Sunday is always quiet at the clinic as those patients who can get out and about, try to do so as there are no treatments during the day. Saturday was the worst night Jenny had experienced for some time due to pain control and general “uncomfortableness”. It seems we are reaching a familiar crossroads as the level of morphine Jenny “thinks” she requires is leading to a psychological dependency, as much as a physical one. Unlike a lot of painkillers, morphine doesn’t have a maximum limit and in theory the dose can continue to be raised depending on the patients requirements. However, like most drugs, as the dose is raised then other effects become a factor and in Jenny’s case the major side effects are confusion, fatigue and disorientation. We are close to the point where I think the level of morphine she is having on a 24 hour period is a bit high and causing some of the above side effects. She is waking up during the night and immediately requesting a morphine infusion before even thinking about it (as if it’s the first things she should do when she wakes up). During last night if Jenny thought a morphine infusion was being prepared then her pain levels would reside, with the same thing happening if she was given a relaxant. I’m not suggesting she is making up the pain but is simply “expecting” pain when she wakes and is therefore associating this with needing instant relief – it seems like a replacement psychological issue for the earlier panic attacks.
What happens now? Well, we have a few options. The first is to ride it out and see whether the issues are part of the switch from IV to oral meds last week and based on the length of time and high dose Jenny has been getting it make take a little time for the body to re-adjust. We could ask for the IV meds to be re-instated which would probably sort the problem in the short-term, but gets us nowhere in the long-term as we would need to re-address this again at some point if Jenny is to return home without needing full-time nursing care which is what would probably be required with a syringe driver. The third option (and my preferred one for the next 24-48 hours) would be to try to work on her “desire” for morphine and replace it with a tablet drug which she has prescribed, but isn’t convinced that it works as well. We’ll discuss this with the doctor at some point but it is difficult for Jenny to fully comprehend all of these issues at the moment as she is a bit off her box on the morphine.
On a positive note her vital signs are stable, her oxygen requirements are lower than before and when comfortable she is coherent and can hold decent conversations etc. She has tended to yo-yo a little bit over the last 4-6 weeks with some days being not too bad and others being difficult for her and at the moment she seems to be in a “difficult” stage. She does have small amounts of food during the day and receives IV glucose and energy drinks as well.
Today also finally saw the departure of John & Mary. Regular readers will know their story and understand how difficult a time they have had over the last 5 weeks with various attempts of returning home to Sydney, Australia being thrown up in the air at the last minute due to Mary’s health. They finally managed to “escape”, but not without quite an emotional farewell with several of us who have grown close over the last 2 months. It is unclear if they will return to the clinic as Mary is able to receive various treatments in Australia which may be more suited in the future. I got quite close to both Mary & John (John in particular) and we have certainly helped each other over the last few weeks. They are going to be greatly missed here at the clinic.
Over the last day or two I’ve got to know Lisa who is here supporting her father Mike. They are from Queensland, Australia and Lisa is a junior doctor. She is great fun and has a bubbly personality which makes her instantly likeable and she fits in well with everyone. I found out yesterday that she is a pretty good skipper (rope not boat) and she has agreed to teach me to skip like Muhammad Ali (or maybe like this). Now that may take some time but one of the first things I bought when I got here was a skipping rope so you never know.
I made it back into the gym today with my new gym buddy Alex, who doesn’t hold back. This is great for me as when I getting to the gym is usually the motivational barrier I need to break – once I’m there I enjoy it. I’m not sure how long Alex will be here for but our plan is for regular sessions now. I’ll be a bit sore tomorrow but no pain no gain and as an added bonus I have a massage with Rochelle.
John & Mary made their escape at just the right time as on the menu for dinner last night was herring – erm no thanks! A few of us decided that we would eat out and the venue was set as the Kurhaus hotel. Hilary & Arthur, Cathy & Dick, Sylvia, Lisa and I had a lovely time and even managed a collective table dessert (pud!). The scene that unfolded in the restaurant once the dessert fridge had been pointed out was a sight to be seen. Discussions flowed as usual with people around the table coming from the UK, USA and Australia. By the end of the meal everyone fully understood correct napkin etiquette, what a pud (dessert), the value of a vegetable patch and the concept of dogging! A few other patients must have felt the same way about the clinic’s evening offerings and also made it to the Kurhaus for their dinner (including Tony, Sonia & Ali and Jackie).
We’ve had some cold weather here over the last week or two and now and again we wake up to a blanket of snow in the village which makes the whole place very pretty. Dick has very kindly emailed me a couple of photos around the village after a recent snow fall.