Primum Non Nocere V

(part one) (part two) (part three) (part four) (part six) (part seven) (part eight)


September 09, 2007 3:33 AM

Sorry I missed your call earlier - unfortunately, today was not that much better than yesterday in some respects. E, for the most part, is no longer exhibiting facial droop / right side paralysis anymore, but she is also no longer operating with both feet in the real world.

The level of drugs is astounding and, worse, E is adamant about needing everything they offer her. My mother and I, while not exactly on the same page, are nonetheless forced to choose between tricking her while telling the doctors / nurses what to administer and what to ignore (some of it is "as needed"), or letting E hang herself in a sea of confusion, pain and narcotics. Sadly, E thinks (still) that grabbing pills from the "help," then saving them for later is a good thing. She even thinks that we should be proud of her, as she is not taking them.

I wouldn't call it dementia, but it is running the gamut from not remembering she ate a sandwich or had a pill minutes after she has, to calling boyfriend Miguel this morning and saying she's going into surgery (no idea where that came from), to expressing a need for vigilance lest the staff start cutting down her meds, as that's what they did to our father, inciting his demise, etc....there's little rational thought at this point...white folks would say it's time for an "intervention" by now...

Of course, everything I say is wrong, though I have moved on to addressing a drug addict, however temporary, and am no longer spending time discussing strategy with E. But my mother knows that, as bad as it is, it will become much, much worse when they label her psych-something or a drug risk. And then there is what will ensue if they discover she's trying to self-medicate (no longer successfully I hope - but I'm only there a few hours at a time, and my mother is exhausted). I suspect she'll be asked to leave the facility, and when it goes through the HMO chain some pencil pusher will look like a hero saving Blue Shield another potential 80K by canceling her policy...

A psychiatrist came in today, before I got there, and E is angry about that. But the psychiatrist was right in saying Lisa needs to detox immediately, as an outpatient, ASAP. Then she prescribed a Prozac substitute, and then a Klonopin (sp?) as well for rest. I've taken the latter once before, and actually got a good night's sleep.

This is what's being poured into E's system daily:

80mg oxycontin (long acting pill) every six hours
10mg oxycontin (short acting pill) every four hours (as needed)
2mg diladud (IV) every two hours (as needed)

1000mg prednisone daily (IV)
250mg depakote 3x daily (pill)

verapamil 80mg 2x daily

valium to relax, though now replaced with the klonopin

Add to that a few other things from insulin to ibuprofen to vitamins to stool softeners that don't matter so much; it's the first three - WAY stronger doses than anything she had at home, even though that was getting out of control - that have her zombie-like, and then that level of steroid comes in and she wants to take apart a Chevy small block, but not notice why.

And (of course), this is all coordinated as if the Pentagon had orchestrated it: thousands upon thousands of dollars for RNs and CNAs to come in every hour and ensure that she gets no solid rest, following (uncoordinated) doctors' orders, and then stepping right back out of her life after playing their part in this slowly unfolding tragedy, and wishing her well. And meaning it - they're generally good people.

Still - I don't bother saying it aloud - I'm thankful that this isn't unfolding just about anywhere else in the world, as it could be so much worse. Also invaluable is my mother's availability, though it's become clear, if painful, that the enabling has to stop. E is going to hit that wall one way or another; and everyday that goes by where she increases her tolerance to opiates, which, I believe, is increasing her discomfort each time they start to run out, and with her mental acuity hovering around -4...well, that's only metastasizing the size of that wall to be hit.

I apologize for making this so grim, sir, though obviously I'm not "making it." I think my policy given the current parameters has been pretty clear: Sleep - if possible, give her the sleeping tabs that are available to heroin users these days when they try to quit, as those pills have some success in allowing an individual to sleep through the majority of the withdrawals. I can't state it like that, obviously, but I'll try to reiterate tomorrow, with my mother's help, that that's our goal for now, a human body healing (and shouldn't it be yours, doctor?), and gingerly point out that it would behoove all of us if we reverse this catatonic / speeded out trend in E's demeanor.

(I'm not holding my breath.)

E has to want it, but as I've mentioned, her thoughts are so foggy that she's relinquishing all those rights. It pains me to say it, but she needs saving.

I'm suppose if Miguel were capable he would be there; thus far, it's been my mother.


September 9, 2007 12:29:38 PM PDT

To say that it's time for an intervention is an understatement. I think that most interventions are undertaken long past time and perhaps that is so here. The problem of course, is that in such a confrontation between good and evil, evil may win (apologies to Zarathhustra).

When I read what has become of my niece, it breaks my heart, but even so, I want to be kept in the information loop.

I'm glad you have backed off the confrontational approach no matter how (rightfully) deserving it was. I'm reminded of a quote from Robert Downey Jr. either on his way to, or out of one of his many trips to drug rehab, when he said "It's like I've got the barrel of a shotgun in my mouth, and I'm beginning to like the taste of metal"..

It does little good to try to rationalize reality with one no longer capable of understanding the concept. I've lost count of the number of years that I tried to do just that, until I began to grasp the concept of co-dependency which, as is true of all co-dependents, I was convinced either didn't apply to me, or that, this one time, I was going to make a difference. It didn't, and I didn't. It was only when I stepped out of R's bursting radius (try to imagine yourself driving by a park across from a homeless shelter and seeing your son there, at home with the flotsam and jetsam of the city, and willing yourself not to stop and at least give him $20). When he finally realized that his life choices were entirely his own, he pulled the needle out of his arm and his head out of his ass, but, he's never forgiven me for not having done "more", even though that "more" might have been arranging for the cremation of his remains.

