. Maybe she wanted a smile or laugh or another outward display of relief. I supposed most people responded to her words with jubilant expressions that the organ in the center of their chests wasn’t abandoning them after all.

I sagged in defeat.

One more false alarm. One more wasted trip to the ER for the unrelenting agony behind my sternum. A dead center ice pick that increased in intensity every time I dared to inhale, spiking my anxiety as I attempted to find a more rational explanation than the laundry list of heart attack symptoms common to women.

My body wouldn’t stop shaking as she pressed the tiny discs under my breast, on my side, down my arms, and up my legs. She had to coach me to take deep breaths as my heart (not my heart—traitor) performed an exaggerated pirouette in its body cavity.

Trapped in a hospital bed, naked under the unflattering geometric pattern of my gown, tethered to the telemetric beeping of the overhead ECG monitor. Waiting for the latest high school graduate to come by and proclaim me a ball of anxiety, overreacting to some unknown twist of sinew conveniently located between my breasts.

“How would you rate your pain on a scale of 0 to 10?” the nurse asked, not bothering to glance up from her terminal.

I wanted to hide under the useless white blanket she’d offered to cover the open-backed gown.

Giving any number felt like fraud in the face of her previous statement. Why protest my chest felt a gaping wound, sucking in the surrounding fascia? How to ask for a chance to view the printed report, confirm she didn’t confuse my ECG with someone the medical team might be rushing into a cath lab at that moment?

The twisting sensation had driven me to beg out of work early—despite my manager’s frown, worse than any rebuke—and consent to set foot in an ER voluntarily. Where did that fall on their chart of misery?

“Around a five.”

I shrugged through the doctor’s distracted list of suggested tests. They felt like afterthoughts. Or a scavenger hunt performed among the team currently on the floor.

“Who can order this test before the end of the shift?”

“Mark your BINGO cards if you find this result!”

Repeating my symptoms in the face of a normal ECG turned my face a permanent shade of crimson. They failed to impress any of the medical staff who paused to examine my vitals.

A chorus of beeps rose from the beds surrounding mine. A melodic counterpoint to the moans and whines. Begging voices pleading for narcotic interference. I bit my tongue against the invisible blows striking my breastbone.

What right had I to pain relief? There was nothing wrong with my heart.

“Your CT shows a hiatal hernia. That’s the sphincter where your esophagus meets your stomach,” the doctor announced. “You need to talk with your GI specialist about a repair if the pain doesn’t stop. But at least you know you’re not having a heart attack.”

“How would I tell the difference?” I asked.

He stopped at that question. “You get an ECG.”

I’d made multiple trips to the ER at that point, facing the judgmental gazes of professionals who appeared concerned until the moment the tracing appeared normal. (Message received)

“For now, we’re going to have you swallow a concoction to help the GERD.” He disappeared. One more obscure item completed on his BINGO card.

“You need to try to get it down in one swallow,” the nurse told me, extending a small Dixie cup. A dinosaur cup filled with whiteout to erase my error in arriving at the trauma unit without a valid reason.

The scent of mint was thick. I tilted it back, attempted to swallow the thick chalk past the obstruction in my chest.

Liquid fire erupted through my body, my esophagus rebelling against the assault. I coughed, choking on the thick poison. My lungs clamped down in an effort to preserve my windpipe; no air allowed to move as the expelled liquid ventured close to my trachea.

Tears spilled down my cheeks as I struggled to regain homeostasis.

For the first time that evening, my face matched an image on the scale over my shoulder. But no one asked me to rate my pain as the nurse rolled her eyes and chided me to finish the last swallow.

IV. The medical community developed the pain scale to aid in research. Pain fluctuated and varied from person to person—anathema to the research community. They needed a way to standardize numbers for clinical settings. With pain control a priority—before the fallout of the opioid epidemic—coopting the scales into everyday use made life easier for everyone. (Except patients, of course)

Why learn to communicate with patients, trust them, and understand where they were coming from when it was easier to streamline conversation to a single number? An adjective? A color?

