I wonder about nightmares. And drugs.
But I’m not referring to the metaphorical nightmare of drug addiction or delusions created by the wrong combination of medications. Those “nightmares” can be awful.
Don’t get me wrong, though.
I like drugs. I’m a happier guy because I’ve taken anti-inflammatory medication to reduce the pain of my arthritic knees. And right now, as I write these sentences, my doctor shifted me to another high-dosage Ibuprofen for a mild (but irksome) back injury. Rest and drugs have made a difference.
Every hospice patient will likely be taking drugs. Some are necessary and will be continued. Some no longer have much value for the patient’s situation and may be discontinued. Dosages will be increased or reduced. New drugs may be introduced, especially as the medical staff helps the patient be as pain-free as possible. Many drugs have side effects (for example, constipation is one of the predictable culprits with many pain meds) and so one “good” drug is accompanied by another “good” drug to address the consequences.
It’s normal not to like drugs. You don’t really want to take any! Or . . . you’d prefer to take more! A family member may have had a negative experience with a particular drug and assumes that same issue will happen to their spouse or parent in hospice. If it didn’t work for you . . . how could it work for anyone? Worries over what drugs to take and when to take them and why to take them take a lot of time with many hospice nurses as they care for patients and support the families.
In a recent meeting, we discussed a new concern about one of our patients.
Her (or his) nightmares.
The patient has had a series of unsettling dreams that disturbed her/his sleep. I don’t know the details about this patient. (Even if I did, I wouldn’t describe them because of confidentiality.) Nonetheless, I was bothered when our first reaction to the patient’s troubling nightmares involved with what drug might help her/his sleep better—in a sense to eliminate dreaming.
I raised a slight, mostly ignored “protest” when medication was suggested. Let me emphasize: it was a slight, barely heard protest. (And my non-medical, non-expert voice in a meeting about patient care should rightly be barely heard and mostly ignored!) But still . . .
Sometimes drugs cause nightmares. Sometimes adjusting or changing or adding a prescription can help a patient’s nightmares (along with delusional episodes and hallucinations).
My father, as his dementia advanced, had delusions. His long, dark nights (and often enough, during the days) included hallucinations. I was glad for drugs that momentarily settled him down, and frustrated when nothing seemed to work. Every patient, every illness, will be different.
But still . . . with some patients, nightmares may be just and only that: bad dreams. Bad dreams that are not caused by illness or medication, but by the ancient and mysterious ways humans wrestle with the roiling mix of emotions and memories and failures and hopes and disappointments that we accumulate in our lives. Writer and Presbyterian minister Frederick Buechner wrote of dreams,
The tears of dreams can be real enough to wet the pillow and the passions of them fierce enough to make the flesh burn. There are times we dream our way to a truth or an insight so overwhelming that it startles us awake and haunts us for years to come. As easily as from room to room, we move from things that happened so long ago we had forgotten them to things lying ahead that may be waiting to happen or trying to happen still. On our way we are as likely to meet old friends as perfect strangers. Sometimes, inexplicably, we meet casual acquaintances who for decades haven’t so much as once crossed our minds.
Dreams. Nightmares. I don’t doubt for one rational second that medication is essential for a hospice patient’s care. But when a patient has nightmares, it can also be an invitation to ask them questions. What are they worried about that they may not yet be admitting to themselves? What are they afraid of? Do they have regrets? What has startled them “awake and haunts us for years to come?”
After my father’s death in 2012, I dreamed about him. Dad and I, along with others, stumbled across a shattered freeway system. We climbed over broken concrete and crumpled asphalt, becoming weary, confused. Dad couldn’t keep up. I kept promising there would be a safe exit soon. The dream ended before “soon” came. I’m no dream expert, but there was a truth in that near nightmare for me: how long my family struggled to find a “safe place” for Dad as he slowly died. My father loved—loved, loved, loved—owning, showing off, and driving cars. I wasn’t surprised I dreamed about something he enjoyed—the open road and freedom—that had become an exhausting obstacle course.
Please, if you are a hospice patient or caring for a loved one who is a hospice patient, trust that the medical staff prescribes drugs because they truly want to help ease the pain and suffering. Please, if you are part of the medical staff treating a patient, remember that both patient and family are often unsettled and frightened by the harrowing changes. Please, whether patient or family or hospice staff, remember that the dreams and nightmares may reveal deeper concerns. At times, the best “prescription” is taking time to ask the patient about their dreams, about their fears and hopes.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)by