Thursday, May 03, 2007

a little scary

The mate is normally headstrong and very much in control. However, these last few days the sense of fear has been pretty strong, so the doc kinda-half-sorta recommended trying more morphine, which tricks the body into thinking it has enough oxygen. We agreed it was reasonable to experiment.

However, yesterday and today in particular the mate was getting spacey and lost. She'd stop in the middle of doing something and just sit. I got alarmed because today she was not responding to my questions but something else, usually a mishearing of what I'd said. She'd forgotten that I'd brought her a coffee this morning, thinking it was yesterday. She was a bit cold in the fingers, though her O2 reading was excellent. And she was really in spaceland, sitting motionless a lot even when she'd said she was about to do something.

She wears a low-dose Fentanyl patch, gets Valium twice a day, and Ativan if a fast effect is needed. Apparently she'd had two morphine doses and two marinols today. Usually she has just one of each. It seemed like this was just too much: she pretty much turned to mush.

Fortunately our night nurse is a very good one; she's competent and responsive, and she likes the mate too. I told her things felt wrong, and she went in with her student nurse. The student automatically asked the mate if she wanted a Valium, and she said yes. But I gave a quick shake no, and the night nurse double-checked, asking the mate how she felt and other questions that determined that she didn't really need the Valium. Our nurse said she'd hold off on the narcotics until tomorrow.

I was totally relieved. Normally, as I said, the mate's very much in tune with how she feels and what she needs, but today she was completely suggestible, saying yes to everything. A less concerned (or less experienced) nurse might just ask the question and go on a positive reply without really sensing a problem.

This is a place where nurses have a lot of power. I pushed ours into a judgement call. I admitted that I couldn't decide which was better: a state where she wasn't having any fear but didn't have much of a brain either, or a having a clear mind but often struck by terrors. She made what was essentially a doctor's decision, to withhold narcotics, and I'm very glad she did.

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