Self-reporting of pain dropped from discussions that ate into doctor time to a checkbox on a form. An objective measure of a condition that never deserved to become objectified.

Scales covered the spectrum to ensure everyone—regardless of age, language, or condition—could be rendered into a category.

“Place your finger along a visual analog scale representing your place on the pain continuum.”

“Find the color that indicates your anticipation of a doctor pressing on your swollen and inflamed appendix.”

“Match the way your body feels with a cartoon face exaggerating the features of a person’s distress.”

For the intellectuals, McGill provided a vocabulary test.

“Which word adequately describes the way your body has chosen to torment you today?” (No need to worry about the numbers attached to each adjective; a narrow-minded doctor will assign meaning to the word once you’ve completed your assessment)

“Are your organs ‘tugging’ out of your body? Or are they ‘wrenching?’”

“Is the pain ‘cold’ or ‘sharp?’”

The list contained 78 ways for someone to illuminate their pain, each one describing a different person’s feelings when in the throes of sheer agony.

One more way to pigeonhole a patient into a category rather than engaging in actual conversation.

Why discuss the impact of bodily torment on a person’s life? Why sit down and hear how pain has incapacitated their existence?

Especially when it’s easier to ask “0 to 10” or “red or green?”

You get so much more information from a “5,” “8,” or “10” than you will from a frank heart-to-heart.

V. People fail to discuss the sound that accompanies musculoskeletal injuries. Television and movies popularized the world-stifling SNAP of broken bones, but they neglected the equally loud POP of a joint as it twists in a sprain or strain.

Then there’s the instant nausea while lying on the ground, attempting to decide if you’re brave enough to move the affected limb. Movement, of course, demonstrates you didn’t succeed in breakage. But a lack of a break means you will, eventually, need to get yourself upright and assess the potential for medical assistance.

Assuming friends, loved ones, or co-workers haven’t already swarmed to your side in laughing admiration of your impromptu swan dive.

Children receive sympathy for bumps and bruises as they tackle the world head-first. Adults get mocked for attempting the same stunts.

Such as the twisted ankle resulting from a tumble in a hole in the middle of the yard (the same one I missed every other time I mowed the lawn two years prior). 

Rolling the other ankle when I failed to properly navigate the height of the Murder Stairs one time out of hundreds of others.

And the spectacular backward plunge on roller skates ten minutes after assuring my husband I wouldn’t injure myself. (The skates and attendant safety equipment purchased on an impulse in the middle of the pandemic lockdown when I could no longer stand spending time cooped up in the house)

Every time, an indefinable CRUNCH followed by an immediate screech of alarm through the neural network controlling the affected appendage. My breath knocked from my lungs as my brain attempted to process the tidal wave of “Something is very, very wrong” signals assaulting my spinal cord.

Topped by a moment to curse my fallibility.

And the inevitable faces bent overhead with a variation of the same question, mirth shining behind concerned expressions: “Are you okay?”

As if my presence on the ground, unmoving, weren’t indication enough of the injury.

Pain makes people uncomfortable—to experience and witness. Everyone wanted an immediate abashed response to their humor, a share in the joke at my misfortune. No gasps or tears or negativity to suggest an actual act of violence took place.

My husband—the tenderest first responder—waited as I unlaced my skates and failed to push myself upright before coming forward. “Can you lift your arm?” he asked, a tight rein on his emotions.

“I’d rather not.”

“Get your shoes so we can go to Urgent Care.” He unbuckled the helmet that cushioned the blow of my skull against the unforgiving pavement of the driveway.

“I don’t need to see a doctor.” I attempted to push him away.

“Right.”

He gifted me an hour to see the error of my ways. Generous, compared to the irritated buzzing of co-workers fearing a workman’s comp suit. They packed me into a car within moments when I tumbled from my knee scooter—reckless driving on an already injured ankle.

My husband was a patient creature, stalking wounded prey too self-righteous for its own good. When I tried to lift my water glass and screamed, he put my sandals on.

