Painkillers

Painkillers

© 2011 by the author

The hospice nurse sat at the kitchen table in my father’s house in Dublin. She was there, she explained to my sister and me, to assist us as much as our father. ‘Our concern now is to make his last days as comfortable as possible and to help you understand what he is undergoing and how you can help him.’

Two days earlier, the consultant at St Brede’s had outlined the options for my father. His kidneys had almost ceased functioning. Further treatment would have no effect. At most he had two or three weeks to live. His insurance would not pay for a hospital stay unless he was being treated. Once treatment ended, he had to be discharged within a day. His choices were a bed in a ward at an extended care centre or enrolment in the hospice programme, which would provide supplemental nursing and other services in his home as long as family members undertook the bulk of his care. My father did not hesitate. He summoned my sister and me to take him home and care for him.

My sister Niamh, who lives in Dublin, had handled the immediate arrangements. She had been at his house when the hospice delivered the supplies we would need to take care of him: a hospital bed, an oxygen tank, a wheelchair, a special foam mattress pad for the bed, a box of adult diapers, a blood pressure monitor, among other things. The deliverymen pushed the furniture in his lounge to one side and assembled the bed in the middle. ‘They were very efficient,’ she told me later. ‘They had everything in place within half an hour.’ They need not have bothered. When the hospice transport van delivered my father an hour later, he rejected the hospital bed and demanded that it, along with all the other equipment, be removed immediately. He grew angry when my sister protested that it would be easier to care for him in the hospital bed. He would sleep in his own bed. He could take care of himself. He didn’t need anyone. ‘Stop treating me as if I were a damn invalid.’

When I arrived a few hours later, the bed had been removed and all other visible signs of a sickroom taken away. Without telling our father, my sister had sequestered everything but the bed out of his sight on the second floor of his house. My father was seated triumphantly in a chair by the fireplace in the lounge, a cup of tea on the table by his side. He didn’t even bother to greet me. ‘You didn’t need to come,’ he growled. ‘If you would get a mobile phone like everyone else, I could have called you and told you to go home. It’s so late now that you better stay the night and leave in the morning.’

‘Da, you cannot take care of yourself,’ my sister shouted from the kitchen. A loud thump of a cupboard door being slammed and an angry rattle of pots punctuated her remarks.

‘I don’t need you and Patrick. That’s just something I told the doctor so that he would send me home. I don’t know why the two of you are here.’

‘Who will do your shopping and cook for you? Who will help you bathe?’ My sister appeared in the doorway, her hair hanging in damp strands around her face. ‘Hello, Patrick. You . . .’

‘I can cook for myself.’ My father interrupted. ‘I can certainly make a decent cup of tea, which is more than I can say for you. This is cold.’ He slammed the teacup against the saucer. ‘If you’re so damned anxious to play at being a nurse, you can take it away and bring me a new cup. And make sure it’s hot this time.’

My sister jerked the teacup up. She grabbed for the cup with her other hand and steadied it on the saucer. Some of the liquid sloshed over the side and ran down into the saucer. She shot me an exasperated look. I had last seen her six weeks earlier. Her face had grown greyer and more lined. She looked weary, her usual precise hairdo and make-up neglected. ‘I haven’t had the time to make a bed up or put towels out for you.’

‘Patrick is not staying here. He can go to an hotel for tonight.’

‘Don’t worry. I can do it myself.’

My father and I spoke at the same time.

‘Da, either you have at least one of us here at all times or you go to a care home. Those were your choices. You chose to have us here and we are here and we will remain here. Patrick will stay with you at night.’ My sister was shouting now.

My father made a gesture of disgust and then said to me. ‘Damned women. They can’t wait for the chance to run your life.’ He settled back in his chair and closed his eyes, shutting both of us out.

******

The nurse arranged the plastic bottles of pills my father was to take on the table as she checked each label against a print-out of his medications. Her fingers were swollen and chapped. She had draped a stethoscope over her left shoulder, almost as if it were a badge of office. A photo ID on a lanyard around her neck proclaimed her to be A. Montrose. When she introduced herself at the door, she had given her name as Athena Montrose. I wondered what quirk had led her parents to burden her with that name. If they had expected name magic to result in a warrior goddess, they must have been disappointed with this tired-looking matron. Even her hair looked listless. After checking on my father, who was resting in his bed, she had accepted my sister’s offer of a cup of coffee and sat down with us at the table in the kitchen. Her face briefly registered her relief at taking the weight off her feet before resuming what I assumed to be its usual look of impatient competence confronting lay ignorance. She answered my query about my father with a dismissive ‘as well as can be expected for a man in his condition’ and then proceeded to unpack my father’s pills without saying a further word. It was clear that we were not to disturb her while she was working.

When she put the last bottle down, she shook it briefly to demonstrate that it did indeed contain pills. ‘Don’t worry if your father doesn’t want to take his meds. At this point it won’t make a difference. If you can get him to take them, fine. If not, then don’t fuss at him. His comfort is more important than a few more hours of life. But it’s important that you take his blood pressure and check his pulse rate before giving him his pills. The blood-pressure monitor checks both. If his pulse rate drops below 60, don’t give him any medications. You probably couldn’t in any case. If his pulse rate drops that low, he most likely will be in a coma. Do you know how to use the monitor? Should I show you?’

