Robert Isenberg works part-time as a standardized patient, an actor who helps train medical students. Students are aware that SP’s are actors, but they are not allowed to know about their actual identities. All names, and many details, have been changed to protect student privacy.
(NOTE: Some of the column’s articles have been removed by request of the author.)
The Pain Scale.
I press a tennis ball against my chest. I hold it just long enough for Hattie, an RN, to wrap a stretch of cloth medical tape around my torso, so the ball is held in place. Hattie continues to circle me, like a mother dressing her son in a mummy costume. She winds the tape until there’s none left, and then she seals it with two clips.
“The ball,” says Kim, “is pain.”
The idea is that I feel pain in my chest—or, more precisely, right inside my left pectoral. If I had pericarditis, I would feel a “clamping” sensation. Pericarditis is pretty fucked up: The fibrous sac around your heart gets inflamed, which presses into your lungs, so you (a) feel like you’re having a heart-attack and (b) can’t take a deep breath because it hurts too much.
“Now try to imagine that the pain is a five,” Kim says.
And so we begin to wince_. There are a dozen of us—young and old, big and small—and we’re all standing in a circle. The classroom is small, so the circle is tight. Here we are, a bunch of actors, pretending that the tennis ball is a “five” on the Pain Scale. We scowl and groan. We lean forward and rub our tennis balls. Clarence, a heavyset man of around seventy, moans and sputters. “Oh,” he says. "_Ohhhh…"
On paper, the Pain Scale is a simple measure of how bad you feel. “On a scale of one to ten,” medical students ask, “how much pain are you in?”
But in my mind, this becomes a bizarre existential question. A scale of one to ten? Is “one” a little bit of pain, or no pain at all? How do you rank a hangnail? A migraine? A stubbed toe?
This is our “pain workshop,” and we all take it very seriously. But every few minutes I take a step back and consider what we’re doing: We’re grown men and women, gathered in a converted office with bland carpet and drop-ceilings, and we’re all pretending to feel lousy. And if ten is the worst a person can possibly feel, then we’re acting like we’re halfway there.
It’s hard not to crack a smile.
“Okay, good,” says Kim in her warm, affirmative tone. “Now let’s make that a seven.”
Now we begin to groan. Some of us double over, clutch our knees, pant. I do this, too, but now my mind is working overtime. What is a seven, exactly? What does that feel like?
Because I have a hyperbolic mind, I compare everything to level ten—the worst pain imaginable. I picture having my scrotum slowly clipped off with burning-hot gardening shears. Then, as my castrated groin bleeds freely, the skin of my belly is slowly peeled off, like an orange rind, with hooks and razor blades. As the muscle emerges from beneath, gallons of vinegar are dumped over the red billows of flesh. Meanwhile, a manual drill slowly corkscrews into my eyeball as my mouth is crammed with Red Savina peppers, which gag my screams.
That, I think, would qualify as a ten.
“Let’s try an eight,” Kim says.
Now our eyes widen with panic. Our mouths gape, and we teeter, struggling to stand. Our movement is involuntary—we’re no longer reasonable people coping with pain. The pain owns us. We are betrayed by our nervous systems. There is only thing we want no—for this agony to end.
“Good,” says Kim. “Let’s go back to one.”
Here’s what nobody says: We’ve all experienced pain. Maybe not pericarditis. Maybe not even a hairline fracture. But all of us—every last one—know what pain is. We remember it. And now we’ve got to use it.
As a rule, our SP’s are in good health. If an SP contracted lice or mono, he wouldn’t be allowed in the examining room. But there are other exceptions, too: Not one SP has a prosthetic limb, a patch eye, a dramatic facial scar. Nobody carries around an oxygen tank, and there is no glaring reconstructive surgery. Never mind paraplegia or speech disorders—I haven’t even noticed a missing tooth. It’s kind of ironic—so many actors playing sick, yet this is the healthiest bunch I know.
But we know what pain is. I look around the room and wonder what they’ve been through. I know them—Rita, Rich, Mary-Beth, Kim—but I don’t really know them. Who fell out of a tree? Who crashed a car? Tonya is a mother—she’s been through pregnancy, labor, childbirth. I glance at Clarence, who wears his bulbous belly like a sling. I seem to remember he had some kind of bypass. What suffering has he endured? What is an eight to him?
I try to conjure my worst pain—was it having my wisdom teeth out? Or was it when I pulled my back? I awkwardly try to put these together. The month-long sharpness of my post-op toothaches with the undulating soreness of my lower spine. But then I have to transfer these to my chest, where the tennis ball is. The tennis ball is incredibly effective—I can place the ball, touch it, feel it—but still it’s just a tennis ball, a hollow rubber sphere covered in felt. As actual pain goes, the ball barely sustains a zero.
Our next exercise in the workshop is to lift ourselves onto an examining table. This is the trickiest act of all, because not only we are “feeling pain,” but we’re doing something that our bodies are begging us not to do. The first to try this is Greg, a soft, short guy with a graying goatee. Greg goes to the table, taking slow and labored breaths. He moves slothfully; his eyelids are low. At last he surmounts the table—in crippled slow-motion—and lets his body recline. Greg lays his arms at his side, and he fills the padded bed, but his chest continues to heave. His eyes clench, sprouting crow’s-feet.
“That was good,” Rita says, nodding approvingly.
“Robert, would you like to go next?” Kim asks.
“Sure,” I say, sidling up to the examining table as Greg slips off. I press my fists into the cushion, take a deep breath and hold it. Then I extend my arms, boost myself up, and fling myself onto the padded surface. I grunt as I do this—a primal, throaty noise—then roll onto my back, moaning, my face contorted, as if to say, Go! You can take it, goddamn it!
“Huh,” Greg says. “That was really different. You, like, went for it.”
I lie there, staring at the florescent bulbs above. I feel the ball, still tethered to my left pec. Greg is right—I did just go for it, just as I’d do in real life. As if I must overcome the pain in a single surge of adrenaline. But somehow that seemed reasonable; that’s how I deal with pain.
And suddenly I wonder why that is.
Robert Isenberg’s new book about his travels through the Balkans, The Archipelago: A Balkan Passage, is in stores now.
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