How to Manage a Pain Management Specialist

During the first two weeks of April in 2000, Mom had gone from excitedly packing for a trip to Germany with me to waking up in a hospital and being told that she had cancer.

It was a painful time.

The cancer was so extensive that the doctors in her small Oregon town decided that, instead of completing the surgery themselves, they would staple Mom closed and life-flight her to OHSU Medical Center in Portland, one of the best teaching hospitals in the country and a very good place to be if you have to face cancer. Mom's continued surgery there went as well as could be expected, but she awoke to a reality that was undeniable -- she was in for the fight of her life. (And it was a fight that she engaged in valiantly, eventually losing it four years -- to the day -- later.)

The day after her surgery, the team of "pain management" doctors descended upon Mom's room. One young resident, looking nervous and rather unsure of himself, stood at the foot of her bed, holding a laminated chart containing a series of line drawings -- round circle faces, with expressions from glee (a big D-shaped mouth) to boredom (a line-shaped mouth) to despair (an upside-down U-shaped mouth).

The intern cleared his throat and, without greeting my mother or introducing himself, asked, "Which of these pictures best shows what kind of pain you're feeling right now?" My mother, still groggy from the surgery, muttered "What?" The Intern took a step forward and spoke slightly louder. "Which of these faces best describes your pain, Mrs. H?"

"None of them," answered my mother, and fell back asleep.

The next day the young pain management specialist returned. "Mrs. H, which of these pictures best shows what kind of pain you're feeling right now?" he asked again, standing like a soldier at the foot of Mom's bed. This time, when he held up his cartoon chart Mom was more awake -- and more herself.

"Is this a multiple choice test?" she asked the intern.

"Well, no... not really. I guess sort of, in a way..." he stammered. "I just need to know what kind of pain you're experiencing, so we can help you."

Mom took a deep breath. I knew what was coming. Even in a hospital, even with cancer, even after surgery, you couldn't take the teacher out of my mother.

"This really shouldn't be a multiple choice question. It's not that simple." my mother exclaimed.

The internist took a step backwards and stood up straight. This was not the sleepy woman he met yesterday.

"This should actually be an essay question, don't you think?" Mom added. "Because if you really want to know about my pain, you should maybe listen to me."

She was on a roll now.

"Do you mean my physical pain, from the surgery? Do you mean the emotional pain of finding out I have cancer? Do you mean the pain of not being able to get up and close the door so I don't have to listen to the chatty nurses in the hall? What kind of pain do you want to know about?" Mom implored.

The intern lowered his chart. Mom the (impatient) patient/teacher continued. "I really think maybe your approach is flawed and I don't want to answer your question." The intern looked at the doctor who was obviously in charge, who said, "That's OK, Mrs. H. You don't have to answer our question if you don't want to. Just let us know if we can help." Mom, who wasn't usually blatantly rude but was always blatantly honest, reluctantly agreed and thanked the doctors.

The next day the pain management team returned. This time there was no chart. This time the intern stood at the side of the bed instead of at the foot of the bed. This time he asked Mom to describe her pain -- which she did. As she spoke, he scribbled notes, looking at her occasionally, but buried in his clipboard. "We just want to help you, Mrs. H," he assured her. "Let us know what we can do for you." Mom was tired and only said, "Just listen."

The next day, the pain management intern returned to see Mom for the last time. He didn't stand at the foot of the bed. He didn't stand at the side of her bed. There was no chart with cartoon faces. The internist pulled a chair close to Mom's bed and put his hand on hers. "How are you feeling today, Edith?" he asked.

And my mother, the teacher, smiled.