This week has been a series of medical challenges. The dog pooped blood. That’s never a good sign. Two trips to the veterinarian and an empty check book later, Nickie is on the mend. The very hour the dog’s symptoms improved, Jack began to shout and moan about pain in his left hip. You may remember that a month or so ago he fell and banged his right hip. That injury, coupled with his shoulders, which he damaged in a previous fall, put him in a wheelchair and set in motion a slew of preparations for dealing with his new mode of transportation.
I do not know what is now causing the pain in the opposite hip. Jack has two theories. One – his physical therapist taped his shoulders which helped so much with the pain in his shoulders, that he now is aware of the excruciating pain in his hip. Or, as a backup theory – he has gout. In his hip. The VA primary care doctor thinks it’s probably an arthritis flare-up. However, because I live with the old Marine and do not want to hear his endless griping about the VA doctor’s, I asked for a blood test to check for gout. His doctor gladly complied. We will not, of course, get the results of that test for several days, every hour of which Jack is, evidently, going to ask me if I’ve called yet to find out what the test said. I have a strong and ugly suspicion that this new nightmare may be the result of the PSP itself, his central brain incorrectly processing or over-processing pain signals.
Whatever the cause, for the first time in over fifty years — since he recovered from stepping on the landmine –Jack is taking an opioid. He insists these new pills do not help the pain, yet when he takes them as prescribed his moaning is reduced. Unfortunately, other behavior increases. Jack has never had firm boundaries, never understood the concept of tact, or been big on filtering his speech. Since the onset of PSP, his speech is more blunt, more emotional, more confused. These characteristics are enhanced by the opioid. The drug also increases his confusion and, though this is difficult to believe, his obstinance.
Here’s an example, and I choose this particular example deliberately because many combat veterans harbor a deep and abiding distrust of the VA. I might even call these feelings paranoia. In addition, combat vets tend to go one of two ways with managing their own health. Either you cannot get them to go to a doctor unless they are literally unconscious and therefore unable to resist, or as in Jack’s case, they are hyper alert and obsessed with their many aches and pains.
One of Jack’s persistent gripes is that labels on medication from the VA pharmacy do not list the purpose of the pills. So, standard procedure around here is that Jack has a new symptom of one kind or another. I call the VA. A doctor, usually either his primary care doctor or his neurologist, discusses trying a new medication to see if it helps whatever problem he is having. We wait a week or two for the new medication to arrive. It gets here. Even though he has been told not to check the mail and even though he cannot operate a freaking cell phone without requiring a trip to the service center to repair his phone, he manages to check his medications on-line. When he sees that a prescription is due in our PO Box, he asks his respite worker, or a friend, to take him to the post office where he picks up one of those plastic baggies of pills from the VA.
He opens the bag. If he does not recognize the name of the pills and if the label does not say what the pills are treating, he throws the pills in the back of his cabinet and ‘forgets’ to tell me they have arrived. A day or two later, he asks me where his new pills are to treat whatever medical problem with which he is currently struggling. I call the VA. They tell me the pills have been shipped. I paw through his cabinet and, usually, find the new pills. He doesn’t know how they got there. I put the new pills in his daily pill box, drop the bottle into the ziplock bag which holds his daily meds, and add the new medication to his meds list.
The first day he takes the new pill, he yells for me, “What is this pill?”
I explain it’s the med we’ve been waiting on for a month.
“I want to see the bottle.”
Which, as you have already guessed, does not clearly state what condition the pill has been prescribed to treat.
“I’m not taking this pill.”
We then have a few minutes of cussing the VA. Once he’s quieted, I say, “Take the pill or don’t take it. It’s up to you. The doctor thought it might help with your problem.”
“What are the side effects of this new poison? The Goddamn VA is trying to kill me.”
Every medication has at least one side effect that mimics a symptom he is already dealing with on a daily basis. This knowledge calls up another few minutes of VA bashing, followed by his go-to statement.
“Until I met you I drank a fifth of tequila a day, felt great, and never took one damn pill. You won’t let me drink and now I’m on a dozen pills day. You and the VA are in cahoots. All of you, doing your best to kill me.”
Knowing he’s venting, I usually let this last little protest slide. But not always. Sometimes I cannot keep quiet. I really cannot.
“It’s up to you whether you take the pill. But, just so you know, if I wanted to kill you, you’d have been dead a long time ago.”
Whether I keep quiet or not, the next step in this dance is that, low and behold, he develops one of the side effects or one of his existing symptoms intensifies. He wants me to call the prescribing doctor and report this phenomenon. I do not want to make this call. I put him off, distract and redirect. But the man is as stubborn as a mule. He may not remember if he ate lunch an hour ago, but he’ll not turn loose of a suspicion that the VA and I are involved in a plot to kill his ornery ass.
Eventually, I make the call, and report what he’s experiencing. The doctor, whichever doc it is, says the same thing every time, “I’d like him to keep taking the medication for a while. If the side effects get worse, give me a call back.”
By then he has a new medical problem and we begin this whole process again.
Jack’s new pain medication, the opioid, has intensified his anger, his confusion, and his paranoia. I am hopeful that, like so much else in life, this pain too shall pass, and he will not have to take the pill for very long. I’m pretty sure that when the AMA says narcotics can kill, they’re talking about the patient. Maybe, when I have a spare minute, I’ll write and recommend they expand that killing zone to include the caregiver.