I Can't Talk but I can Feel

I view my work with CARP Advocacy as public education. Over the past year I have shared with you scientific facts on numerous pain related conditions, as well as information about what works and what does not work in our system of health care. Awareness and knowledge empowers you as a patient, advocate for a loved one, or just plain interested, to get better care and also help make changes in the system. Continuing on the same vein, just this past month I came across two cases of patients in pain that I want to share with you.

A colleague of mine in the hospital who works in administration called me on the phone quite distraught. Her father with Alzheimer’s was residing in a nursing home. While he was forgetful, he was quite self sufficient in personal care, pleasant and well interacting with the family who visited often. That is, until he was diagnosed with neck cancer and was sent for a number of radiation treatments localized to the neck. Unfortunately, the radiation caused some serious burns in the neck that needed lots of local treatments and dressings to help the burns heal. This is when the man changed. The bewildered daughter described him as unable to speak or respond to close family members, thrusting violently at times and quite unable to even feed himself. She called me to discuss his case as the nursing home staff had no clue what to do.

One of the reasons people with substantial cognitive loss get derailed and confused, is when there is big change in their environment. The man had frequently been taken for treatment in an outside and unfamiliar facility. That could partially explain his behavior. The other big reason is untreated pain. I strongly recommended that he is given some liquid morphine regularly, so the daughter went back to the nursing home staff and suggested this. The change was dramatic. Within 20-30 minutes of ingesting of liquid morphine her father would be able to sit up, eat and communicate. A couple of hours later, when the drug wore out or when the dose was insufficient, he would resort back to silence and inability to do his basic things, wincing and unable to interact or talk. I suggested dose increase and also more liberal use of the drug in frequent intervals. Two weeks later, as his burns were healing well, the morphine was much reduced and he was returning to his old good self.

In another extremely sad case I saw a few days ago, a 45 year old woman was brought to me from a nursing home outside the Greater Toronto area by her caring sister. She was bound to a reclining wheelchair, the left leg was in a brace with the knee straight and the left hand curled under the covers. Her story was the stuff horror movies are made off. About 5 years ago she was shot by her husband in the head and he committed suicide afterwards. This lady survived but with huge injuries. The bullet went behind her eyes and destroyed her eyeballs, so that the eyes had to be removed from their sockets leaving her blind.