Tuesday, February 6, 2007

pain begins in earnest

This was the first time that I clearly understood that my father has pain. I know his arthritic knees have been bad but this exceeded anything that has gone before. I sat down on his bed and drew his wheelchair over to be closer to me. His hands were freezing cold and his sweatshirt hood was up. He looked like a wannabe street kid. Very thin and his eyes hollow. I covered him with his wool blanket. I put up a few more Valentine decorations. The sun shone through the red heart-shaped lights. He had moved his chair across the foot of the bed but it was stuck at this point. I was putting up hearts, a large stuffed fuzzy red rose and rearranging the window. I had bought a soft, heart-shaped red pillow from the grocery store, of all places. I put it in his lap. He did not seem to understand what it was. I hung it on a hook, meant for a wreath, that I had hung over the door. It had held his Christmas wreath. It was a bright red spot in his room. It cheered me and I have been told that it cheered others. It shows that someone cares.

He proceeded to leave the room as I was trying to visit with him and I was perched on his bed. I lowered the bed, since it was raised to get him in and out of the chair lift. I kept asking him where he was going. I wasn’t sure if he thought that he had to go down to dinner, since I was there and I always fed him dinner. He kept going out the door. A respite worker was walking by. He said, “Hi. How are you?” She spoke to him for a few seconds. I laughingly told her I was trying to visit and he had left me alone in the room! I left him there while I finished up his window. When I brought him back in he was becoming more agitated. He seemed sedated, but in pain. I held his hand under the blanket. He kept pushing up with his right arm – as if trying to escape some pain. I asked him many times and many ways if he was in pain.

“Are you in pain.?” Pausing for a response. “Does it hurt?”

I clearly enunciated each consonant and he kept asking me, “Pardon?”, turning his bad ear towards me. I wondered at this!

“Do you want a pill for pain?”

“A pie for pay?”

If I weren’t so upset and worrying what to do it would have been funny. There is no way he can understand. Eventually, however, it became abundantly clear. He kept saying, “Ow! Ow!” paired with a sucking in of breath through clenched teeth. This time I went to find the nurse. There are several levels of nursing care. There are nurse who give out the medications. There is a Charge Nurse who is above her and is “in charge”.

I found the floor nurse and spoke to Heather. She obligingly came down to dad’s room. One of the ones with a wonderful bedside manner, she must have spent fifteen minutes with us. She went through, feeling his abdomen to see if he had any reaction and, therefore, pain in that region. He did not wince at all and so she kept at it. I pointed out the huge concave places in his temple, lovingly smoothing it with the back of my hand and he winced. She kept asking him if he had pain, hurt, an ow but he couldn’t hear the words. We ran out of synonyms. She felt his head: the top, the sides, the back. We thought he might be having headaches since there was no indication of pain elsewhere.

At the very least he needed something. It was an hour before the next meds were to handed out. At this point he was getting clorazepam (Ativan) to reduce the agitation, as well as the pills to prevent seizures (Dilantin). The clorazepan had calmed him down enough, but it wasn’t a pain medication, as I had previously thought. She went down and got his regular meds and crusheddad them and mixed them with applesauce. These days it was hit or miss whether he chose to take them. I was worried. She smiled at him and tried to coerce him into taking them. Eventually, as I stood behind him with baited breath, he took them. I thought that sometimes he refused to take them if he knew I was watching. It was hard to say.

It was time to change his meds. She told me that we would have to get a doctor’s orders to up the medications for pain. She asked if I had talked to him at all. I told her I had seen the doctor doing rounds the previous Friday but we hadn’t really spoken, She asked if we had had dada case conference and I told we had, but the doctor was not there since it was the day of the accreditation meeting. I asked how I would be able to talk to the doctor to ask for a pain prescription. She willingly wrote a letter, to be delivered when the doctor came in again. Although he wasn’t scheduled to do the second floor for a few days, he was coming in to do rounds on another floor.

All the way home, driving through the snow covered forests, I worried about what to do. When I made it home, obviously agitated, I looked up the doctor’s office number and phoned. The office was closed, to reopen later that evening for a walk-in clinic. I knew, from the Family Council meeting, that the charge nurse was the person I could speak to and I phoned the front desk. Jackie said she could put me through and I talked to Barb, the charge nurse. She said there was no problem in phoning the doctor. She would phone me back with a report later. Sure enough, after a few minutes she phoned back. The doctor’s office was closed but she had left a message at his home to call her. Barb said she would let me know what happened later. Eventually she phoned me back again and reported that the doctor had given order for Percoset, which would help dad with pain. Percoset, which I looked up in my pill book, is acetaminophen with codeine – prescribed for mild to moderate pain. I hoped it worked. I decided I would go in early the next day to see if it was working.

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