“I don’t want to go,” I whined as I let him walk me outside, buckle me into the car. “I’m not going to behave.” I made threatening faces as he escorted me through the door, entered my information into the kiosk.

“How would you rate your pain from 0 to 10?” the receptionist asked, pen hovering over her keyboard.

His fingers held my good hand in a reassuring grip. A grown-up tattletale poised to interfere if I dared lie.

I wanted to shrug but thought better of moving the grinding bones in my left shoulder. “Eight.”

"You’re our second shoulder injury of the day,” the nurse said cheerfully. “We just had a gentleman leave who wiped out on a beach buggy. What were you doing?”

I boosted myself onto the exam table with a sigh. “Roller skating.”

VI. “How would you rate your pain from 0 to 10?”

I gripped the edge of the chair and attempted to leverage myself into something approximating a sitting position. Dull-edged blades cut into my spine and down the backs of my legs, informing me that movement (any movement) was ill-advised. The knuckles on both hands blanched white, the fingers shaking with the force of restraint.

For the briefest moment, I saw sympathy flicker in the nurse’s gaze. He took in my ramrod-straight posture, the pallor of my skin, and the locked jaw of my teeth embedded in my bottom lip.

Yet he still waited for an answer.

Despite my hobbled walk across the ER lobby and inability to function as a healthy individual, he needed my report on the pain incapacitating my body. No informed opinions allowed.

Tears started in the corners of my eyes, but I blinked them back. I refused to succumb to the hysterics I imagined he wanted to see.

“Eight.” The number fell from my lips.

Every time I swung my legs over the side of the bed, fire boiled down muscles and sinew. I grasped for the headboard, the wall, anything to drag myself into an upright arrangement that eased the unceasing pressure on my spine. Walking devolved into shuffle steps around the bedroom in a futile attempt to distract the brain from processing the synaptic impulses telegraphing up the vertebral column.

All so I could collapse and repeat the process over the following hour.

Exhausted in a horizontal plane on the bed, I slept. When my legs consented to hold in place, there was blessed relief for hours (minutes?) where the nerves fell into a numb stupor, content to remain silent. If I could decipher the secret of paralytic sleep, I wouldn’t have any need to wake up screaming in the night, flailing for assistance that didn’t exist.

It was nothing more than back pain.

Everyone endured back pain, particularly in the veterinary profession. We moonlighted as contortionists.

“We’ll call as soon as we have a bed ready.” The nurse held out a hand as if physical support were all I lacked to lift my corpse from the chair.

The rush of morphine through my veins: Liquid fire seeking my heart and brain, followed quickly by a momentary pause in my pulse. I hid a smile behind my coughing as the nurse cast a startled glance at the ECG over my shoulder, watching to confirm my heartbeat restarted.

My head wanted to disconnect from my body, but the poker wedged in my spine refused to let go. The hospital bed designed for patient comfort refused to accommodate the impossible position my back longed to contort into. I curled on my side, walking fingers along vertebrae in search of anything amiss.

“Have you fallen recently?” the doctor prompted me.

Always a question of falls, as if I required constant supervision for survival. How to explain nothing preceded the horror entangled in my lower back?

Nothing had happened: I rolled over to switch off my alarm and started screaming. (“My body didn’t want to wake up.” That would go over well)

“You have a pinched disc,” the doctor said. “Actually, you don’t have much cushion left between your vertebrae from L3 to S1. You need to talk to an orthopedic specialist.”

Standing, walking, bending, twisting: Work had destroyed my back. When I approached my manager for the time off for my spinal fusion surgery, she raised her eyebrows.

Was I aware of how many people I was inconveniencing?

My back was inconvenient for me, too.

I needed it to stand.

And walk.

And bend.

And twist.

And it was killing me more every day.

VII.  “How would you rate your pain from 0 to 10?”

The gold standard of pain intensity is supposed to be the patient's self-report. Neuropathic pain (diabetes, trigeminal neuralgia, spinal cord injury), mixed pain (migraine, fibromyalgia, multiple sclerosis, lower back pain), and nociceptive pain (arthritis in all its flavors, inflammation, exercise injury) all (supposedly) adhere to the analog scale of visual cartoon depictions.

