Lesson Learned: Pain Scale

6 Feb

I didn’t want to come to the emergency department. My primary care doctor told me to go after he poked my belly, gave me the most pitying look I’ve ever seen, and he said he’d call the hospital to request an emergency a CT scan.

But at the hospital emergency department, the triage nurse is the gatekeeper of care. My temperature is only slightly elevated. I have no spurting blood, no disfigured limbs or torn flesh.

She is all-powerful: no matter who my doctor talked to, I must answer her questions to cross the bridge, and get help. The stakes feel high for the last, most important question:

“From one to ten, where ten is the worst pain you can imagine, what’s your pain level?”

Wrong answers are punishable offenses. I will receive a lower quality of care if I give the triage nurse any reason to suspect I’m not genuinely in pain–and in fact, I think that’s what this question-barrier is there to guard against. Emergency departments see enough drug-seeking behavior that the nurse has to be on guard.

I don’t want morphine–it makes me forget to breathe, plus other discomforts–but she doesn’t know that. So I focus on answering the exact question she asks, to the best of my ability.

Right now, I can’t take a deep breath, sleep, work, read, or track the plot of even a mediocre TV show. But there are parts of my body that don’t hurt. And I’m not on fire.

The question asks me to imagine the top end of the scale. So if I start with remembering the time I had a gall stone the size of a pecan lodged in my bile duct, and Tylenol and Tums and writhing on the deliciously-cool linoleum floor wasn’t quite helping enough–well, that was pretty bad. Was that a 10?

But I could have gotten in a car wreck that night, on my way to the hospital. What if I had also had a newly-broken limb? Or worse–a crushed limb? Or worse–a crushed joint? Could that be what a 10 feels like?

What if I had had an asthma attack at the same time? While having something removed from my eyeball? While my love lay dying? She said “where 10 is the worst pain you can imagine…”

As far as I can tell, I can imagine big differences between the numbers on the high end of the scale. If were to graph them, they’d look like this:

pain-scale-top-end

I realize I can always imagine more pain–heck, I write fiction. That’s part of the job. The way the question defines it, a pain level of 10 is unreachable. The graph goes asymptotic.

The triage nurse blinks. She’s willing to wait.

Am I in the same kind of pain as the lodged gallstone, I ask myself? Well, it’s different, but the floor does seem similarly writhable-upon. But it might be the best answer I have–which puts me at a six. Six doesn’t feel like the right answer.[1]

I want to be thorough–and accurate–so I work on the other end of the scale.

What could a one be–a stubbed toe? Or is one a badly stubbed toe, like when you think it’s probably broken, and it turns colors the next day? How about when I bruised my tailbone tobogganing? That hurt pretty bad–is that what a four feels like? Or is it not even a two?

I realize my understanding of the low numbers is… low. I don’t know how to rank minor pains in various parts of my body. There just doesn’t seem to be enough difference between them to distinguish where they fall on the scale.

If I were graphing the low end of the pain scale, it’d come out flat–I can’t tell the difference between them.

pain-scale-bottom

So I still have no answer, so I can’t get past the question, and nothing has improved.

My husband pats my hand and stares at me as if he can make the right words come out of my mouth just with his brainwaves.

So the nurse repeats herself with a new emphasis, because maybe she thought I wasn’t understanding the question well enough. “What’s the pain you’re feeling right now, from zero to ten, where ten is the worst pain you can imagine…”

Oh! Well, that’s different. Because I’ve been sitting on the melamine vomit-proof chair for a few minutes, not moving, mostly holding my breath so that I will hurt less.

But I still doubt. “What if the pain comes and goes?” I ask.

“Right now,” she repeats. She’s stopped blinking–I think she’s irritated.

And I don’t want to lie, so I use the best answer I’ve come up with so far. “Six?” I ask.

Six, it turns out, was the magic number to race to the rear of the triage line. As I waited, every other person was called back to a room before me. They finally called my name, after I laid myself down on the floor (yep, linoleum) of the waiting room because I just couldn’t sit in their godforsaken chairs anymore.

Luckily, my doctor really had called ahead–I did eventually get the CT scan and IV antibiotics that helped me feel better. The attending physician suggested opiates a couple of times–my husband had to intervene to explain that no, I really didn’t want them.

The next day, between naps and antibiotics, I scribbled notes and graphs about the pain scale. It felt like a revelation when I realized two things:

  1. I’ve been trying to answer a linear scale, but I only have exponential data.
  2. I’ve been reading the wrong axis–Y vs. X.

 pain-answers-before-after

So here’s my new system:

  • If there is obvious external sign of physical damage, like spurting blood, a limb bent or swollen to unusual size, charring or smoldering–I’ll point at that, and say “8.”
  • If there’s no obvious external damage, but a persistent feeling that requires me to breathe, sleep, eat, or work differently or not at all, I’ll say “9.”
  • If I’m already at the hospital or doctor’s office, and the pain increases, even if there are probably still parts of my body that don’t hurt, I’ll say “10.”

