So what do you think of when you wake up at 3:30 in the morning in unmanageable pain?

In the Wasteland, my first thought is always the Scorched. There’s always something wrong with that bunch. Wander around camp trying to get something done—boom, scorched with a pitchfork. Go fishing in the Cranberry Bog—boom, Scorchbeast followed by its little scorched children.

Back in the real world, it’s not always that easy to explain. Sure, if one hasn’t just had a joint replaced, there are plenty of culprits. Maybe it’s one of four dogs with no concept of personal space. Or maybe it’s the Scorched again—I swear, they follow you into real life. (Before anyone calls in a wellness check, that was a joke. I hope people still recognize those these days.)

This ties into yesterday’s post about humor—and empathy. I’ve written quite a bit about empathy lately, especially since I’ve found myself on the receiving end of symptoms and deficits I used to treat. I wrote a whole piece about empathy for stroke deficits. I wasn’t a bad caregiver before; I just didn’t live the deficits. Sometimes being a good provider just means giving a damn. It all boils down to that—give a damn.

But pain is a strange thing to empathize with. Let me explain.

When I became a nurse, the pain scale was still a relatively new concept. It took something purely subjective—“rate your pain from 1 to 10”—and turned it into a pseudo-sign, something we treated as quantifiable even though it isn’t. Two people can experience the same cellular-level pain, but one might call it a 3 and the other a 9. Medicine, however, tends to treat an 8 out of 10 the same way for everyone.

That’s frustrating—for providers and patients. I lost count of how many times I asked a patient their pain level and got, “It’s a 12.” For context, the right way to ask is:
“On a scale of zero being no pain and ten being the worst pain you’ve ever experienced, what is your current level?”

The phrase “worst pain you’ve ever experienced” grounds it in personal experience. Chronic pain patients might say “one” or “zero,” meaning the pain is just background noise. Meanwhile, acute pain sufferers sometimes go off the charts—15s, 20s—because they’re blinded by that moment’s agony.

When that happens, your provider isn’t ignoring you. They’re trying to get to the cause of that pain. Treating the pain without fixing the cause is like patching a bullet hole with a Band-Aid.

If I were redesigning the assessment, I’d go simpler. “Are you in pain—yes or no?” Or better: “Is this new pain?” That’s often the real key.

We still don’t have a great system for understanding or treating pain. And now that I’ve been on the other side of it—wide awake at 3:30 a.m., cursing my shoulder and my own stubbornness—I get it in a way I never could before.

Pain management isn’t just pills. It’s an ecosystem—physical therapy, cold or heat therapy, positioning, rest, circulation, education. It’s a team effort. My post-op lesson came the hard way:
– Strike One: My cooling pad got too cold. (Pro tip: frozen water bottles last longer but can turn you into a popsicle.)
– Strike Two: I skipped the opiates when I probably should’ve taken them.
– Strike Three: Poor prep and lack of proper padding.

Pain management takes strategy and follow-up. You can’t just toss someone a prescription and call it a day. Providers need to explain the why, the how, and what comes next. That’s what I didn’t fully grasp until now—how the smallest interventions matter more than the strongest meds.

So, no—my beliefs about pain management haven’t changed. But my understanding has deepened. This little 3:30 a.m. lesson hurt like hell, but it came with clarity.

Back to the Wasteland now, where my dog’s love and a good “kiss my boo-boos” from Mom work better than a Stimpak any day.