Some people only get stomach sick when they drink too much or have the flu. For those of us with gastrointestinal chronic illnesses, however, nausea is a… more familiar friend.

Having spent much of my life in the clutches of a goblin called CVS – “Cyclic Vomiting Syndrome,” a nausea-inducing illness of indeterminate origin – I am closer than most with my stomach’s less friendly moods. And while I have meds and a doctor to control it mostly now, there are still days and situations that plunge me back to the grody brink that is nauseating illness. You see, there’s no ‘sick’ and ‘not-sick’ dichotomy for me and other chronically ill folk; it’s more like how sick you feel at any individual moment.

So how do you know how nauseous you are, and how to react? I created this personalized Nausea Scale to help myself and others pin it down! Read on for reference...

Stage 1 – “Pre-Nausea”

Something feels wrong in the stomach, but it’s pretty ignorable. You’re not quite nauseous yet. If you’re not careful, though, it’ll sneak up on you. This level may be accompanied by The Grumblies™, and associated digestive flukes. Leave the bathroom door open.

Me at my stomach... 'Don't you dare.'

Stage 2 – “Low-Key Nausea”

You don’t notice you’re nauseous until you burp. Then you get the infamous Taste of Death breath. Tasting it makes you want to puke immediately, so you just avoid breathing deeply. Who needs air, anyway? Not you, for the next few hours.

Stage 3 – “Mild Nausea”

This stage almost always includes The Grumblies™, along with a generic gross nauseating feeling in your throat. Do not breathe or belch at this point if you want to live. Sudden movements and being vertical can both aggravate your stomach, so you’re officially heading into the bed rest stage – get ready for lots of laying down and hoping it will go away before it hits stage 4.

Stage 4 – “Mid-key Nausea”

Are you nauseous now? Yes. Can you move? Only very slowly. Can you drink? All the ice in your soda will melt. This stage is where you desperately want to puke just to make it go away—but you’re enough on the other side of the verge that you can’t make yourself just by willing it. ‘Mid-key’ in this case is a rhyming synonym for ‘Misery.’

Stage 5 – “High-Key Nausea”

This stage can come on slowly or out of god-awful nowhere. It’s the part where you spend twenty to forty minutes at a time curled around the toilet in your bathroom, and stock your bedroom nightstand with Sprite, Powerade, drugs, those accupressure bracelets that probably don’t work, and a trash can or bucket. You will not sleep. You won’t do anything else, either. Vomiting is a relief because it eases the nausea… for a while, anyway. Lots of gagging and dry heaving.

PLUS: Bonus Level!

Stage 10 – “Death Nausea”

A rare or Special nausea, this happens when you are puking so violently that you think your throat might actually come out of your mouth. Don’t bother brushing your teeth after this one, because you’ll be back in three minutes hacking up your guts. Don’t even try to take your nausea meds during this, either. Water is about the best you can do. Everything else comes back up shortly.

And… congrats! You did it! You made it to the maximum level of sickness. Now the next time you pop into the doctor’s to check out whatever stomach bug you’ve caught that winter, you can make handy-dandy use of the Shields Scale to explain just how bad you’re feeling, and why, no, really, professor, you don’t think you can make it to class.