Next time I get emergency medical help, I don’t care how linear they think their pain scale is, or how they ask it. I will focus on getting past the barrier it presents to getting help.


[1]Anybody who thinks I’m just overthinking this is wrong. This is what actually happens in my brain when I am at my most vulnerable. I don’t need to second-guess how I think in the middle of trying to answer a poorly-constructed, well-intentioned question while I’m in enough pain to be told to go to the ER.

“Say the prayer”

6 Jan

There was a piece of rug with writing on it—two words, one on top of the other. When people would see that I had it, they would smile and say, “Say the prayer”—as if to be encouraging, as if in anticipation, like a good, expected thing would finally happen.

Not only didn’t I know what the rug was, or what they were talking about, or any prayer that related to the words, I felt chest-tightening terror that these people expected some words to have some power in themselves that would change our circumstance.

There was also a wedding. I was in the same building, in a long hallway punctuated by stairs down to the first floor, lined with mismatched chairs and occasional tables.

It was like a popular café opened a second-floor in-between space with an optimistic capacity, and carpeted it with an overlapping patchwork of rugs. In this weird space, where occasional great-aunts sat as responsive as the furniture, I saw the fragment of rug again.

I gathered the copious skirts of my dress, snatched up the piece of rug, and ran toward the brightness and noise of the wedding ceremony.  

It was a large room at the center of the strange second-floor hallway. People stood all around the center, and I ran in—the sound stopped, and I was interrupting. I blushed.

In the center of the room, in the center of the rug, there was a hole. The people realized I carried the fragment, and there were murmurs and smiles, and gestures toward the hole in the rug and the fragment still in my hand.

I heard the same anticipation and encouragement that frightened me before—but now, having just interrupted, in the middle of all of them, I felt I had no choice.

The people cheered and smiled and held their breath, and I put the fragment of the rug back in place.

It turned out that the two words on the fragment belonged to two different phrases. Their sense shifted, torqued—and I struggled to read the whole thing before the happy, delighted, celebrating people could recite it, together.

Tears came to my eyes as I finished reading, as realization began to dawn—my terror was justified.

The room brightened—and then I was in a different dream, assembling bamboo weapons for immediate export. Stephen Fry was irritated that I had been so slow, but he knew it was because of the ridiculous dress I was still wearing.

And that’s what my dreams are like.

Not while I’m watching.

30 Dec

To: Manager of Y
CC: Y, X’s Manager, My manager
Subject: Incident this AM

I was working in [my building] this morning when I overheard Y talking vehemently with the X, the barista. I intervened when I heard the word “bitch” being used several times, and voices raised. When I came to stand at the counter, the conversation continued—she protested that she has never treated a customer badly, and he said that it was the customer’s word against hers. Tensions were high.

Y apologized to me, and explained that he didn’t know I was there, that he was a regular customer, and that he and the barista have had many conversations. He said that he wanted to tell her that this was being said about her.

I told him that it was an inappropriate conversation whether I was there or not. Calling someone a bitch while they are trapped behind a counter—especially if you think they are alone, and are taking advantage of that—is exploiting an imbalance of power. Another way to have achieved that end would be to ask her if she had a moment when she was not working (and therefore free to leave), and telling her “I heard this, and thought you should know.”

Because of Y’s initial belligerence when I interrupted his confrontation, I asked to take a picture of his badge—that picture is attached.

[Manager of Y], I bring this to your attention so that you can address as you deem appropriate. The way Y approached the conversation was in the manner of bullying, and I will not tolerate it. I hope that this was a momentary lack of judgment on his part, and we can all grow from it.

Thanks,

Torrey

Doing

18 May

Writing the novel

Enjoying friends

Shopping for groceries

Changing the oil

Meeting, writing, emailing: working

Thinking about scrubbing the bathroom

Writing for the website

Travelling east

Listening to others

Showing knives

Flying rockets

Reading nonfiction

Reviewing nonfiction

Learning Aikido

Feeding the chickens

Restoring orphan tools

Drawing for fun

Showing up

Battling evil

Saving the world

What am I writing these days?

20 Apr

On the web, I haven’t written much–so here you go.

In the novel, we now know some of the motivations of some of the greater powers beyond our protagonist’s control. We don’t yet know what will happen when she takes control of things–and we don’t know how the God of Earth and the Underworld will change the stakes, but he just kidnapped her.