Wait two hours for the selected therapy to settle into a patient’s nerves and repeat the question.

If the patient is coherent, aware, and responsive, employ the Mankoski scale to justify a refusal to change their original reported number. (Narcotics exist to blunt the rough edges of human misery; how dare someone deny their influence?) Launch into a mind-numbing recitation of the benefits of treatment, sunshine, exercise, stretching, human companionship, optimism, water consumption, walking, interaction with an emotional support peacock.

Repeat the question.

Something must budge their response. No pain is immune. Any patient who refuses to indicate improvement is an addict or a liar.

Medical science is infallible.

VIII. Where did my bladder continue to find pee?

Fifteen trips to the bathroom in under thirty minutes; there couldn’t be a drop of moisture left in my body. I’d hurled the meager contents of my stomach into the toilet within minutes of eating breakfast, so I knew nothing had survived digestion for processing. Rolling waves of nausea turned me away from any thoughts of sipping my water bottle. Nothing was going in, but something still managed to come out.

I was loathe to describe it as urine given the color.

My fingers tap-danced a pattern along my left flank, searching for the blade I felt confident must be embedded in my back. Nothing other than a serrated knife could explain the piercing sensation deep in the tissues under my lung, twisting tighter and tighter whenever I attempted to stand upright. I would have blamed an aspect of my breathing if I wasn’t clocking so much travel time to the gleaming porcelain god—a feat I’d never managed, even during my worst college drinking days.

“Do you need to go to the hospital?” Jen asked, catching the whimper I tried to swallow.

“I don’t know.” My automatic response whenever the question arose.

I’d braved Urgent Care two days before and received a relatively clean bill of health. There was no sign of infection. Odds were there was nothing wrong beyond a flare of interstitial cystitis: My bladder pitching a temper tantrum in response to environmental, mental, or physical stress. (Or a combination of all of the above, as it was wont to do)

The hospital didn’t care to see me for the equivalent of an anxiety spiral.

I pitched forward, stilettos punching repeatedly into my back. Every blow delineated the shape of a bean in the left quadrant, hanging innocently behind the twists and turns of my intestines. My hands gripped the counter in a death grip, and tears spilled down my cheeks, unchecked.

“I’m calling your mother,” Jen said firmly. The threat was as cold and damning as it ever was when I was a child.

“How would you rate your pain from 0 to 10?” the nurse asked, her tone bored.

I wanted to laugh, to scream, to lift the chair I hunched over and throw it across the room.

My body stretched taut, unable to find a comfortable position. Fine tremors ran the length of my arms and legs, compelling me to run towards the nearest bathroom to expel a few paltry drops of blood or dry heave until pain collapsed me against the bowl. (I never knew which impulse would win; my nervous system kept things fresh)

I’d lost track of whether my eyes were wet with tears or exertion, the constant weeping blurring my vision. The lobby was surprisingly empty, yet I’d paced ceaseless circles around the periphery; a caged prisoner unable to escape the presence of her tormentor.

“Ten!” The word deafened me.

Throughout post-operative phases when I thrashed in senseless delirium, I’d never uttered the sacred syllable. Three letters fractured my self-control, and I collapsed onto the chair as she wrapped a blood pressure cuff around my arm. Sobs choked my throat.

“I’d say you have a kidney stone,” a nurse chirped, examining my pathetic urine sample. (And all this time, I thought everyone peed Bloody Mary mix) “What do you say we get you some pain medication?” (What do you say I cut out my left kidney here and now?)

The hydromorphone took the slightest edge off the stone assaulting my urethral tract. It accomplished nothing for the cheerful demeanor of my medical team, insistent on reassuring me the small size boded well for easy passing.

I sat in a drug haze, listening to comparisons between kidney stones and childbirth (as if a human infant shared any characteristics with calcified oxalate), scrambling for the green sickness bag each time the crystal shifted further down.

