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When Grampa died, a nurse from his nursing home came to my aunt and uncle's house to help them tell Gramma the news. She happened to check out Gramma's pain meds and strongly recommended that the family call her oncologist and ask that she be put on Morphine Sulfate (MS), explaining that most cancer patients (especially terminal ones, she said outside of Gramma's hearing), were prescribed this; it was one of the few oral pain relievers that could touch the pain of cancer. My uncle called her oncologist and asked for a prescription. The oncologist reacted as if my Uncle had just asked for cyanide to escort Gramma straight to Grampa; he was utterly horrified. "But that's addictive he said. "You don't want her to get addicted, do you?" The fact that Gramma was terminal and had been told in January that she probably only had 6 months to a year to live, was totally irrelevant. Morphine is addictive and 'tis better to be dead than addicted in our society.
Luckily for Gramma, her internist was either more enlightened or more compassionate (we really didn't care which), and he prescribed the Morphine, as well as a Fentanyl patch to supplement.
Three weeks before she died, the pain had reached a point where oral medications couldn't control it any longer. She was admitted to the hospital, and given IV morphine with a PCA. (Patient Controled Angalgesic; this is a device that allows the patient to push a button and administer their own pain meds, within strictly controlled time/dosage paremeters.) The morphine helped to some degree, but Gramma couldn't tolerate it at the dosages she needed to control her pain. She became violently ill from it. She was given an IV into the epidural space, which reduced the nausea and did a better job of controlling the pain. The epidural was supplemented by the PCA, but the amount of morphine delivered through the PCA was a small enough dosage that it didn't trigger nausea. This arrangement worked, up to a point at least.
The Tuesday before she died, her internist came by to visit. Gramma had just got back into bed after going to the bathroom. Since any movement more strenuous than changing positions in bed increased her pain, she was very uncomfortable when the internist stopped in. After chatting with her for a few moments, the doctor motioned my mother out into the hallway and said, "We're going to remove the epidural since it's obviously not working. We'll put her back on IV morphine, and discharge her to a nursing home." Mom tried to explain that the epidural was working, that Gramma couldn't tolerate the high doses of morphine she would require through an IV, and that they would move Gramma to a nursing home over Mom's dead body. A nurse paged one of the anesthesiologists who had given Gramma the epidural, and he convinced the internist that Gramma was no longer the internist's patient, but his. The epidural stayed, Gramma was not moved.
Her oncologist also stopped by that day, and suggested more radiation treatment. Mom asked him what the benefit to Gramma would be, and the oncologist said it might reduce the pain, and allow the doctors to reduce the amount of morphine she was receiving. "Morphine's addictive, you know," he told Mom disapprovingly. "Your mother is going to die an addict."
Mom told him to stay the hell away from her mother and shooed him off. Gramma's nurses, and the two anesthesiologists, reassured her that she had done the right thing. Gramma, they told her, probably only had days - weeks at most - to live. What was important now was making Gramma as comfortable as possible.
Gramma died that Friday. Uncle Rodney, Aunt Ellen, Mom and I were with her. As far as we could tell, she wasn't in pain. It was, I suppose, as good a death as one can have from cancer.
©1997 Lisa Stalnaker Hellwig
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