Morphine: No Cure for Pain

morphine

Just before 6 a.m., my dad’s voice floats through my dreams, a distant call echoing through a warm, nighttime fog.

“Amanda, I can’t breathe.”

My eyes open and before I hear the second syllable of my name a second time, my feet are on the carpet, running, running, down, down, down toward my father who is standing with his walker at the bottom of the stairs, his oxygen cord a tangle at his feet.

“I’m sorry,” he says,  but I can’t breathe.”

He isn’t gasping. He isn’t blue. But he is upset, confused.

I shepherd him through the darkness toward his saggy, lopsided recliner, a green leather monster that moved into our house a few years ago when mom and dad did.

In the kitchen, a few feet away, I reach for morphine, a tiny square bottle packaged like it’s a precious cologne, Chanel No. 5  for the dying. A high school health teacher warned us so many times about the dangers of morphine that even now, 30 years later, it’s counter-intuitive to give this drug to someone I love.

The morphine is the same pine green of NyQuil and no thicker than water. I insert a syringe thinner than a pencil into the bottle and fill it about 1/4 full, only a few drops, less than an 1/8 of a teaspoon, the prescribed dose dad can take once each hour.

When I turn on the light by dad’s recliner, I’m startled. My father is there, but he seems to have turned into my grandfather, his own father who died in 1990.

Until this moment, dad never resembled my grandfather, a self-righteous, blue-eyed Irishman, red hair gone to frost.

We, my father and I, have always been Schneebergers, taller versions of my German grandmother, with hazel eyes, a dimple in our right cheeks, almost always harder on ourselves than we are on others.

“Dad, I’ve got something that is going to help,” I say, holding the syringe where he can see it.

Until now, I’ve only given dad morphine twice a day — once at breakfast and once before bed. Hospice prescribed the opiate after his esophageal cancer and chemotherapy combined to cause weeks of diarrhea, leaving him so weak he couldn’t stand.

Morphine causes constipation, so the diarrhea ended. And I know it can also slow the respiratory system so dad, whose cancer has spread to his lungs, won’t feel like he’s gasping for air.

Dad tilts back his head and opens his mouth, his gums pink and wet, naked without his dentures. And like a mama bird feeding a hatchling, I insert the syringe and plunge the morphine down his throat.

This change, this sudden morphing from Schneeberger to Garrett unnerves me. So does this increasingly unfamiliar and traumatic family drama.

A room away, my mother sleeps, oblivious to her husband’s struggles. More and more she’s living in her own bizarre  dementialand.

Most days she insists she can’t go to the bathroom without eating cheesecake and smoking cigarettes. Other days she says she can’t stop going to the bathroom unless she eats cheesecake and smokes cigarettes.

The television remote control, for her, might as well be a martian spaceship.

She’s can’t figure it out.

Fifteen minutes after I give dad the morphine, he’s still having a tough time breathing.

I worry this is the first of many such episodes to come. No one from Hospice has yet told me what to do.

Maybe dad is having a panic attack, I wonder.

The day before, when I was taking a shower, my dad sobbed to the aide who visited for an hour to give him a bath. Stacie, who’s helped mom bathe for nearly four years and who took care of my aunt with Alzheimer’s before that, is part of our family now and dad trusts her.

He’s been unwaveringly brave in front of me, but he confided his deepest fear to Stacie — suffocation — and she wisely passed that on to me.

I go back to the kitchen and reach for dad’s other new prescription — a generic form of the anti-anxiety drug Xanax.

For a moment, I think about popping one of the tiny yellow pills myself, but I have never taken anything like that and decide it’s too big of a risk. If I have some sort of weird reaction, my husband is saddled with this mess.

So I half-fill a glass — well, really a plastic tumbler with textured sides that old, feeble hands can easily grip — with water and carry the Xanax in to dad. He swallows it, thanks me and closes his eyes.