Maiden, mother, queen, and crone–they languish. Well, no they don’t. I am still writing on them, but it’s been interrupted and slow. There’s more to write–and draw, and decide, and research, and validate. I worry that I like the idea better than I am prepared to write about it–so there’s nothing to do but better prepare.

Short stories–perhaps writing another would be a lovely diversion, kind of like taking a day trip in the midst of a longer journey. At the same time, perhaps those “lovely day trips” are often terrible ideas, that only serve to further exhaust the resources depleted by the long journey. Right now, I don’t have any short stories on my plate, though I’d like to. They feel light and easy, even though my memory reminds me of the months I’ve spent wrestling them, in the past.

At work, I’m writing very short, very precise things for review by multiple stakeholders before eventually, right before release, it all changes again and gets rapidly rewritten, re-reviewed, then localized, then published to the world. Also having lovely discussions about capitalization, typography, punctuation, and the appropriate function of the ampersand.

So, life is good. Write on.

You have to read this (2012) book

3 Feb

With that description, about two dozen con members, including Beth Mitcham, Manny Frischberg, and I as panelists, shared recommendations and Hugo-related thinking at the Foolscap 2013/Potlatch 22 combined convention in Redmond, WA on February 2.

I promised notes, and here they are. The list of recommendations is first, and then notes about what would disqualify an otherwise-eligible book from consideration, and what we’re suckers for.

Recommendations:

Mentioned, but not recommended for a Hugo by those in the room:

What makes a book not Hugo-worthy?

  • Part of a series, and can’t stand separately from that series. Agreed that it’s probably unfair.
  • Not as good as the author’s previous works (whole room agrees that it’s totally unfair, and yet true. It’s just not about the rest of the nominees or the rest of the books.)
  • Unmotivated transformation of a character–when they suddenly start making decisions and acting differently than they have the whole story so far, and there’s no reason for the change
  • Breaking the story’s own internal rules
  • Pinheaded politics (like when the author sets up a strawman for ideas they don’t like, but doesn’t do those disliked ideas justice.)
  • Author intrusiveness (unless it’s done very well.)
  • Broken economics (like when there is no source of fabric, food, or water… and yet folks survive for generations.)
  • Lectures about the author’s point of view.
  • Women lacking agency
  • Deus ex machina
  • Predictable stories

What are we suckers for (what do we love to see) in a novel?

  • Steampunk elements
  • Characterization and dialogue
  • Science fiction ideas (Stephen Gould and John Scalzi were brought up as examples of authors who do this well)
  • Humor
  • Coming of age
  • Not formulaic
  • Aliens who aren’t humans in alien suits
  • Real social/interpersonal/societal conflicts
  • Agency
  • “Off-mythology”–mythologies we don’t hear enough about (like Norse, for example, and unlike Greco-roman.)
  • Networks of characters
  • Moral ambiguity–characters making tough choices
  • Technology as it affects people
  • Books from which we learn something–especially when what we learn is plausible or “real.”

Note that I didn’t capture who recommended what, and might have missed a thing or two–feel free to comment, add, disagree without trolling, etc. Thanks for participating in the discussion.

A metaphor explains that my #NaNoWriMo and #Write1Sub1 shortcomings won’t always be so short.

28 Nov

I look up to master storytellers who can plan their stories the way a master gardener can espalier a pear tree, knowing where each bud will bloom, at what angle each leaf will grasp its own light, and how the fruit will taste.

I’m a gazillion ploughed rows from being that good.

I put a seed in my earth and the full sunshine of my hope. When I put up a pole or a cage or a fence to guide the story’s growth, it is a drastic act of imagination.

I rejoice in the miracle of the first shoots, and feel lucky when the vines climb. My job is to attach the young story to its bare outline, to the few rules I reliably remember to use.

Over the growing season, that frame weathers and shows its weakness. Inevitably, I must buttress the structure against collapse.

All the while, I learn new rules, new ideas, from others who grow their stories. But there are better and worse times to put them into regular garden use. I shouldn’t overshadow my story with a massive structure it’s not ready for—it’s not strong enough for—it can’t reach. Too big of a change will cripple or kill the adolescent plant.

Instead, I must wait for—and allow—a period of quiescence before the next growth begins, even if that means putting away the shiny new thing to wait for the next growing season.  

In that precious in-between time, it’s okay that my writing diverges from my daily fiction. It ploughs inward instead, stirring up my symbiotes and mixing in more fertilizer. I retire to the shed of unused notebooks and decadent pens, abandoned during the growing season of efficient word-processor use. The lessons of the past season become the ambitious frame my next seeds can reach toward.

