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Thursday, 01 July 2004

A mother's final, best lesson: Part 6

category_bug_journal2.gif Mom owned what I still believe was the world’s longest sofa. The day came when she announced she wanted to move to the living room, and the sofa, she said, would suit her fine as a final resting place, so to speak. The three of us laughed together at her joke, I arranged linens on the sofa and Joe carried Mom from her bedroom.

In the weeks I’d been caring for her, Mom's weight had dropped dramatically. There wasn’t much padding left on her bones and it took only a couple of hours to discover that the sofa upholstery was too harsh on her skin, too painful to endure even through two sheets and a diaper.

An experienced caregiver would have known about a product the medical supply business refers to as a “convoluted foam mattress overlay," known in the vernacular as an “egg crate mattress.” It took me, an amateur, the better part of day to learn of its existence and then track down a store where it could be purchased. But once cut and fit over the cushions, Mom pronounced the result to be excellent.

Mom’s physician had prescribed three drugs: Halcion for sleep which she used only occasionally, a non-narcotic pain pill and Roxanol, liquid morphine meant to be administered by eyedropper on the tongue. It was several weeks after my arrival before Mom, always a stoic, mentioned that the pills were not helping her pain enough. Still, she resisted the morphine.

“I don’t want to get addicted,” she said – this from a woman who until her breast surgery the year before requiring a reduction in her alcohol intake, had spent decades in a way too cozy relationship with a bourbon bottle.

It took two days, during which it was obvious she was suffering, before my arguments and the intensity of the pain convinced Mom she was unlikely to run down the block and rob the nearest candy store. We experimented with the number of drops on her tongue until we found the right dosage and frequency and it wasn’t long before she was enjoying the morphine a whole lot more than would have been a good idea had she not been dying.

A couple of weeks later, Mom’s voice wakened me from a dead sleep. I stumbled from my room, not really conscious yet, to find the sofa empty. Not possible. The woman could no longer walk. Still in a mild stupor, I thought she might be in her bedroom, but as I moved to check, I heard her call again from the direction of the living room. When I turned on a light, I found her on the floor wedged between the sofa and coffee table. She had no memory of how she’d gotten there.

With her paralyzed left arm and general weakness, Mom couldn't help me much in getting her back onto the sofa. That she was also stoned out of her mind on morphine made her even less cooperative, but by squatting on the sofa and hooking my hands under her arms, I was able to lift her from the floor. When she was re-settled and comfortable, Mom spoke up: “The heart in the elephant can substitute for the Faberge egg because it looks shiny and bright,” she said. I stifled a giggle and decided to stick around to see where she was going with that idea. “You can have the egg now. I thought you were too young for such a beautiful thing before…He’d be angry because you let me have a cigarette and a drink…I don’t want you to wear that ugly brown skirt to the party…The Dalmation is exquisite, don’t you think…”

Then she looked me right in the eye: “What am I babbling about? I’ve got enough mental capacity to know I’m babbling.” With that, she used her working right hand to pull up the blanket, closed her eyes and went to sleep. She never again asked for morphine, and I have no idea if the pain subsided or if she chose to suffer it to keep her mind intact.

…to be continued…

A mother's final, best lesson: Part 1
A mother's final, best lesson: Part 2
A mother's final, best lesson: Part 3
A mother's final, best lesson: Part 4
A mother's final, best lesson: Part 5
A mother's final, best lesson: Part 7
A mother's final, best lesson: Part 8
A mother's final, best lesson: Part 9
A mother's final, best lesson: Part 10
A mother's final, best lesson: Part 11
A mother's final, best lesson: Postscript


Posted by Ronni Bennett at 01:51 AM | Permalink | Email this post

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Ronni, after just going through the dying process with my best friend, I cannot tell you how helpful and comforting in many ways this series has been.