Eleven days before, dad entered Hospice, both the program and the facility. It happened on a Saturday after he wouldn’t get out of bed.

A nurse practitioner who had visited the day before as part of dad’s palliative care had noticed the decline in his health. She said it was best for him to decide whether he wanted to give up on chemo and opt for Hospice. But she changed her mind on that Saturday when I called and told her about the situation.

A Hospice intake nurse came to our house and, by then, dad was sitting in his recliner. I was ready, as his power of attorney, to  sign the Hospice forms. But dad rallied enough to do make this decision himself and, for this, I will be forever grateful.

Although Hospice would almost certainly argue otherwise, signing up for comfort care is surrendering to your disease. I didn’t want to wave the white flag for dad. It was good for him and for me that he made that choice.

My husband drove dad a mile away to the Hospice care center, a nearly new facility with several indoor fireplaces and rooms that overlook an equally new park where people jog with dogs and push strollers around a blacktop path.

I followed in a separate car with my mother, her wheelchair, three one-gallon Ziplock bags of dad’s medication, dad’s living will, my power of attorney and a pack of dad’s Pall Mall cigarettes, a red Bic lighter stuffed inside.

Three days later, after Hospice got his diarrhea under control, dad came back to our house to celebrate his 58th wedding anniversary with my mom and told me he never wanted to go back to Hospice.

I worry now, watching him in his recliner, that he will end up back in Hospice, that I might not be able to handle this.

It’s been almost an hour since he woke me and I give him another dose of morphine.

This squirt of green, in combination with the Xanax, works.

He nods off.

Later, when I call Hospice, a nurse named Ginger reassures me I did the right thing with the morphine and the Xanax.

She gets permission from a doctor to double dad’s morphine and his Trazadone, a pill he takes before bed that helps the mind relax.

Then she ask me if I know what do when someone dies.

My first thought is “run,” but I don’t say it. I don’t say anything.

Ginger fills the silence with a “What To Do When Someone Dies — For Dummies” talk.

The person will stop breathing. Their eyes may be closed or may still be open.

Don’t panic. Don’t call 9-1-1. Go slow. Take your time. Call Hospice immediately or whenever you’re ready.

Once Hospice arrives, staff will verify the person’s dead. And then, whenever you’re ready — remember, there’s no rush — Hospice will call the funeral home.

As she’s explaining this, my mother hollers from somewhere in the house demanding a cigarette. I seek refuge in the pantry overlooking our wooded backyard and notice for the first time that spring green has started coloring the tips of the trees.

Once Hospice calls the funeral home, Ginger tells me, it usually takes about an hour for the staff to arrive.

The only decision to make then, she says, is whether you want the dead person’s face covered or uncovered as he’s taken from the home.

Who cares, covered or uncovered, I think to myself. Ginger’s already told me my dad’s going to by lying there for hours in my house dead, his eyes possibly open.

By the time I hang up the phone, my husband has taken my mother out for a cigarette and helped my father back to bed.

I reach for the tiny bottle of morphine again to soothe my father’s breathing and wish that Hospice offered something just as powerful to cure my pain.

This happened two days ago. My father is sleeping more, eating less and, for the first time since he was in the Army during the Korean War, passing up cigarettes. Although I  know his final chapter is closing, no one knows when that will be. For now, I stand guard with the morphine and Xanax, trying to make him comfortable. Morphine was one of my favorite bands of the 1990s and a half-dozen of their songs still occupy my favorites list, including “Cure for Pain.”morphine

Is it better to be tied to a tree than squashed on the freeway? Caregiver angst

boytree

Baby Walter — that’s what everyone called him since his dad was also named Walter and no one much liked the sound of “junior” — spent most of his single-digit years tethered to one heavy object or another.

His older sister Tina was one of my closest friends. We grew up in the 1970s and 1980s at different ends of the same rural road in Ohio, an unlined swath of blacktop connecting old farmhouses to the fields of green soybeans and sweet corn planted in between.

