tHe haPPy grOUch

tHe haPPy grOUch

Sunday, June 23, 2013

As it turns out, the decision of whether or not to continue Dad's medications seems to have been made for us.
He has spent the last 24 hours asleep. He can't take anything by mouth if he's asleep.
I should mention here that he's not asleep in the fashion that you and I are thinking.. you know, the kind of sleep where you can wake a person.. "oh, good morning"... He's in the kind of sleep where you could holler and shake him, and he will simply flutter his eyes, open them for a brief moment, small twitch of the eyebrows, maybe even a groan. Then it's right back out. His arms are dead weight, always.

Side note...
Even though I am a devout skeptic, I can't help but think there was something cosmic in this. As if Dad knew that Sharla and Mom and I would never agree when to cease medical treatment... That Sharla would wear her "nurse hat", and push for strictly comfort care. That Mom and I would be the "clingers", and not be able to agree... As if he knew, and made the decision for us.
Anyway...

We know that this is part of the dying process.
First they stop eating (which he did a few days ago). Then they stop drinking (he took his last sips last night after check in at Bangor). And then they just sleep. All the time. Like Dad.

Mom and I, in our last desperate moments of denial today, decided to take him off the morphine drip. Wondering if he'd have any moments of wakefulness. Just one more second to make eye contact, get a smile (or grimace), or one last "I love you too"...
I should mention that he is on the lowest dose possible; 1 milligram per hour. Many people could operate a car under that dosage. Then again, Dad's liver and kidneys aren't really functioning, and so there is the theory that it would be more potent for him, as it's not necessarily being metabolized.
Statistically (here come those statistics again), in a "normal" person (with functioning organs), after 120 minutes, half of the morphine will have passed out of the body. Another 120 minutes, the other half. But of course, these statistics don't really apply to Dad.
And so, unfortunately, we'll never really know when or if it will have made any difference, unless we leave him morphine free for a good while longer. He's been off the drip since 6pm (it's midnight as I write this).

And then there are the potential medical complications of taking him off the morphine.
And the moral issues as well...

Besides pain relief, morphine also relaxes the muscles and allows for easier breathing. And dad's breathing is already quite compromised as it is. If in fact he was getting even a little relief from the small dose, we may see his breathing become even more arduous. And more uncomfortable.
Then there's the pain question. Is he in pain? Is he uncomfortable? Are we making him more uncomfortable? Are we making it worse? Is he aware of his pain? Is he scared because he can't catch his breath?
And of course, he can't tell us. We will most likely never know.

Mom is staying with him tonight. The nurses are keeping a close eye on him. The palliative care doctor said to call anytime during the night. If his breathing becomes more labored in any way, or if he gives the slightest hint of pain awareness (groans, twitching, agitation, anything), they will give a bolus of morphine and restart the drip.
And if there's been no change tomorrow morning when Sharla and I return, we will discuss restarting it anyway. If he is truly in the sleep that is the precursor to death, then we will make sure he is comfortable in his journey. We all at least agree that it appears it will be a short one, no matter how much we want to deny it.

I sound like any author, just telling a story.
This is my coping.