“We’ll set you up with an appointment with a urologist tomorrow, just in case,” the doctor told me, prodding my irritated kidney with indifferent fingers.

“In case of what?” I asked, contemplating whether slapping him counted as assault.

“You don’t pass it. It’s always a possibility.”

“Possibility I surgically excise my own kidney?” I lifted an eyebrow.

He laughed.

The opioid in my system had transformed me into an unintentional comedian.

IX. “You can’t even cough without keeling over in pain,” my husband said, hand firm under my elbow as he escorted me out to the car. “That indicates something’s wrong, and we’re going to the ER. It isn’t a question.”

“I’m pretty sure taking someone against their will is the definition of kidnapping,” I wheezed, allowing him to help me into my seat. I winced when his fingers brushed my abdomen as he clicked my seatbelt in place. (A considerate hijacking, at least)

“You can let them know after they examine you.”

The tension in his voice communicated the tender concern lacking in his words. He’d held his tongue for two days, watching me grow quieter and quieter as the pain ate through the center of my stomach.

As I expressed confidence and reassurance, he attempted to run interference against a full workday routine and life as normal. The surgical site appeared inflamed—a widening ring of raw flesh that oozed fluid onto every attempted bandage I slipped in place to disguise the angry tissues.

My only saving grace was my healthy temperature.

Healing bodies required time, and this excision was a step further than mine felt comfortable accepting. Parting with my uterus and fallopian tubes, my system had made its peace with; the right ovary crossed a line in the sand my body had decided was a step too far. Post-operative pain my penance.

But pain was nothing more than weakness leaving the body.

“They’re going to say everything’s fine and send me home,” I said quietly.

“If you complain one more time,” my husband sighed.

“You’ll turn the car around and take us home,” I said in satisfaction.

“No, I’ll start speeding.” He cast an irritated look in my direction. “Then I’ll get pulled over, and you can explain your stupidity to the police. I’ll bet we get an escort to the hospital.”

I stared in horror. Gone was the nurturing caretaker who doted on my recovery, replaced by a frantic individual I barely recognized. “You wouldn’t.”

“Try me.”

I felt the subtle vibration of the engine, communicating to the ravenous monster chewing the internal tissues of my abdomen.

He took my startled silence for acquiescence.

“How would you rate your pain from 0 to 10?” The nurse’s fingers were gentle on my wrist as she counted the stuttering beats of my heart.

I met her gaze, searching for condemning judgment. She’d listened to the paltry story of a surgical procedure completed not five days earlier; the unceasing sensation of acid dissolving every layer of skin and tissue—seeking something inside I couldn’t name. I’d reluctantly peeled away my latest concoction of gauze and tape to reveal a sweating mess of pink fluid. Her sympathy radiated in waves as she took meticulous notes, reaching for the pager to summon an immediate room.

The word perched on the tip of my tongue, the weight of my husband’s terror a presence behind my shoulders. A coughing spasm wracked my core, throwing me forward in an uncontrolled motion, hands splayed to prevent my forehead from connecting with a corner of the desk.

“Ten.” The whisper was lost in a sudden spate of tears.

I never asked if she heard me. I watched her fingers press two digits into the keyboard, cementing my perceived hysteria into the record. My brain entertained ideas of overreaction born of my presence within the walls of the ER—surrounded by individuals coughing, retching, and sneezing—while a lone scream demanded recognition.

But I could no longer stand or stretch; the number was valid.

“How would you rate your pain now?” the nurse asked me two hours later.

My husband’s fingers squeezed my hand gently. There would be no lying this time, no disguising the agony twisting my internal anatomy into a Gordian knot. I cringed at the potential onslaught of another dose of morphine into the recesses of my brain but sighed. “It hasn’t touched it.”

She brought me hydromorphone. No stumble in my pulse, but the agonizing slowing of my breathing, tormenting the pulse oximeter perched at the end of my finger. I glared daggers at the monitor every time it alarmed. (It turned a deaf ear to my continued insistence I breathed and lived)

The knives in my belly withdraw a fraction of an inch, giving me enough space to contemplate a full breath.

