My dad had back surgery when I was very young. The scars and his story about the surgeons removing pieces of his hip to strengthen his spine were part of who he was when I was growing up. I always thought of him as a man in pain because he complained about his back. A lot.
So when he moved into an apartment on my property after my stepmother died, I didn't worry about the fact that he immediately sought out a pain management doctor.
Pain clinic or pill mill?
He still drove at the time, and it never occurred to me to ask if I could go to one of his appointments with him. His pain was his business. And besides, we worked pretty hard at keeping him busy. He enjoyed woodworking, so we gave him projects that I reasoned could be contributing to his back pain.
Who was I to question how many hydrocodone tablets he was taking? When he said the pain doctor offered him spinal injections I dutifully drove him to the day surgery facility to have them done. I did question the fact that he always said they didn't do him any good. And I did offer to make an appointment with my chiropractor.
He rejected the chiropractor outright. "That's quackery," he'd say. Then he'd say he was never having one of those shots again either.
I know enough about chronic back pain to know that everyone's experience is different. And everyone's pain tolerance is different. Those two things combined kept me from speaking up, even when the pain clinic added fentanyl patches to the pills. They should know what they're doing, right?
He wrecked his truck and I still ignored the problem
A good daughter would have questioned his sobriety when he told me about running his truck off the highway in the middle of the night. I laughed with him about how he should stop sleepwalking-- and driving.
I continued to ignore the problem even when he started complaining about how hard it was for him to drive thirty miles to the clinic every month for the paper script required by law. I commiserated with him about how senior citizens should be exempt from such red tape.
And even when he complained about the pain meds no longer giving him relief I never gave his addiction any real thought. Like I said before, he had complained about his back my entire life. Why should I worry about it now?
And then he broke his back
I have never seen anyone in so much pain in my life. He writhed. He couldn't keep his feet still. He made noises I'd never heard before. The ER nurses kept injecting him with morphine but nothing changed.
I was astonished when the ER doctor said he had broken two vertebrae and that they would get him up on his feet shortly and then discharge him.
"Discharge him to where?" I asked.
"Can't you see how much pain he's in? He can't even lay still? How would he go home?"
What the doctor knew and I did not at the time was that with the high doses of pain killers my dad used, they would never be able to get him out of pain. He would die of an overdose before that happened.
When my dad could not stand on his own, the doctor had no choice but to admit him, but I could tell it went against the grain. At the time, I felt he was a cold, heartless doctor and that the ER was profiling my dad as an elderly man best left to die.
It's easy to look back now and see that what he saw were an old addict and his enabler daughter. He may even have thought I was an addict as well.
The floor nurses would have let him die
It took half the night to get him a room, but I didn’t stay for that. I went home to sleep. (There's that bad daughter thing again.) He called me early the next morning and sounded coherent for the first time since the fall.
He asked for breakfast from McDonald's. By the time I drove to the city, picked up his food, and arrived at the hospital, everything had changed.
He was too weak to speak. His bed was soaked in bloody diarrhea and the nurses were nowhere to be found. I found an aid to clean him up. That lasted all of ten minutes before the mess was repeated.
Half an hour later another aid arrived to check his vitals. When she couldn't get a blood pressure reading, she blamed the electronic cuff. When she finally got a manual reading of 65 over 40, she was puzzled.
"That's too low," I said, wondering why she wasn't alarmed. It took her a good five minutes to get a nurse's attention in the hall. When the nurse arrived, she immediately called a code.
The code team revived him
I stood back in shock as the team worked on him. How did this happen? He just fell and fractured a couple of vertebrae. What the heck would he be dying from?
The answer finally came from my angel of a gastroenterologist, who at first refused to treat him in the ICU because he was so unstable. Once they got his BP leveled off and controlled his irregular heartbeat, my doc scoped him and cauterized a massive bleeding ulcer. What he said was that my dad must have been eating aspirin or NSAIDS or both like candy. The fact that he was addicted to opioids kept him from feeling any pain in his stomach. He simply began to bleed out.
What stood out to me in that conversation in a darkened hospital hallway at midnight was the word addict. This was a doctor I knew and trusted telling me that none of this situation was shocking to him. He'd seen it all before. When the massive doses of opioids are no longer enough for an addict, they start on anything they can get over the counter. His theory was that the blood loss was probably what caused him to fall in the first place.
The addiction raged on
And yet the hospital that saved him, enabled him on his way out the door. They brought in their own pain doctor, who softly cooed that she would help him find relief from the pain. My dad loved her. She was blonde.
It took another five years and a diagnosis of dementia before his primary care doctor and I finally weaned him off the pain killers. I now have to watch everything he puts in his mouth. Given free choice, he'd take a couple of dozen Tylenol for a simple headache.