Richard E. Waltman, MD
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When I was a second-year resident, I was called to the OB floor to see a patient in early labor who was asking for more pain
medication. I evaluated her, and in as professional a tone as a second-year resident can muster, I explained to her why she
did not want to take too much medication early in labor and suggested she try to put up with the pain a bit longer.
"How many babies have you had?" she asked. "This hurts. Give me the pain medication!"
I realized immediately that her life experience trumped my book learning. I ordered more medication for her.
Over the many years of my medical practice, it has repeatedly occurred to me that we might be better caregivers if we had
a more visceral rather than purely intellectual understanding of what our patients are experiencing. So without wishing terrible disease and suffering for all of my colleagues, I humbly offer the following six suggestions,
which might help us to do a better job.
EVERY PHYSICIAN SHOULD HAVE A MIGRAINE
I do have migraines, and if you are lucky enough not to have them, believe me that no textbook explanation comes even close
to capturing how terrible a good migraine can be.
First of all, you feel like you are going to die. No matter how many articles you have read, even a physician like me finds
it impossible to believe that pain this severe can happen without a space-occupying lesion in the brain.
Second, you want to die. The pain is that bad.
Third, you cannot control your behavior. You grimace, gag, speak incoherently, and flop around. That is why patients with
migraines can be categorized as drug-seeking or crazy; trust me, they are neither. In the midst of a severe migraine, you
just can't control your behavior. Fortunately, there are now good agents for treatment and prevention of migraines, but my
own experience has taught me how severe the pain can be even in the absence of structural disease—and how emotionally overwhelming
such pain can be.
My own experience as a migraine sufferer has given me a better respect for pain and the impact it can have on our patients.
You have pain? I will deal with it.
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