“Your CT shows a seroma at your surgical site,” the doctor said. “We can’t tell if the fluid is an infection or not, unhappily. So we’re going to admit you and alert your doctor. He’ll decide whether to take you back into surgery.”

“I’m not going back to surgery if an operation caused the problem.” Opioids as the proverbial truth at the bottom of the bottle.

The corners of the doctor’s mouth curved into an indulgent smile. “That isn’t your decision.”

“I don’t want to stay,” I said.

“Also not your decision,” my husband replied.

In the space of a moment, I’d lost independent thought and responsibility. I looked between the two, cursing the three letters that sent me into the hospital bed.

My body contorted, determined to demonstrate health it was no longer entitled to. I gasped, collapsing onto my side as tears started from my eyes.

Two gazes swung to the FACES on the wall.

I cursed.

I protested.

I cried.

I pleaded.

I bargained. (The stages of hospitalization; there is no acceptance, only admission)

Drowning under another dose of narcotics, I lost my right to sign paperwork. My husband stepped forward to commit me to the suffering embrace of a hospital room, the tender mercies of a nursing staff determined to see to my every need and care.

As I tossed and turned, content to exist within the bounds of misery, they stopped asking me the dreaded question that led to my confinement.

Outside my door, “Extreme Fall Risk” signs plastered the hallway.

“We need to go back to surgery and remove the fluid pocket,” my surgeon said, amid apologies for the common yet uncommon surgical complication. “It’s continuing to grow, and the only way to prevent sepsis is to clean it out.”

“You already did this,” I accused.

“And I’m trying to rectify it.”

Misery brought about by millimeters of fluid collected beneath the skin. Hollowed out by a scalpel and packed with gauze, leaving me dependent upon the very people I’d done my best to alienate.

“How’s your pain now?” my husband asked, helping me transfer from the wheelchair to the car.

“Give me your hand; I’ll squeeze yours until it matches,” I said, pressing my fingers between his in misplaced gratitude.

X. Always a moment’s hesitation when the question falls from someone’s lips: “How would you rate your pain from 0 to 10?”

Are they interested in the truth, a truth, fabrication, or falsehood?

Does what I feel equate to a number? Or do the numbers fail to encapsulate the horror my body has created? How to transform the laughable state of my malfunctioning nervous system into a digit? Is there a cartoon available that adequately describes the nightmare of my existence? (Beyond the dumpster fire depicted in so many memes)

As I scan the FACES, I marvel at the lower end of the spectrum. It’s a fantasy world I’ve never visited. Are people capable of experiencing no pain? Is that real? Life where nothing impacts the nerves? Not so much as a scratch or bump?

That feels like a trap designed to weed out pretenders and hypochondriacs from an overwhelmed system.

Except my answers—numbers verging dangerously close to the tipping point—brand me as a hypochondriac and liar.

Would I get more sympathy if I dared to suggest a lack of pain? A superhuman capability to brave the world without the influence of synaptic agony?

Does that frighten the medical community more or less than my daily battle against pinpricks and burns and chills and aches and cramps and itches and stabs and tugs and slices and crushes and twists?

The world tells me to long for the ideal of the lower scale, blithely unaware of the terror that “0” holds.

A lack of sensation means one thing to the individual with chronic pain: “Am I alive?” The perverse logic of needing overwhelming input to confirm our continued existence.

Every day, asking the same question of ourselves that we revile of our medical staff: “Where’s my pain on that damned scale of 0 to 10?” Drafting a rational chart based on the ability to walk, stand, sit, work, and breathe.

Made it through the shower today without needing a break—3.

Nope, needed to sit after scrubbing—8.

Would anyone outside our circle understand the logic?

A contradictory system for measuring something compiled of equal parts emotion, physical feeling, and enjoyment of life.

The patient’s invisible experience distilled into a single number.