But for that reason, and the knowledge that my friend was most frightened of losing control--as was your mother, it seems--I'd like to point out that morphine works differently on different people, and that no one should resist it and put up with pain based on this fear. My friend was both on morphine patches as well as the drops once she couldn't even swallow liquids. While she dozed constantly, when she was awake she made perfect sense--something I consistently reassured her about. Otherwise, I feel she would have endured more excruciating pain rather than feel she had lost control of her thoughts.

Susan...

You're right about morphine affecting individuals differently. I have a couple of funny stories of my own from a past hospital stay or two...

But in the case of my mother, she continued to use the non-narcotic pain pills after she stopped the morphine and as far as I could tell, they worked - or worked well enough. I didn't believe it was my call to force the morphine on her. Because she was fully lucid until she died and had lost so much independence, I left as many choices as possible to her.

You're right, of course. Manipulation of meds is geared towards the main goal of pain relief, with as little sedative effect as possible. Everyone's pain tolerance is different, and if less medication can control it, that's the best. Chris stayed away from the morphine as long as she could, and we were happy to see that by the time she had to go on it, it did not affect her mental abilities aside from limiting her time spent awake. And I must add, that the nurses were amazed at her tolerance for the morphine; almost as if she were fighting its mind-altering effect.

I have been reading this series with rapt attention as memories flood back of my own father's last weeks as we cared for him at home. All the emotions, difficult decisions, and the change in the relationship from cared to caregiver...you have described so poignantly! Thanks for a lovely blog.

My own father died of cancer, but unfortunately I didn't have the strength to deal with him as you did and he died in hospital without me at his side. I tell myself that by then he was no longer lucid and didn't know where he was, I tell myself that it was too much stress for my 7 yr old daughter and my wife - which may all be true. But I still wish I had kept him at home.

I have to go back and read some of the entries I missed, but you have such an incredible gift for succinctly telling a story. As a two time breast cancer survivor myself, who (knock on wood) has had not had a recurrence in seven years, I always know how blessed I've been so far. I lost my own mom-in-law and a very close friend from this horrible disease. Glad I had time to stop by tonight.

As I continue reading your account, I think how fortunate your mother was to have you as a caregiver. With her situation indefinite, what enabled you to take so much time off from your work? My mother, who died last year, had seven surviving children, four of which lived in her town. All busy people with active families of their own, they cooperated to give her in-home care until 24-hour care was needed. My thoughts then move to the future. I have two sons, not daughters. Neither one is the nurturing type. Would their response to an aging father be different? My wife, like my previous wife...and you, I believe, have no children. What scenarios might be expected for them? Not that I expect an answer from you, and not that there aren't good answers...but your story inspires related thoughts of "what if..."

I resisted morphine for pain control for precisely the same reason as your mother. Knowing full well that one has an "addictive personality" as one shrink malproped to me, it was imperative to avoid it after successfully cutting the bourbon out of my life. Like your mother, I finally relented. The relief was phenomenal, immediate and allowed me to kick a thirty-five year, two pack-a-day smoking habit over a one week period, too. And yes, I was able to stop the morphine after a week, even though pain continued. It just didn't have the grip on my mind it once did. I hope that is how it was for your mother, too.

Denny, when my friend Chris died last week, another friend who luckily is a nurse, and I were with her taking turns to be there every hour of the day. Her two daughters are wonderful women, but one lives in Arizona and the other about two hours away. The closer one came and stayed the last couple days and helped care for her mother. What I'm saying, I suppose, is that friendship is as strong a loving bond as family.

Wil, thanks for the personal note on morphine. It is sometimes necessary when the oxycotrin or other pain meds don't handle the pain, and it's just good to let people know that while it may have knockout-effects on some people, it's not always nececessary to avoid it until the very end. And, it can be tried and discarded if the side effects are worse than the pain it controls.

So poignantly lovely, Ronni, this depiction of the final shinings of your Mom's strong personality through the pain and suffering of her last hours. Her life remains alive and well in our memories of her cast through your loving, caring eyes . . .

Very nice site. Keep up the good work.

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