Morphine made Mom psychotic. We didn’t know that, but she did. She refused to take an adequate therapeutic dose, a decision which left her screaming and writhing in pain for a good part of the last 6 months of her life. It was frustrating (to say the least), but it was her choice. Mom would take control any way she could. Control was always of paramount importance to her.
I shrugged off her complaints about the morphine. She said it made her “feel crazy,” but she always had a litany of complaints about medications. Her list of “allergies” was long and earned her frowns of skepticism from most healthcare providers. I would roll my eyes right along with them. “They’re not ‘allergies,’ Mom. They’re sensitivities. Side effects. Whatever. Not allergies.”
When she was admitted for inpatient chemotherapy last February, it seemed the perfect opportunity to get her pain under control for once and for all. She was given intravenous morphine. She said she felt better. I didn’t say, “I told you so,” but I thought it. I hoped this would help her see that she should follow the recommendations of her oncologists, who are quite adept at managing cancer pain for most patients.
Then she went berserk. You see, Mom wasn’t like “most patients.” She was more like a wild animal, the kind that would chew its foot off to escape a trap. The narcotic-induced psychosis caused her to do all kinds of strange and unadvisable things. She got out of bed against orders in the middle of the night and fell in the bathroom, where the nurses found her. She yanked out her PICC line (which delivers chemotherapy into the superior vena cava, its tip residing very near the heart). Eventually, her psychotic state deepened and she became restless, nonverbal, eyes rolling back in her head, unable to focus. Still, she relentlessly tried to remove her clothing and groped for the IV poles.
“Don’t touch those, Mama,” I admonished. “There’s medicine in there that can hurt people if it spills.” At these words, she would draw back momentarily, then begin again. She had to be relocated to the room across from the nursing station. A “sitter” was assigned to stay at her bedside at all times.
Of course this dismayed me, but since I work in the medical community, for some of the very same doctors who were caring for Mom, I was also a little embarrassed. I wondered, Why can’t Mom behave herself? Why can’t she be a “normal” patient? I knew she couldn’t help it, but still. She was causing everyone so much trouble.
With reversal of the narcotics, my mother returned to lucidity and could be informed of what we, the family, already knew: the one scan she’d held still enough to complete showed her cancer had literally “exploded,” now occupying the vast majority of her left thorax. There was disease in the contralateral lung and both adrenals, not to mention her ribs and spine. Chemo was pointless. The orange drip was disconnected. Without the whirr and beep of the pumps, the hospital room was quiet. She would be discharged on hospice.
“They’re sending me home to die,” mom said tearfully in one of the few instances when she gave in to despair. She was right. They were. It was the prudent thing to do.
I try to be gentle with myself. After all, it wasn’t my fault I didn’t fully appreciate the gravity of her situation. Even seasoned oncologists were shocked that her tumor had regrown to the staggering size of 18 cm in the three short months following her extensive surgery, during which time interval she was actively undergoing therapy with radiation. Neither was I to blame for my failure, after a lifetime of hearing her gripe about medications, to appreciate just how severe her reaction to the morphine had been for all the months she refused to take enough of it to control her pain. As it turned out, it really did make her “feel crazy.” Go figure.
Five weeks after her homecoming, Mom was gone. When I think of her behavior now, I smile. Embarassment has given way to a kind of pride. In the bigger context of her illness and where she was headed, I’m glad Mom fought like a wild animal. I’m glad she refused to negotiate with her illness, the drugs, all of it.
She didn’t want to be a cancer patient, a cancer survivor, a cancer anything. She just wanted to be.
Good for you, Mom, I think. Give ’em hell. Whatever else I’m glad or sorry about, I’m glad she wasn’t well behaved at the end. I’m glad she was feral. Because that was the real her. Narcotic-induced psychosis or not, that was Mom. She wasn’t the lie-down-and-accept-it type. She wasn’t the be-nice-and-don’t-make-waves type.
They say people die the way they live. She died fighting. For her, it was the honest thing – the only thing – to do.