Medications Near Midnight

different meds

The nurse arrived in my mother’s dimly lit hospital room.

Near midnight, even his soft voice seemed loud. One of the first things he said was, “This won’t hurt.”

He lied. This was in 2013. Seven years after her death, I still remember his false assurances.

The nurse was there to place a peripherally inserted central catheter (PICC, or “pick”) into Mom’s upper right arm. My mother been offered Dilaudid—a brand name for hydromorphone, a narcotic comparable to morphine—for pain management. The medication would be housed in a CADD pump (Computerized Ambulatory Drug Delivery) connected to her PICC line. The linked pump and the catheter would give a predetermined, regular amount of medication to ease her physical agony. A “button” could be pressed on the CADD pump for additional dosages.

Are your eyes glazing over with all the medicalese?

Mom’s body was riddled with cancer and the two surgeries undertaken for “comfort” had added complications. As I calmly write this years after her death, I understand why she said “Yes” to that PICC line: she wanted the wrenching pain to end and she was ready to die.

But the nurse, who seemed rightly weary in the near midnight hour when he entered Mom’s room, first caused more pain.

He swabbed her arm with disinfectant and inserted a needle.

She grimaced.

I held her left hand. Watching her tore my heart apart.

She gave a slight gasp.

Soon—but never soon enough—the line was in and functional.

For the final days of her beautiful, simple, graceful life, Mom was mostly free of physical pain.

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A PICC line is one of many ways for medication to be administered.

Around breakfast time, I usually shake out several pills into the palm of my hand. They are “supplements,” including vitamin C and a stone white capsule with a lengthy name that supposedly helps osteoarthritis. I pop ‘em into my mouth, swig juice, and swallow. Down the hatch! While few enjoy any medication, most are good to go with taking a pill or two.

Nearly everyone has had a sharp object—yikes, a hypodermic needle—for delivering medication or donating blood. How will the vaccine for Covid-19 be undertaken? More sharp objects? (In a few days, I’m having a blood test my doctor ordered. Nothing like an appointment with a grinning phlebotomist that wants to legally stab you!)

Hospice patients—along with non-hospice patients—often can’t swallow pills. Some medications can be taken sublingually in a liquid form. Sublingual literally means “under the tongue.” Similar to sublingual is a buccal dose . . . liquid medication placed between the gums and cheek. Exciting, eh? Even when patients can swallow pills, the apparently quicker-into-the-body benefit of a sublingual or buccal dose may be the better choice.

There are embarrassing and squeamish ways to deliver pills. Dare I whisper . . . a rectum suppository? (Sorry, I’m not going to italicize that one.) Enough said, though it can be one of the few good options for a patient.

How about wearing a patch?

Some pills are crushed and added to liquids or soft foods like applesauce or pudding. (Please note, certain pills should never be crushed . . . talk to your hospice nurse about this.)

Though rarely used in hospice care, an IV line is a frequent choice for medications or nutrients in hospital settings.

There are a host of methods for giving drugs, from the ease of tossing an aspirin into the mouth to the careful positioning of a slender PICC tube linking to a vein. There are some options I likely haven’t mentioned. I am, after all, no medical expert. Yes, I easily understand that “sublingual” comes from the ancient Latin and means “under the tongue.” But for all of my chats with medical staff and searching the web, I really don’t understand why “under the tongue” can be the best spot on your body’s real estate for morphine.

However, I understand why people don’t want to stop some medications.

In hospice, when facing a life-limiting illness, there may no longer be a need to take prescriptions for high cholesterol or low blood pressure. But even if a doctor or nurse says they don’t matter anymore, you resist. After all, these drugs helped you live this long! After all, they are a daily habit. After all, though the doctors all explained you have six month or less to live, what if you keep living!? Unless “old” drugs create problems with “new” drugs, the hospice nurse probably won’t argue with you. Nonetheless, I encourage everyone—patient and caregivers—to listen when the hospice medical staff reviews the medication you need. Or don’t need.

And I understand why certain medications are refused.

My mother nixed morphine. She recalled a bad reaction, including odd hallucinations. Dilaudid—also an opiate—better suited her body and her real or imagined concerns about morphine’s side effects. After a severely broken leg years ago, I took morphine without negative reactions. Everyone’s reaction will be different.

Morphine, properly given, improves breathing in some patients. But it’s still morphine, a drug many question regardless of the benefits.

Some patients and families don’t want powerful opiates because they fear becoming dependent on the medication. They value being alert over being drowsy. It doesn’t matter how a drug is delivered or what other positive results it may bring, they just say: No!

Are medications like morphine, methadone, or Dilaudid addictive? Yes, if abused, they can be. But when in hospice care with a painful life-limiting illness, don’t you want the best medical options for you or your loved one?

I hated that a nurse hurt Mom again when setting the PICC line into her arm. But she needed relief from her overwhelming, relentless pain.

Even the good choices during “end of life” care can be troubling. Though medications can be delivered in a variety of ways, it’s nearly impossible for us to be delivered from anguished emotions as family and friends seek what is best for their loved ones.

(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.)

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