No Pain, No Gain

Doctor’s offices and hospitals often have charts to help you rate your level of pain from 1 to 10, using the increasingly severe grimaces on little iconic faces on the chart.

The problem, of course, is calibrating the chart. For example, it’s hard to imagine anything more painful than, for example, being burned at the stake, or being dragged under a moving freight train¹. So I’d rate those as 10 on the chart. I have to admit the face on the chart doesn’t quite look like someone being dragged under a train. This is more appropriate:

Unfortunately, though, that means any pain that I’ve ever actually experienced is probably no more than a 1 or a 2. So, of course, I’ll be waiting in the emergency room for a long time.

On the other hand, just waiting around at the doctor’s office is extremely exasperating, which, I think, qualifies as a kind of pain. So given that, I would almost always be at least on level 2 by the time anyone bothers to ask.

But then there’s a whole range of pain in between that’s difficult to quantify. What number is a broken leg? How about a compound fracture? How about passing a kidney stone? Where on the scale are these things.

I really can’t describe my pain in any meaningful way without reference to some other pain. Just putting a number on it doesn’t work.

“How much pain are you in?”
“7. This is definitely 7 pain.”
“Why?”
“What?”
“Why is it 7?”
“Well, if 6 is a broken toe, and 8 is being impaled by a fireplace poker, this is somewhere in between.”
“Oh.”

¹ The fact that it’s carrying freight is probably immaterial. I would imagine being dragged under a moving passenger train would be equally painful. I just thought freight sounded better.

Death Rays or Knife-Wielding Robots

We are truly living in the world of science fiction. Sure we don’t have flying cars or nutritionally sound meal-in-a-pill capsules yet, but in many ways, we’re the Jetsons. (Remember, when that show was created in the 1960’s, “jet” still sounded like pretty advanced technology.)

One way I know this is by the choices I have for treatment of my prostate cancer: knife-wielding robots or death rays. Of course, health care professionals refer to these choices as surgery and radiation, but let’s not mince words.

The surgery is often done robotically. The doctor sits at a console and basically plays a 3D video game version of the old board game Operation. The doctor’s movements control mechanical arms with little clamps, scalpels, etc. on the ends, to pull the little plastic prostate piece out of its little plastic well, hopefully without triggering the buzzer and making the patient's nose light up.

The radiation, on the other hand, can be controlled by computer models of the prostate, or by 3D imaging, to completely fry the prostate while barely putting the surrounding tissue on defrost.

Note that the computers haven’t completely taken over yet. All of these procedures are overseen and controlled by highly qualified medical personnel who, hopefully unlike the cast of Gray’s Anatomy, spent their medical school and internship years learning and acquiring skills instead of rutting like rabbits.

So now it’s up to me to choose … robots or rays.

Minor Medical

How Health Care Works

With all the talk about health care in this country, it would be helpful to get an understanding of how health care actually works from a qualified expert.  In the absence of such an expert, however, this will have to do.

When a person (hereinafter known as a patient) has some kind of problem, such as a pain in the whatsit, he or she goes to the doctor (hereinafter doctor.)  More precisely, the patient goes to the doctor's office, a large sterile environment decorated with early 20^th century magazines.  Here the patient has the opportunity to pay an exorbitant fee (hereinafter co-pay) and take a seat.  After waiting the requisite 59 minutes (longer if there's a paid parking lot), the patient is escorted into another sterile room, called the examining room.  The patient is asked to undress and then wait another 59 minutes in his or her underwear (hereinafter skivvies.)

Eventually, the doctor enters the examining room and performs a thorough physical examination, sometimes lasting up to 90 seconds.  The doctor jots down some indecipherable notes, and dispatches the patient back to the front desk to a) pay another fee, b) schedule another appointment, and/or c) get instructions for using some prescribed drugs or equipment such as a framistat.

The doctor has had extensive training for this.  He or she has been through at least 4 years of medical school following college, and has also undergone 3 or more years of residency, during which he or she has been required to work long and erratic hours, treat actual patients, and have a series of torrid but ultimately unsatisfying affairs with other residents, interns and people with medical sounding titles.  (This is all vividly documented on Gray's Anatomy.)

Despite these apparently ample qualifications, however, the doctor's judgement is ultimately subject to review by the health insurance company (hereinafter bloodsuckers.)  The insurance company designates a medical claims specialist to review the case.  The specialist underwent rigorous college training majoring in Basque Literature, which enables him or her to divine all the pertinent facts about the patient's condition from a few three-letter codes on a claim form.  Based on this detailed analysis, the specialist can determine a) that the condition could be treated with a whoosiejigger instead of a framistat, and the whoosiejigger is 1/10 the cost, b) that the patient has not yet met the annual deductible of $16 million, so the whoosiejigger will be paid out of pocket, and c) that the patient's premiums should increase due to the cost of processing the claim.