Turns out there’s more #NaNoWriMo can do for me…

17 Nov

I’m supposed to be at 28K words–and I’m at 10K or so.

The thing I’ve consistenly taken away from #Nanowrimo–every year, from 2006 to last year, is a renewed habit of the daily discipline of sitting down to write.

Last year, I specifically used NaNo to re-develop that habit, and I’ve successfully kept it up–daily writing, all year long.

But there’s more I should be getting out of it, this year–more that I could be getting from it: the discipline of sticking to the goddamn outline, or failing that, at least sticking with my characters and their story.

It’s a touchy balance between “the story I first thought up” and “what the character wants to do” and “oh crap, I hadn’t thought of that.” They are each pitfalls, and they are each paths.

The discipline is to be honest with myself which one it is, and pressing on or redirecting as necessary.

So–no more blogging for me right now. I’ve got a plot to de-re-enpitfallize. ;-)

#NaNoWriMo–behind, but steady & satisfied.

10 Nov

I’ve never posted such low November word counts. It feels like I’m doing something naughty.

On the other hand, I look at my outline, the story I’ve been trying and trying to write, and I’m right on target.

According to the 50,000-word goal, I should be at 16,670 words today. As of right now, I’m at 8,366.

But given this past year of daily writing, for-real writing, even my dubious brain points out: 8,366 is about 10% of a salable-length novel. I recognize that the plot is established, I’m deep into character development, and it’s probably time to do some more work on establishing setting.

I’m doing a good job.

I also don’t expect to keep all these words, mind you. This is raw, first draft, needs work, will-be-edited prose. But the first step for me is getting it roughed out. Having it be on-story through this first, crucial start, means that the characters just have to be themselves, and the middle will take care of itself.

So–should I worry that I’m not driving to 50,000 at the blistering pace? Nah. Because I’m driving to 80,000 (or so) in a direction that will actually take me there.

#NaNoWriMo day 5, in which I reset expectations and still write to win.

5 Nov

I’m going to tack differently into this 2012 nanowrimo wind. Lemme explain.

In 2006, knowing nothing about writing novels (or writing any kind of fiction), I wrote fluidly, solidly, for 84K or so. Since then, no other novel-length work have I written so fast or full of story. But paradoxically, I’ve come to understand that I can write better than I did then—I can choose better words, better pacing, better structure, more satisfying story arc and setting.

But writing to a word count doesn’t help me improve any of the things my writing needs: better characterization, a more nuanced grasp of setting, etc. Even in my day job, I write for meaning first, then trim or expand to make the best use of the available space, to best communicate the necessary information.

So I’ve been frustrated with Nanowrimo, and my husband helped me figure out why: I’ve been playing varsity fiction writing—not necessarily winning, mind you, but playing—and now I’m doing a JV word-count workout, and I’m wondering why the hell I’m doing it.

My writing heroes have written all kinds of stuff—from novellas to flash to novels to essays to poetry to whatever the hell tells the story. Word count isn’t a useful criterion for goodness of story. Appropriateness for a particular market or publishing strategy, sure—but that comes later, after it’s burst forth on the page.

So why am I still participating in Nanowrimo?

First, for the community, camaraderie, frivolity. That’s all good stuff, and stuff I need. And, it should be noted, stuff I get year-round with my regular writing peeps, for whom I’m intensely grateful.

Second, for the structure. Last year, I made a commitment to come in to work on an even earlier bus, and to spend that reclaimed time writing fiction.

I intentionally used last Nanowrimo to start that habit, and have carried it all year—even during crunch-times. There were perhaps four mornings during the year that I started early with work-writing instead of fiction-writing; there were maybe five mornings I was too exhausted to create an imaginary world that wasn’t simply asleep. That’s a record I’m proud of, and I have every intention of continuing.

So did I write 50K words per month? HELL NO. Because there isn’t enough editing time in the world to make that many words usable. This year’s total new fiction word count, so far, is approximately 35,300 words. Some of it is explorational—it may be turned into something, someday, but so far is a fragment in search of a home. Some of it has been submitted and published. One of the best pieces is one of the shortest—fewer than 1000 words—and was the easiest to write.

35K words is not a novel worth of prose. It’s not coherent, and I’m clearly working through experimentation with characterization, setting, story, and pacing. All of which is totally reasonable for anyone in this part of their writing career—by which I mean, is totally reasonable for ME, in this part of MY writing career.

So, what about Nano? I’m going to write, write, write, and lead a write-in, and enjoy the community, and not try to be The Perfect, Fast Novelist.

Will I win for writing 50K words? Probably not. Instead, I’m hoping to win what I actually need—including reasonable, appropriate goals, and practicing patience with myself.

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