I don't know where to go or what to say to make E better, but I'm glad you're there. I did offer yesterday to sit with E for a bit so your mom could at least have a break, but I'm not sure how able I'd be to assist E to get to the bathroom with IV connected, etc. We.d also be glad to feed the Jimster; the cats; the ugly dorg II; the geraniums, or anything you can think of. I mean it.

Your concerns about the possibility of some valiant bean-counter siezing an opportunity, if presented, to turf E out of the system is a valid one. No reason must be given them to do that, and I know you know that. No evidence of non-compliance; no threat of litigation; nothing.

No, you aren't making it grim; it is grim.


September 9, 2007 12:31:03 PM PDT

So far today:

Went back by around 8 am - the Klonopin from last night did allow for some sleep, and has been prescribed thrice daily. The psychiatrist apparently made it known yesterday that she feels E's major problem is the huge amounts of narcotics, and that scaling back immediately is necessary (hmmm....). The doctor covering for her main doctor conveyed as much this morning, and stated that a reduction will commence tomorrow, as ordered by her main doctor. E's comprehending bits and pieces, as the Klonopin seems to have overridden everything else, at least somewhat. She wasn't insisting on pain meds, and in fact thought that her long-acting Oxycontin, the massive 80mg / 4x a day was only 3x a day. I slipped out of the room and caught the Sunday doc in time, asking, "I don't know if you are able/willing to make this call, but..." E's dosage of that one drug is now 3x a day, and I'm hopeful that she will remain sleepy enough to not notice the triggers, real, imagined or constructed, that would otherwise have her asking for the other two, the short-acting Oxycontin and the Diladud...it's a start...

I left without asking my mother to go home; they've given E an enema this morning, the necessary response to that poppy field she's had in her abdomen all week, and it's understandably embarrassing (though compared to...). I'll be checking back in later.

The neurologist is due in sometime today, and - maybe - he can make that call reducing the steroids back to 500mg instead of 1000mg every 24...if it "holds," the lack of hemiplegic migraine symptoms, I think the transition to oral steroids for the taper is entirely possible within a few days. The IV, a delicate situation in itself, has been there since last Sunday, and they don't want to try and start a new one, the last attempt taking a couple dozen poke-sies...oh; what I was trying to say the other morning, but had my terminology incorrect, wasn't "stick," but "pick," and it's when they run a line straight into the heart. For now, that option isn't even in the dining room...my mother is adamant about that enough for the both of us.

So, a faint glimpse of maybe...will keep you informed...thanks again for being there...


September 9, 2007 12:38:02 PM PDT

I totally agree with the R D Jr quote, and have often been thinking aloud (to me mum) that one attributed to Mick Jagger when referencing others around him: "After awhile, the person's main focus is on obtaining more of the drug. No matter what."

I'm sure one of two others have reached this conclusion as well...I certainly have before...


September 9, 2007 4:17:22 PM PDT

Beg pardon...(sleep, come hither!)...I meant, with motto sarcasm, one or two others have reached this conclusion, meaning such as any honest health-care personnel, or just unlearned pipples like me, who have come in contact with those who have mortgaged everything of theirs and a fair amount of that belonging to others in the pursuit of consumption, the payoff of which rarely, if ever, does little more than achieve parity, at best, but by default relegates those pre and post-wake to the "externalities' column...not that I'm trying to be "deep"...

Miguel, according to the definition of the two types of man passed down to my parents from Great Uncle Irving, is of that second tier: He who doesn't know he doesn't know (and therefore can't be helped). A go-to guy in several international business disciplines, I'm sure; however, timid of hospitals and apparently impervious to "if this, then that" logic 101 concerning his girlfriend. That is hardly a solution set here...

It is difficult - make that impossible - to imagine what you were going through with R. That the story might have ended with the father burying the son touches on another constant - that, regardless of birth, letting drugs take the helm can create something with so much desperate inertia...it doesn't discriminate, does it?

But, unlike everyone that comes to mind in my personal experience, at least your son made it. As did my father three-plus decades before him. Exceptions to the rule, both. So very few are afforded as much. Somewhere, in some eventual short stories...DE LA MANO DEL SOBRINO!...er; sorry, that just sounded cool...somewhere, I'll probably scribble a couple of them out someday. Delightful reading...

Both the UD2 (current moorage at Legs Akimbo Sofa, San Diego, CA) and I thank you for offering to come by. I suspect it will be a few more days at the saucepital, and am hopeful that the worst is over. I can live with E not liking me much as long as E can live with E actually living.


September 10, 2007 12:55:55 AM PDT

Updating: Checking in with my mother, who has been getting decent intervals of rest there in the reclining La-Z-Boy now that E is more sleepy, has reports coming back more positive than yesterday. E's neurologist stopped by, stated that E certainly appeared better, and reinforced the consensus that we've already hit the ceiling on pain meds, period. My mother corrected E's responses when they went astray ("I haven't eaten or slept in days, am in pain constantly" and the like), and there was some common, positive ground acquired, which we can all tell E about at some future date. He does want to wait at least one more day before dropping the steroid level, which is massive and necessitates keeping the IV in that much longer, but, all things considered, this was a glass-half-full-day in my eyes...

E was already asleep the last time my mother and I spoke around 8:30 this evening, and the big concern throughout the day - what E said and what was truly bothering her - has been her insides being so blocked up. The enema earlier this morning did generate some activity, but not enough - her stomach was actually distended, and may still be somewhat. But...maybe...that wall with which she has an appointment won't be quite so tragically thick...

(Half-full, ouí? Just disregard the Mattel logo at the bottom of that Beijing '08 sippy cup, right?)


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