Friday, January 26, 2007

Things Not To Ask The Nurse, Volume One Gazillion

....but first things first. Change of Shift is up here.

So. Mama's been in the hospital now for months with something nobody can identify, and it's not looking good. Right now we're betting on either some sort of wasting disease like CJD or a particularly rare diffuse glioma.

I knew I'd have problems when, weeks ago, I met Sonny for the first time and he said, "If you should happen to make a mistake mixing medicines, I'm not going to mind."



This is the fourth hospital Mama's been in. She's had various bits and pieces taken out and put in in an attempt to fix whatever the hell is wrong; she finally ended up with us when it became apparent that the taking-out and putting-in wasn't working. That's how it always goes: months after you might expect a diagnosis, or at least a stinkin' brain biopsy, a very sick person lands in one of our beds, a testament to other people's inability to know when to say "stop".

Well, Sonny wants to say "stop." Papa, not so much--he's convinced that a little full-brain radiation and a few drugs and hey, presto! Mama will sit up and ask for a Coke. That's not gonna happen, barring the sort of miracle that seems only to have happened a few thousand years ago.

So Sonny's been dropping little hints here and there. "How long would Mama live if we unplugged everything?" Days to weeks. "What's the most likely thing to kill her?" Pneumonia, but we're treating that.

Finally, Sonny asked me point-blank yesterday how much morphine, exactly, I would have to give Mama to slow her breathing down to the point that it got the job done.

"More than I could ever manage to get or to give" I replied. Then I pointed out to him that putting the metaphorical pillow over Mama's face wouldn't do him any good anyhow; she's a full code, so even if she stopped breathing, we'd bring her back and it'd just be more of the same.

The ironic thing is this: over two months ago, when Mama landed on our doorstep, she and I had a conversation. (This was when she was still able to talk and make sense.) She was strongly pro-euthanasia for herself, should she ever get to the point where (and here she was explicit) she was fed through a tube, was in danger of developing bedsores, and couldn't speak.

Check, check, and check. Unfortunately, Mama discussed these issues with the nurse and not with her family.

Our hospital's in a really, really bad neighborhood. Pretty much anything you want can be found within a few blocks of the parking lot, be it whores or crack or opiates. I'm wondering how dedicated Sonny actually is.

In the meantime, I've talked to both attendings and the DON on the quiet. Papa knows nothing of this. I've referred the problem off to the ethics committee and to the chaplains. Then I requested that I not be assigned to that patient again for at least a week. Then I went back and made double-damn sure *everything* was charted. Including my refusal to give morphine or other sedatives to Mama because Papa refused them.

If Mama died peacefully in the night some night after Papa went home--Sonny stays every night on a rollaway bed--I would not be surprised. Nor would I be surprised if she were dead long enough before discovery that she couldn't be coded. Nor would I be surprised if, on autopsy, opiates were found in her bloodstream.

They won't be *my* opiates, is all I can say.


Anonymous said...

Wow Jo. What a situation. I think you handled it very sensibly. It wouldn't have occurred to me to cover my back so well, but I think that was a very wise tactic. Good luck to Mama, Sonny, and Papa, however things work out.

Judy said...

1. I really do not want your job - but I'm glad you do.

2. Need to make double-damn sure I talk to various and sundry family members AGAIN about not waiting around for unlikely miracles.