Painfully aware

She didn’t look well.  No one “looks well” sitting in an crowded ER, but she really didn’t look good.  At first glance from across the room I assumed her to be fairly old, how old I wasn’t sure.  Scrawled atop her clipboard in red Sharpie was ADMIT TO MEDICINE. I pulled the board and walked over to her.  She was sitting up on the gurney, rocking and moaning.  Many others were doing the same, a keening ritual in a bloody church.   But she was my only parishioner for the moment.

The clipboard reported her vitals, an age of eighty, a few scrawls from various medical professionals and her previously stated disposition.  The rest was mine to learn.

“I got cancer,” she said between moans.

“Do you know what kind?”

“In my pancreas they said.”

As I observed her, I saw the truth of it.  Her skin was a papery grey-yellow, her belly looked absurdly pregnant given her age, and her eyes gave off an unhealthy fluorescent glow.  And she didn’t smell right.

“When did they tell you about this,” I asked. “Do you have a doctor who’s taking care of you?”

“Well, musta been about a year ago.  I never been much for doctors, but the pain is so bad,” a sudden sob accentuating the obvious.

“Where is the pain?  What does it feel like?”

“Doctor, it’s in my belly, and it feels like someone is pushing in with their fist and never stopping. Like I just want to die to stop it.  I can’t eat, I can’t drink, I can’t sleep cuz of the pain.”

Following the usual line of questioning I asked, “Have you tried anything to help with the pain?”

“Heroin.”

She said it the same way I might say “Motrin.”

“Uh, OK, uh, how did that happen?”

“Well, I tried it once back in the day and I never took to it, but I figured maybe it would  help.  One of my nephews got me some.”

“OK, well, did it help?”

She looked at me for a second, stopped her rocking, and using the voice I’d imagine she would use on a simple grandchild, said, “Doctor, if it’d worked, I wouldn’t have come here. I told you I don’t care much for doctors and such.”

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4 Comments

  1. Lynda M O

     /  September 19, 2011

    Wow, I have NO idea what others go thru in their lives. I am humbled by her ability to cut thru any type of BS and just tell the reality as it is. “I don’t care much for doctors…”

  2. I have become astonished by the age of the pts that use heroin. Addiction to heroin is a new reality to me; how someone would continue to “skin pop” after having their leg/arm/belly opened because of an abscess, with all the pain, only to come back later with the same issue? Wow. That’s a powerful drug. If only there was some other substitute…. Alas, no. No such thing.

  3. Oh my. In the UK, diamorphine is used in palliative care (it’s also used post-operatively, which is how I have had it). I cannot imagine the level of pain she must have been in, assuming she managed to get heroin that hadn’t been cut to hell.

  4. Barbara

     /  September 21, 2011

    back in the 70’s I provided hospice care to my mother who suffered from intractable pain from bone cancer….mixing methadone and Valium(as close as one could get to a legal form of heroin) wouldn’t even touch the pain….
    …I appreciate the patient’s comment….after spending the last 35+ years in the field, I respect the heck out of docs and all HCPs…but don’t care much for them when I am the one in need.

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