Pain control is very important. Over the past decade or so, you’d have to have been in a hydromorphone coma to have missed all of the hullabaloo. We have scores now, and we pay much more attention to pain control than before. In the old days they made patients chew on a towel. Now pain control is so important that it has been called “the fifth vital sign.”

I’ve been thinking there must be additional important things we could be asking our patients and measuring besides the usual lowly vital signs like temperature and blood pressure. There must be a sixth, seventh, or even eighth vital sign.

I’ve observed that my patients are usually hungry. No matter the time of day, they always seem to be eating. Cheetos and Mountain Dew are a popular combination – particularly for patients with abdominal pain and children who vomited 3 hours prior. Some object to this wholesome snack, but I have no problem since most of the food groups are represented: dairy (there is cheese), grains, sugar, caffeine, and preservatives.

Since the entire nation seems to always be hungry, the only logical course of action is to create a hunger scale. This scale allows caregivers to make a judgment about how much food will satisfy the hunger in any given patient.

If we stick to the standard 1-10 scale, a 1 might indicate that a person has eaten recently but wouldn’t mind a small snack such as a pint of Haagen- Dazs or a large Snickers bar. A 5 might need something more substantial such as a turkey sandwich, a generous side dish, soda, and dessert. A 10 would be more of a challenge and may require ordering out. A Chinese family dinner plus fortune cookies or a 16-inch loaded pizza with cheesy bread should do the trick. More may be needed if family is in tow.

Now, some of our patients don’t quite get the 1-10 thing, so pictures will be necessary. I believe that the smiley face/frowny face scale would not work, and patients might be confused if you are asking about pain or hunger.

Traditionally when someone is very hungry, they say that they could eat a horse or a cow. There’s a start. That is an antiquated expression, however, in use prior to the supersize generation. I think that a cow should equal a 6 – a horse could be substituted depending on religious preference. Working down the scale, a pig (tapir can substitute) would be next followed by goat, dog, chicken, and ferret. Working up, hippopotamus would be next and then elephant, mastodon, and finally dinosaur.