Tuesday, April 22, 2008

Perceptions of pain, pt. II

From the depths of her contorted and decrepit frame, the woman screamed.

Every time I touched her she would shriek in some unintelligible manner, her tone wavering and exhausted as the last bit of her breath was forced to the effort. She was a mess. 89 years old and more co-morbidities than I had time to count, the dialysis staff where we found her told me that she "needs to just die." ...But for some reason, she wouldn't. Not a DNR, not four times a week hemodialysis, not cancer, not massive systemic infections would finish her off. Instead, she sat there in her chairs and stretchers, writhing in pain and suffering through every minute.

Her family calmy watched from the waiting room. This happens all the time, they say, but they don't want to give her too many pain medications because she "isn't herself" when she's on them. They've been cutting her oxycodone pills in half with a butter knife at home and feeding them to this woman slowly, as they deemed necessary. I stared at them in horror as they relayed the story.

The woman had advanced dementia. She was weak beyond helping herself and wasting away in a slow, agonizing manner. What personality this woman once had seemed to be long gone, or recessed so deep as to never be recovered. In front of me was a bag of bones, a writhing shell of a person who once was. If there was any consciousness within that body, and if it had any sense at all, it was probably pushing from the inside desperately trying to escape as soon as possible.

...But the pain was real. It had to be. She yelled so loudly when we moved her that the nurses had to apologize to the rest of the patients in the facility. It was a harsh, agonizing cry, and even though it was technically unintelligible it somehow, through seeming urgency or subconsciously perceived texture, spoke clearly to all who heard.

Let me go, it said. Let me go.


Lucky D said...

I'm sorry. I work for a hospice and consequently see people much the same as the one you described here all the time. My last full time private duty patient's husband had a very similar attitude towards roxinal and ativan and it wasn't until the day before his wife's slow, painful death that I managed to persuade him that it was time to medicate her. It WAS time. It had BEEN time for a few weeks, but he wanted her 'normal' as much as possible so he refused to allow me to administer the medication her physicians prescribed to her.

Once I had gained permission and had given her the first dose, though....it was like night and day. She went from being a confisued agitated stranger who scremed every time anyone got near her to the sweet, gentle, generous little old lady I'd cared for for the past year. She was a little sleepy, yes, but she was present and more importantly, she was comfortable. She passed away very peacefully at sunset, in her own home and surrounded by her family and friends. I can't help but think that had we not medicated her she'd have ended up in a hospital or home because she'd have become combative and just too much to handle at home (I'm sure you know what I mean by that).

I adore your blog and have bookmarked it. I just started my own, too....

Medic 61 said...

Great, but heartbreaking post. You're a wonderful writer--I need to catch up on old entries!

NJ EMS said...

ERRRRRRRRRR!That story made me mad.

Anonymous said...

It's normal for their grandmother to be screaming in pain? Someone call social services on these fools!

Anonymous said...

I am aspiring premed student and college and currently an EMT for 2 years. On one hand medicine's goal is to save everyone's life and keep them alive at all costs, and then you get these cases. Sometimes I wish euthanasia could be legal, for the poor patient's sake... As me and my other partners in EMS always say, if we ever get to that stage in life, just put a bullet through our heads and let us go 'peacefully'