All people are gifted. In the ED, I see a wide variety of gifts, such as yodeling, knitting, and swearing (mostly swearing). One gift I rarely see is math. As a whole, the U.S. sucks at math. When compared with 33 other nations, the U.S. ranks 25th in math (though first in confidence). Despite this, we expect our drunkest friends to be mathematically coherent on their worst days.

I enter the room to find Mom. The chief complaint was “assaulted.”

Me: Hi, I’m here to evalu–

Mom: He’s in the shower.

Me: Excuse me?

Mom: He’s in the shower.

Me: We have a shower?

Patient (drunken shouting): I’m in the shower!

Me: Why is he in the shower?

Mom: I’m not sure.

Patient: I was cold!

Mom: He was cold.

Me: But he’s been assaulted?

Mom: The doctor’s here to see you!

Patient (drunken anger): I’M TAKING A SHOWER!

Me: Are you in pain? (pause)

Patient: Um, yeah, it’s 10/10, but come back later!

Mom: Can you come back later?

Me: I guess I’ll come back later.

Patient begins singing Michael Jackson’s “I’m Bad” loudly.

I leave the room confused, in part because a 1980s song sung so enthusiastically by a person in the worst pain imaginable seemed odd. Also, who uses an ED’s shower?

My next patient, a 22-year-old with no history, had back pain. Jimbo’s father accompanied him because Jimbo had been self-medicating with beer.

Me: Hi there, Jimbo. What brings you in?

Jimbo: I got back pain.

Me: OK, when did this start?

Jimbo: I dunno.

Jimbo: Maybe 3 weeks ago?

Me: Are you asking me?

Jimbo: I dunno.

Me: OK, where does it hurt in your back?

Jimbo: It hurts IN my back (he gestures vaguely over his right shoulder).

Me: Ah.

Jimbo (leans forward, twists completely to the right to grab his dropped remote, then twists completely to the left for his video game): It hurts EVERYWHERE!

Me (straight faced): I see. It says here you have 10 out of 10 pain.

Jimbo (a bit peeved): That’s wrong.

Me (a little relieved): Oh?

His father then interrupts.

Dadbo: Yeah, your scale’s wrong.

Me: Well, 0 is no pain, 10 is the worst possible pain. So how’s it wrong?

Dadbo: Yeah. Well, sometimes pain is bigger than 10.

Me (getting queasy): Uh-huh.

Dadbo: Sometimes, I have 15 out of 10, but if it’s gettin’ pretty bad, it’s a 20/10.