Whether it was on the Visual Analog Scale (VAS), the Verbal Numerical Rating Scale (VNRS) or any other scale, my patient’s pain level would have been put at the possible maximum. When I met him, he would speak in superlatives about his pain, using words like ‘astronomically high’ to describe it.
This cold morning however, he was not using such words; he was hardly talking. All I heard were groans and whimpering sounds. There was no doubt he was in pain—it was cancer.
The senior registrar immediately turned my way and of course I knew the question that would come next. He asked, as he squinted to read my name tag, “Miss Nwagbara, what do you know about the WHO Analgesic Ladder, and what do you suggest we prescribe to relieve this patient of his pain?” Having stayed up late studying this fifth vital sign, different scales of its measurement and its management, I gave a most impressive answer.
I went back that night to check if the intravenous morphine had taken effect. He was talking again, not using those big words that cracked me up every time, but he was talking. I sat next to him, trying to read him and decipher his pain level; and he looked back, blank-faced.
“Can I do anything to relieve your pain?” I asked
“Can I do anything for yours, Doctor?”came the reply.
I was shocked, not only because I had not expected that response, but also because there was some truth to his words.
” I am a medical student, Sir. Since I cannot do anything for you, I guess I should leave”. I was getting up already.
“You can talk to me, Doctor. It’s not like I would have the opportunity to tell anyone; I am a dying man”. He laughed. “Your eyes are swollen”.
Never in a million years would I speak to a stranger about issues that plagued me, about my pain; I had not even told my closest friends. Maybe this was what I needed—talking to a complete stranger. I needed to talk with someone who would not look at me with pity afterwards. I did not want to talk to someone who would realise I was not fine and may not be fine in the nearest future.
“My pain is not like yours, Mr Akinteye. It is not physical”.
“Call me Olumide”. I nodded.
“It is pain that comes with loss, pain that has changed me forever, and I am afraid it will never leave. It is always there, always in there. What do I do?” I asked, as tears welled up in my eyes.
“Live with it”.
“He always says the most ridiculous things”, I thought.
“Would living with it be the worst thing?” He must have read my mind!
“It is part of you now”, he continued, “You may as well acknowledge its presence and live with it”.
I stood up and left, tears streaming down my face. Of course I know he did not mean to make me cry. It must have been the realisation that his journey was coming to an end. He must have thought my issue was trivial. After all, I was not dying, like he was. Or was I?
As I walked down the corridor, I could not help but think how different our pains were and how it was my job was to treat his. But what about mine? Who would tend to my pain? Such thoughts belaboured me and my head hurt.
He was not there the following morning. He was not dead but had left, not wanting palliative care.
He left me a note however: “I would prefer to die in the arms of those that mean the most to me, not on your bed. I want my three-year-old daughter to be the last person I see, not a doctor in a white coat. I did not mean to make you cry last night but try and live with your pain, Doctor. It really never leaves, does it?“