I always forget, when Mom's not feeling good...
...that recuperating, for her, now, involves minor relapses. It always surprises me, as it did tonight when she awoke from her nap. Her feet were swelling, again. Her blood glucose was back up to 189, for no dietary or medication reason. She was tired, lethargic, preferring the chair to walking. In addition, it was hard to ease her breathlessness, even at 6/lpm O₂, so, finally, tonight, I decided to marshal Morpheus in a Bottle...hmmm...I wonder if stories about genies in bottles are metaphors for morphine or other narcotic substances and their related experiences.
    I shot the lowest dose quoted to me under her tongue: .125 mg. I also combined the dose with a leisurely shoulder and arm massage, enticing her to relax her arms and upper body. She'd been so tense in her effort to breathe that she'd been propping herself up with her right arm against one rocker arm and keeping herself from falling over the left rocker arm by bracing herself against it with her left arm. She looked terribly uncomfortable and her back and arms were as tight as a guitar string wound an octave too high.
    Did the morphine work? It's hard to say. I can report that it did not affect her ability to stand or talk or conduct herself as she usually does. It didn't nauseate her. She didn't become loopy. She was already tired when I gave it to her. I don't think it increased her tiredness. When we headed into the bathroom for night prep she was no more tired than she's been many a night.
    I didn't think to count her breaths per minute before giving her the morphine. About thirty minutes after the first dose (I gave her another an hour and five minutes later for maintenance purposes, using the "for pain" instructions) I engaged her in conversation to make determine whether she was as lucid as usual. She was lucid enough to be irritated with me for stopping the progress of a new movie she was watching, a "Jesus" movie, one of her favorite types. At that time I also counted her breaths per minute: 32. Higher than the Hospice RN count, at 28, on Thursday afternoon. About every 15 minutes I'd count again and continued getting 32. A couple of minutes ago, though, at 0147, I counted them over the monitor and got 28. At the very least, about 20 minutes into the first dose she reported that she no longer felt breathless. Every time I'd asked her previous to dosing her with morphine (and, it was hard not to ask her, her labor to breathe was very obvious tonight) she'd answer that she was "a little" breathless. We'd adjust her position or I'd prompt her to blow her nose, but nothing seemed to relieve her effort.
    I'm not sure if morphine is expected to lower breaths per minute or if it's just supposed allow the recipient to feel comfortable breathing, regardless of one's blood oxygen level.
    Twice in the hour and a half she was on morphine before she set her head on her pillow, she mentioned, suddenly and spontaneously, that she didn't feel good. Both times I asked her if she felt nauseated (one of the possible side effects) or dizzy or heavy limbed or nervous about how she was feeling (my way of asking her if she's feeling agitated, which she doesn't interpret very well and to which she always says "no", I think because she connects the word "agitated" with someone who's twitching or displaying excessive jerky motions. I also asked her if her skin "feels weird", an attempt to elaborate on the "agitated" question. She responded in the negative to all my questions. Both times, as well, within less than two minutes when I asked her, in follow up, if she still felt "bad", she looked at me as though I no reason to ask her this and declared, "I feel fine!"
    So, I guess the morphine worked. I'm wondering if she needed it because she was relapsing in her battle with her infection. I'm hoping I'll be able to tell when she awakens for the first part of her day tomorrow.
    Right after I gave her the first dose of morphine I felt a wave of relief and let down with a few tears. It was rather like having gone through an initiation. As each five minute increment passed beyond the dose I further relaxed and felt more comfortable with and in control of what I was doing, even though I'm not sure it actually accomplished much of anything. At the very least, my mother did not turn into a Morphine Beast, which I was, apparently, expecting. Don't ask me what nature I was expecting this Morphine Beast to display...I have no idea, which, I guess, is often the nature of fear, isn't it? It's not about what you're imagining, it's about what you can't imagine; it's what fills in the gaps when you are missing information. Nothing happened to her at all except that began reporting that she was no longer breathless. After about 45 minutes I noticed I still had her on 6/lpm O₂. I dialed her back to 5/lpm and waited. No change. She did fine. She didn't breathe any slower, but she didn't breathe any faster. Because she is still obviously fighting the good infection fight, I didn't dial her back to 4/lpm.
    I'm going to call Hospice tomorrow and review instructions for its use for air hunger. All my instructions applied to using it for pain relief. It seems to me the Hospice RN may have included informal instructions when we talked about morphine use for air hunger on Tuesday but, if she did, I didn't write them down and I don't remember them. I do remember her telling me if I had any questions or difficulty to "call Hospice". So, I will. I just want to make sure all our possible options for use and dosage are displayed within easy reach for us.
    I'm continuing to listen to her on the monitor. It doesn't sound like she's resting particularly easy, but, then, throughout the last week or so this hasn't been unusual. I think I'll shut down the house and peak in her room on my way to bed. Her eyes were still open when I looked in on her about 45 minutes ago. I hope they're closed, now, even if she's a little restless.
    Later.
- posted by Gail Rae @ 02:23   email  this post