Baby Walter and Tina lived in the last house on the right before our road crossed over Interstate 71, the busy freeway connecting Cleveland to Columbus to Cincinnati.

And Tina’s mom — not overly protective of Tina or her older brother — worried constantly that Baby Walter would run down the slope of their side yard and onto I-71 where he would almost certainly be smashed by a semi-truck hauling automobiles or steel or some other heavy thing manufactured in Cleveland and destined for points south unknown.

Today, a doctor would likely diagnose Baby Walter with ADD and scribble out a prescription for a medication to calm him. But at that time, our patch of Ohio was stuck somewhere between “Hee Haw” and “Jesus Christ Superstar.”

We rarely questioned our fate and, if we did, we asked God via Jesus to help us, not some stranger in a lab coat. On rare occasions — like those Sundays when our preacher wrapped up his sermon in time to catch Browns kickoff — we knew God kicked in. But mostly, we fended for ourselves and worked with what we had.

That meant it was Tina’s job — and my job, too, when I was at her house — to keep Baby Walter safe by following instructions from Tina’s mom:

Tie Baby Walter to his bed for his nap.

Tie Baby Walter to the barn ladder while you’re in the loft so he doesn’t fall.

Tie Baby Walter to the tree so you all can play outside.

I know it sounds wretched now and certainly there were many what-ifs — like what if the house caught fire and Baby Walter was trapped, unable to leave his bed. But nothing bad ever happened.

Baby Walter would inevitably wrap himself around the tree like a tether ball to a pole, but it was fun — for him and for us — to unwind him until he wrapped himself around again.

He was happy, well-loved and well-fed and seemed to grow accustomed to the ritual, often waiting for someone to tie him, as if he, too, didn’t trust himself not to run into I-71’s siren song.

I’ve been thinking about Baby Walter — who must be 40 by now — all day.

This morning, before sunrise, before anyone else in our house was awake, when the temperature hovered at -16 degrees, my 83-year-old mother crept outside with her walker — wearing only a t-shirt, tennis shoes and a coat — and smoked a cigarette.

She made it back to the couch safely and we only discovered her crime when my father, who has cancer, went out for his first cigarette of the day and found an overturned coffee cup and a half pack of red Pall Malls scattered on the snow.

It frightened me, but it enraged me just as much.

How long does it take a 104-pound woman to freeze to death if she falls in the snow when its 16-below? Or how about our dog or two cats that always hover around the front door?

My mother has a combination of Alzheimer’s and vascular dementia (caused by smoking). She also has spinal stenosis and scoliosis that leaves her bent at a 50-degree angle, unable to straighten, unsteady on her feet and challenged to hobble on a walker more than a dozen feet without sitting down.

Her physical frailty has in some ways made her mental frailty easier to deal with. I can almost always catch her before she runs amok. But it’s done nothing to temper her bullheadedness or nicotine craving (yes, I’ve tried and failed to convert her to patches and gum and e-cigarettes).

From the first week mom and dad moved in, there has been a single rule that has dominated our lives: Mom must never go outside — or even open the door — unless someone is at her side.

Her dementia has stolen much of her left brain, always her weakest side. She doesn’t know $5,000 from $5. But even now she knows the door rule and knowingly broke it for a cigarette.

Nursing home was my first thought. I’m nearing the end of my caregiver rope.

Standing by my dad as he negotiates cancer — an oncologist today decided to end his radiation a week early so he can go on chemo because the tumors in his lungs are leaving him short of breath — is exhausting. And it’s sad.

Lassoing my mother’s wants and needs at the same time is nearly impossible.

But here’s the thing: My dad’s final chapter is closing.

And even though my mom isn’t the woman she was — and both OG mom and dementia mom make dad bats — I know he’d rather have her close as he fades away.

So I’ve got myself a Baby Walter dilemma: How do you prevent someone you love from running into traffic and getting killed?

I have a tree, but I’m unwilling to use a tether.

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