In Cheryl Strayed’s “Heroin/e,” she writes about her mother’s death from cancer and how Strayed found her own escape from the pain by using heroin. Managing her mother’s pain at the end of her life was a difficult balance. Strayed writes, “The nurses came one by one and gave her morphine with a needle. Within a couple of weeks my mother was dead. In those weeks she couldn’t get enough of the drug. She wanted more morphine, more often. The nurses liked to give her as little as they could” (4).
What is your philosophy when it comes to pain management? In a comment below, share your thoughts about pain management at the end of life and how it compares to your thoughts about pain management in other (non-end of life) situations.
Works Cited
Strayed, Cheryl. “Heroin/e.” Junk: A Literary Fix, 16 Sept. 2012, https://junklit.com/2012/09/16/heroine/. Accessed 21 Feb. 2018.
My philosophy on pain management is that if medication can be avoided, it should. I think that there’s obviously a big problem with pain medication nowadays, and if we can prevent further issues with future patients, that would be a big help. My dad has a lot of pain from breaking his femur a couple years ago, as well as other injuries to his neck and his head, and doctors try to prescribe him a lot of medication that he doesn’t even want to take. He chooses to go to physical therapy and use exercise to help with his pain instead. When someone is in a situation where they experience pain regularly, I think that whatever can be done to help with that should be done, and that it should also be left up to the patient to decide what route they want to take. There are many types of pain management, and I think that every pain management patient should be aware of the different options.
In the case of end of life patients, I think it should also be left up to them to decide what would make them the most comfortable. In the case of “Herion/e”, I think that although they didn’t like to give the mother morphine, they made the right decision to give it to her, because you want your patient to be as comfortable as possible, especially in her situation.
I think that everyone deals with pain and grief differently so I believe that if people find a healthy outlet to use to plug their pain into then I think that pain management can be really helpful. Strayed’s outlet was heroin, and that is definitely not healthy, it could be damaging, so in that case the idea of pain management isn’t good and has almost been taken as an excuse to do reckless things. People don’t judge those who form alcohol addictions or drug addictions in times of crisis. They forgive and forget those who do the reckless things because they suffered so much pain. As for her mom, I feel like the morphine she was given was okay, because she was suffering and she just wanted to be eased. If a loved one is in that much pain, they should be given the medication to be relieved if they want it. Unless, the patient is/was a drug addict or becomes easily addicted to the medication, then the pain should be monitored and treated closely and handled properly.
I am vaguely familiar with the drug morphine, and dealing with end of life pain management. I have dealt with many peoples passing within my five years of being an LNA. During end of life care, we move the people as minimal as possible (as moving their body may hurt them, as we see their face wince or grimace upon movement), and keep them on appropriate levels of morphine. I believe pain management during end of life is very crucial. I think the number one importance is the patient themselves. There are many obstacles that challenge the idea of comforting the patient first. The biggest obstacle is the family. Many family members do not want their loved one to be “drugged up” because they don’t want to lose the ability to contact their relative in their last days. I have seen many POT’s refuse pain medications because they also believe that morphine and other such drugs “speed up the process in dying”. I feel like communication is essential in educating the family members/relatives in what the pain management is, and how it is comforting the patient to the best ability. In terms of pain management in other situations, I feel a lot of times that drugs aren’t always enough in terms of comforting the patient. I believe the patients emotions should be addressed. The doctor should allow the patient to express their feelings concerning the pain, and the situation they had just encountered (whether the pain came from a car crash, a serious incident, an illness), and then help the alleviate the emotional toll that had lingered from the situation.
My thoughts about pain management vary widely from end of life situations and not end of life situations. In the end of life, I believe that pain is something that should not be felt. The wishes of the person who is dying is of the utmost importance, and if that wish is to be pain free, so be it.
In a not end of life situation, I take pain management on a much more serious note. There is obviously an opioid epidemic in American, and we have no one to blame but ourselves. I believe that in Western Medicine we depend much to highly on curing a symptom rather than an underlying cause. We think of the quick fix, and this is what patients have come to know and to seek. In a culture so dependent on the term fast, that is what healthcare is becoming. But, the road to true recovery is not often fast. Pain management is obviously important, but when it overrides actual healthcare, as it seems to be, that is when something needs to be changed.
I agree with you when you say, “I believe that in Western Medicine we depend much to highly on curing a symptom rather than an underlying cause. We think of the quick fix, and this is what patients have come to know and to seek.” How can we change this kind of a medical culture?
I think we need to train our doctors, as a whole, not to just give a patient what the patient wants. The thing is, even if you are the one saying no, you can’t have the pain medicine that you do not need, the patient will just go to another doctor who says yes. Doctors would have to work as a united front to really “do no harm”.
At the end of life comes unimaginable pain, pain you can really only feel if you have ever been at the end of your life. Of course we all want to fight that pain, win the battle but sometimes, the battle wears you down to the point you need that boost. I think the pain management at the end of life is essential to keeping the person sane. As an LNA, I witnessed many elderly people suffering from so much pain that taking a breath seemed to suck every piece of energy out of them, the pain so unbearable that they wanted to take their last. Morphine allows the body to rest, to finally be numb from the monstrosities of death.
In non end of life situations, pain is temporary. Sometimes it is only there because you think its there. Let’s say you have a patient having a total hip replacement surgery and is prescribed pain medication as needed during recovery. There are times that these people can become addicted. While that pain may be there legitimately at first, that pain endures in your head but not physically, it becomes the crutch to get more pain medications. I saw this in the psych ward. Patients getting admitted because they were addicted to narcotics. Narcotics they got from a previous procedure. In this scenario, your life isn’t full of pain, but it is full of what you think is pain, a thought that allows you to take these narcotics without guilt.
