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How The Hell?

by on January 17, 2011

It’s Monday night and I actually believed that things were settling down.  I had been keenly warned by all the Hospice staff to be wary and do not take things for granted.  They were right.  Satomi had another terrible night.

Earlier that day I had met with our RN and spoke of my weekend experiences with Satomi’s bedtime meds.  This lady is all business and it is reassuring.  We talked of Satomi’s restlessness after receiving her meds and the long time it took for her to actually sleep.  I thought it unusual that it took two subsequent doses of the Oxycodone and Ativan for Satomi to sleep.  She immediately looked at the medicine bottles.  They were mislabeled.  Instead of “o.25ml to 1.oml every two hours”, the Oxycodone bottle read “0.25ml every two hours”.  I checked the meds order and confirmed that this was true.  So I could actually give Satomi a 0.5ml dose at once and likely calm her quickly.  A similar error occurred on the Ativan bottle.  With that, I was confident that the bedtime meds would be smoother.

At 10:00pm I gave her all normal meds at the new elevated dosages.  I watched her for 60-minutes.  No change from normal.  Crap.  After 60-minutes she began her restless but painless sleep.  I’d call the RN in the morning.

At 1:00am I was startled to hear Satomi’s voice through the baby monitor.  She was grasping her head and moaning “…my head hurts…Sean…”  I ran in the room.  She was awoken out of a drug-induced sleep.  This must be bad.

The RN had also advised me a few basic rules.  She said not to play around with pain.  If it’s bad, hit it with your strongest med in a big dose to kill the pain fast.  Several partial doses can be less effective than a single big dose and the extra time means that the patient will agonize needlessly.

With that in mind, I gave Satomi a full syringe of 1.0ml of Oxycodone.  That’s a lot for such a small person.  I’m also told that Oxy is two to three times the potency of morphine.  Maybe that comparing apples to pineapples but it’s a good enough for us non-medical types.  I also gave Satomi a full syringe of 1.0ml of Ativan, an anti-anxiety medication.  Based on everything I’ve learned so far, she should be knocked on her ass.

Satomi:  “My head….Can I go potty?”

Me:  “Nope.  You have a Catheter.  Just relax.”

Satomi:  “Ok.”

15 seconds pass.

Satomi:  “My head…Can I go potty?”

Me:  “What?  No.  Just Relax”

Satomi:  “Ok.”

Repeat two more times.

She finally lies down and I leave the room but I watch her for the next hour tossing and turning.  Her Mom is standing over her bed with moist towels on her head and temple massages.  Her Mom looks tired.

It’s now 4:00am.  I was started awake again by Satomi’s moans  “…headache…Sean…headache…”  I get back into the room and calm her down.  She’s squirming around in pain.  I prep another 1.0ml dose of Oxy and Ativan.  Crap.  I give it to her and there’s another debate with her about the potty, a catheter, and her pee.  She settles down and I return to bed.  I keep watching her for what seems to be another hour.  Tossing, turning, moist towels, massages, and tired Moms.  Somehow I fall asleep.

My alarm goes off at 7:15am.  I drag my chubby ass into Satomi’s room and watch her.  She’s sleeping like a rock without any pain.  A few minutes later I am told she finally settled down between 6:30am and 7:00am.  

I contemplate the night’s battle and get ready for work.

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