Saturday, September 29, 2012

Searching For Tramadol To Supplement Morphine

Mama went home Tuesday, September 4th
(*** This is a long post so please bear with me)
After consulting with Mama’s primary care physician and infection control specialist on Sunday and Monday, Larry and I decided to ask them to discharge Mama on Tuesday. For some reason, she was quite cranky on Sunday (Sept. 2) and even told some visitors to please be quiet or leave so she can rest. She said “Puwede ba umalis na kayo para makatulog ako?” Maybe because she was in pain earlier in the day and was finally started on Morphine tablets. Previously, she was only taking Tramadol (Ultram). When Larry arrived on Saturday night, she was still able to sit up on the chair and use the bedside commode. However by Sunday, she stopped doing so. I don’t know that was her way to finally giving in because we fulfilled her wish for us to be together, or not. When the Morphine finally caught up with her on Monday, she slept most of the day and said no to every treatment and food offered. Her doctor ordered a nasogastric tube for feeding but she refused, even after Larry had already bought the equipment.
Monday was a very busy day for Larry as he had to check on Mama’s burial plot, memorial plan, and mass services, among other things. I was so relieved that Larry was around because he knew his way around Zamboanga. I was pretty much useless and helpless in that regard so I just stayed in the hospital and let him do his thing unencumbered.
 By Monday night, upon learning of her possible discharge the next day, Mama started taking fluids orally again, and by Tuesday morning she bounced back, was in positive spirits, and started eating again. She actually asked for arroz caldo (a rice soup with chicken and ginger) for lunch and told me to get it from a restaurant across the street called A Taste of Asia (ATOA). Well, I’ll be darned. I was looking for the same thing a couple of days back because I felt I needed more fluids. We didn’t know where to find it and opted for a different kind of soup instead. Larry and I should have asked Mama first.
Tuesday was discharge day. Larry took care of the hospital bill and gave me an exit pass to show to the security guard on our way out. He then went back home to borrow the Tupaz’s car to transport Mama back home. With all the personal belongings that had accumulated in the hospital room, we were thankful for the presence of a few Mother Butler friends of Mama who helped us carry them to the car. An orderly came by the room with a wheelchair to move Mama to the parking lot. When we got to the elevator, a potential disaster came up. I had lost the exit pass! Thankfully, the orderly saw it on the elevator floor. I must have dropped it in the frenzy. We then headed to the rear parking lot of the hospital where Larry was waiting with the car. With remarkable strength and despite turning his ankle earlier that day, Larry transferred Mama from the wheelchair to the front passenger seat. We were on our way home and fulfilled another of Mama’s wishes. When we got home, Caloy got a wheelchair and Mama was wheeled into her apartment with Larry and I lifting the wheelchair from the front and behind, the two steps up and into the door. Earlier in the day, Larry and Madie had rearranged Mama’s room and moved the bed to the middle to accommodate an oxygen tank and so that the caregiver and helper could more easily assist her. Not too long after Mama had settled in bed, Larry had the unenviable task of telling her that he had to leave that evening for Manila, but reassured her that he would be back the following week. I was saddened to see him go later but I had to be resolute for Mama’s sake. After all, Larry was just a phone call or text message away if I needed his advice.
Early Tuesday evening, Mama’s appetite continued and asked for Chow King noodle soup. Well, the helper was new to the area and I didn’t know any better where to find the nearest Chow King. Thankfully, Neneng, the caregiver came to the rescue. She arrived for her shift and found a Chow King nearby. She fed Mama the noodles that evening. That may have been the last time that Mama ate a solid meal fairly well because on the days that followed she no longer had any cravings. She subsisted mainly on small portions of Prosure which Larry brought from Manila.
I don’t know if Mama ate too much solid food that day more than she can tolerate, because by mid-evening she was complaining of severe abdominal pain. The doctor hadn’t reordered the Tramadol and the Morphine wasn’t tamping down the pain. It was difficult to see her suffering and probably due to the extreme pain, even accused us of making fun of her.  We had to do something to help her. I asked Neneng what medications Mama had available and we found Rivotril (Clonazepam or Klonopin in the U.S.) which is an anti anxiety medication, but ordered by the doctor to help Mama sleep before her hospitalization. I asked the caregiver to give it to Mama in addition to her night dose of Morphine and we were relieved that it worked in taking the pain away for the rest of the night.

 I planned on seeing her doctor at the clinic the next day to reorder the Tramadol so Mama could have round the clock coverage for her pain medications. That was the least we could do for her. The doctor did reorder the Tramadol but I had a difficult time finding it in a couple of drugstores. The third one I went to only had a limited supply and it was days later when I found more at another drugstore.

 The doctor also said that if the Morphine doesn’t work initially and Mama was still in pain before the next dose of any pain medication, we could split a Morphine pill and give it to her as a rescue or emergency dose. Oh boy did we need that rescue dose later that day because Mama complained of extreme pain again mid-afternoon Wednesday. We were about to give her the half pill rescue dose but couldn’t find a pill splitter. The Morphine wasn’t even scored in the middle. Madie resorted to using a regular kitchen knife to cut the pill in two and Mama promptly received the half dose. We were hoping that the pain would finally go away but it didn’t. Mama was still in agony. So much so that she asked for more painkillers and said she would take responsibility for the consequences because she didn’t want to die in pain. According to her “ako na ang bahala”. None of us present at the time should be making decisions normally made by a physician or give a medication other than how the doctor prescribed it. But Mama was suffering too much, so with much reservation I asked the caregiver to give her the other half of the pill, hoping it would not O’D her. That was a very tough decision to make. I planned on seeing the doctor the next day again to ask for a faster acting Morphine, perhaps in liquid form which would also help because Mama was also starting to have difficulty swallowing. Thankfully the second half pill worked and Mama’s pain was relieved for the rest of the day.
A short anecdote before I continue. When I returned to Mama’s apartment after seeing the doctor, she told me her PLDT (telephone) bill arrived and I should pay it at Union Bank across the street. I saw the bill and noticed that there were several places that you can submit payment. Mama insisted that I just cross the street to pay the bill and even told me exactly how much it was. She was right, of course. She may have been under the influence of painkillers but her memory was still stunningly intact.
Still other things happened that Wednesday but this post is too long already so I shall continue some other time.
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larrydlp said...

These were the days when I held her hand by the bedside. Finally able to do so after weeks of longing for it.
I spoke with her that Monday, whispering to her ear. I told her, "Kuya Noel and I are here. We love you." And her reply, that still clearly resounds to my mind up to now, calmly, reassuringly, she said, "I know".
I asked her if she wanted already to rest. She said yes. I told her not to be scared, that Kuya and I will take care of her. " I'm not scared.", she said.
The afternoon when I told her I needed to be back in Manila, was a very difficult time for me. She sort of started to protest. But upon telling her that I had to get back to work and meet my classes, she understood. Even at that point, she was still very much concerned about the professional character of her sons.
I left with a heavy heart. And the next few days were unbearable for me. Kuya Noel was in control. That reassured me.

Noel DLP said...

Thanks for your confidence in me Larry, even though I wasn't feeling the same at the time. Recalling the events of those two days was very emotional and after I posted this entry, I got a headache. I don't normally get those. But, I feel better knowing that we were able to deal with those two crises and that Mama knew she was loved to the end.