You bring up an interesting point about pain perception. This is real. Pain is subjective.
I believe that at the end of life people should be more comforted than earlier years. When people are at the end they have more pain and it should be allowed that they can have the pain taken away. In earlier years though I believe there is many other pain remedies people can try to take away the pain other than drugs. There is therapies and other remedies they can use. I think pain killers should only be given to people who they know will not abuse them and that is hard to figure out, but we shouldn’t be using hard pain killers anymore unless for really serious events. I think that people need to realize that pain management can be helped in many various ways other than drugs.
My thoughts on pain management is to give as much as the patient is willing to receive. I understand that giving medication to someone who is dying to bare the pain can be limited. Health care clinicians are willing to do everything they can and were trained to do, but they cannot do everything the patient asks. Giving more morphine to Strayed’s mother allowed her to not deal with the pain of dying from her cancer. I can understand why the nurses felt uncomfortable because your drugging a patient to not be able to “feel”. They become unaware of themselves and rely on a drug for protection and security. I believe that people who are dying should be given a choice to decide how they deal with their pain. However, there comes a time when people should learn how to give in and decide if it is really worth pushing if they are just going to be drugged constantly, trying to mask the pain.
I think that when it comes to pain management, we have all the drugs at our hand in today’s world, that there is no reason for patients to really suffer. Personally, I believe that some doctors and medical professionals push medication on patients far too easily without really knowing if its going to help or not. Prescribing people with so many different medications to try out for trial and error, feeds the increase for patients to become addicted to pain medications or other drugs. When a patient comes in to be seen and is in pain, I think that pain medication should be an option for them if that’s what seems to be the only thing to keep them comfortable. I don’t think doctors should prescribe pain medication to patients who aren’t in severe pain and aren’t under care of doctors in the hospital. When it comes to end of life, I believe that doctors and medical professionals should do anything they can to keep the patient comfortable for their last couple days alive. I do not believe it is humane to allows patients to suffer before death when we have so many drugs available to use to prevent this pain. If the doctor knows that the patient has a short time to live, I believe it should be their choice whether or not they want to be drugged up on pain medication to stay comfortable rather than suffering in their last days. Unless the patent agreed for decisions to be made for them from family members, they should have the last say because it is their life. From experience, I know its really hard to watch someone you love in pain and not be able to help them escape from it, so they should be able to choose how they want to spend their last time alive.
Personally, I try to suffer through most pain and take over the counter drugs when I can no longer handle it. I am very sensitive to opioids and the few times that I have been prescribed even the smallest doses my stomach is in knots and I am more miserable than before. My experiences, with my own health and as a healthcare provider, I would avoid pain medications and opt for other treatments. With the opioid epidemic that we are currently immersed in, I would be very reluctant to give these drugs due to their highly addictive nature for patients that have more life to life. In non-end of life care, there are many options other than opioids like PT, acupuncture, etc. I would work my way up to opioids as a last resort and usually with other treatments to keep my patient on a low dose. However, for end of life care, my views soften. Who I am to prolong someone’s suffering if this is to be their last moments of life? How would I feel, if in a similar situation, if my physician kept me in agony because their principles are stronger than their empathy? I couldn’t do that to a dying person.
I personally believe that pain management is taken too far in many circumstances. I recently had my wisdom teeth out and was prescribed an opioid pain reliever. I needed no more than a couple tylenol every four hours for two days. The pain was not nearly bad enough to need an opioid. I know that many people have worse experiences than I did with wisdom teeth removal, but I still feel that pain medications are over prescribed. A large amount of non-end of life pain can be managed with OTC medications or other treatments such as ice and PT. Some pain is extremely severe and requires heavy pain medication, but I think the prescription of such drugs should be stricter. In my experience as an EMT, the paramedics I work with rarely give fentanyl. It is only given in severe cases and there needs to be other signs of pain other than the patient simply stating that they are in pain.
My views are much different for end of life care. People are only put on end of life care when it is clear that they will be passing away very soon. I have witnessed the suffering that people go through at the end of life as there body stops functioning. I don’t see any reason to withhold medication from these people if they are already suffering so much. They are only taking the medication in order to pass peacefully and have their last days be comfortable. They are not seeking out pain medication to misuse it or when they do not need it. I have also seen many doctors give it as a reparatory inhibitor to ease a patient into passing. I believe the use of pain medication is much different at the end of life.
My philosophy on pain management is always changing. As I read new information that is published or hear more stories of loved ones’ experiences in hospitals, I flop back and forth with how I understand this issue.
What I do know is that pain is a natural sensation that needs to be felt. The body is able to tolerate pain to a certain extent. If pain is not felt, the patient usually is not aware that there is something very wrong. Pain is not a bad thing. When a five year old touches a hot stove, they feel pain. The child remembers this pain and it serves as a reminder not to touch a hot stove again. People learn through pain.
If there is an understanding that the patient is going to come out of the situation alive, there is no use to drug them so they feel no pain. When people break a leg or an arm, it is not natural that they do not feel any pain. By giving too much medication, we are leading patients down a road of addiction to opiotes. When the pain is gone, but there is still leftover Percocet, patients will gain a dependence on the drug and continue to use.
When it comes to an end of life circumstance, I do not believe that health care providers have the right to tell someone that they are not allowed to have more morphine. If it is inevitable that the patient is to die in a short amount of time, it should be essential to make the patient’s last days on earth at least comfortable. If morphine is being administered at this point, it is safe to say that the end of the road is near.