When my sister said that she did, Mrs Montrose appeared inclined at first to dispute Niamh’s assertion. Then she shrugged as if to indicate that in the end it did not matter. She opened her bag and removed two more items. ‘Now this is a painkiller.’ She held up a white plastic bottle. ‘If he is in pain, you can give him one of these pills every six hours. It will help him rest. And this is an anti-anxiety medication. People in your father’s situation often become agitated. This will calm him down. It’s a gel. It’s absorbed through the skin. You tear open a packet’—she held one of the packets up for us to look at—‘and then smear the gel onto his skin. The best place is the wrist.’ She turned her left-hand palm up and with the fingers of her right hand mimed the action of smearing the gel on the inside of the wrist. ‘If you can’t reach one of his wrists, the next best place is the back of his neck. Be sure to wear plastic gloves when applying the gel. Otherwise you will be dosing yourself as well as your father.’

‘And this,’ she said as she pulled a small brown bottle from her bag, ‘is liquid morphine. A dosage is two or three drops. The easiest way to administer this is to rub it on his gums or the inside of his lower lip. This is to be used only if the pain killers are clearly not working and he is in extreme pain. Don’t combine it with the other pain killer and don’t use it if his pulse rate is under sixty.’

*****

One of the brochures the hospice gave us outlined the stages of the patient’s reaction to dying. We could, the brochure predicted, expect the initial stage of denial and anger to be followed by a period of withdrawal and finally one of acceptance. The brochure confidently foresaw that the patient would use this time to set his or her life in order and to prepare quietly for death. The authors of the pamphlet had never met my father. His predominant mode was rage. The prospect of dying intensified all his worst character traits. I can scarce recall those days without lapsing again into the anger that radiated outwards from my father and overwhelmed that household.

*****

‘It’s cold in here. Turn up the damned heat. I can afford it. Or are you concerned that there will be less for you to inherit if you keep me warm?’ My father was wearing a heavy sweater and two pairs of heavy wool socks and had a blanket wrapped around his body. The thermostat was set at 26 degrees and all three bars of the electric fire on the floor beside his chair glowed red. I had stripped down to my vest and was still sweating from the heat. For days I had kept the heating vent in the bedroom I was using on the first floor closed. Even so, I had to keep the door shut and a window open so that I could sleep. The rest of my father’s house was sweltering.

I stood up and consulted the thermostat. ‘It’s 28 degrees in here.’

‘I don’t care what that says. I’m cold. Turn the heat up. It should be set at 26 degrees. And turn on another bar of the electric fire.’

‘It is set at 26 degrees, and it’s now 28 degrees in here. The furnace won’t turn on until the temperature drops below 26. And all three bars are on.’

‘Why are you lying to me? Don’t tell me it’s 26 degrees when I know damn well it isn’t. And I can see that only one bar of the fire is on.’ He didn’t even bother to look.

‘Da, the thermostat is set at 26 degrees and all the bars of the electric heater are on. I will get you another blanket.’

‘I don’t want another blanket. I want you to turn the heat up. And don’t sigh at me like that. This is my house, and you’ll do what I tell you to do. It’s no use your being stubborn. You got that from me. You learned your stubbornness from me. We’re alike in that.’

‘I am nothing like you.’ That was the worst thing my father could have said to me. I had tried for so many years not to be like him that his assertion that I had inherited even one of his behaviours appalled me. I think even my father was taken aback by my anger. I threw the book I had been reading on the floor, pressed the up button on the thermostat until it read 30 degrees, and walked out. As I was closing the hallway door into the lounge, I glanced back at my father. He was smiling with satisfaction. It was one of his negotiating principles—I had heard him expound on them many times when I was growing up—that you had to goad your adversary into a display of emotion, preferably anger. Once you had done that, you were well on the way to winning. Once again, he had provoked me and driven me off. To his way of thinking, it was another point to him in our on-going struggle.

I sat in a pub for an hour nursing my grievances against him. When I was seventeen, I witnessed my father drinking with some of his cronies. They were seated around a table, and my father was holding court. The drink had lessened what few inhibitions he had. He was bragging about a deal he had just concluded and deriding his opponents’ ‘feeble’ attempts to circumvent his schemes. He was arrogant, argumentative, and condescending, even to his colleagues seated at the table. At that point, I resolved not to be like him. Of course, by then, it was too late. I had already picked up many of his habits and attitudes. It still infuriates me whenever I find myself behaving like him.

My growing coldness and distance initially bewildered my father, a fact that gave me no little satisfaction. When he realized that I held him in contempt, he began to treat me with equal contempt. He routinely ridiculed my choice of a career as a journalist and then a novelist. I made sure that he was the first to learn of each of my successes. When it became known that I am gay, he leaped on that. No occasion passed without a sneering reference to it. He has never consented to meet Lewis and always refers to him as ‘your friend what’s-his-name’ in inverted commas. Our adult relationship has been marked with constant arguments and discord on both sides. Had it not been for my mother, we would long before have given up on each other. As long as she lived, we maintained a resentful truce. Even after she died, we adhered to the modus vivendi we had constructed. It had become a habit, a way of interacting at a minimal level. Both of us still clung, I think, to the idea that we owed each other something and that there ought to be some sort of relationship.

My mood that night wasn’t helped by the guilt I felt. He did feel cold, and it didn’t matter what the temperature was. He would never feel warm again.

*****

‘Help me dress.’

‘Da, you can wear a bathrobe when they visit. They’ll understand.’

‘I am not going to entertain my friends in a dressing gown. And bring me a tie. The red one. You and Niamh are so gloomy, I need to do something to keep Monighan’s and Jacob’s spirits up. You would think someone had just died, the way you act.’

My father’s friends were due to arrive at 10:00. He was dressed in a suit and seated in a chair in the lounge impatiently awaiting them by 9:00. His clothes made it apparent how much weight he had lost. He had tied the tie tightly around his neck, but the shirt collar was made for a man with a much bigger neck. The fabric was bunched and puckered around his throat. His suit jacket hung from his shoulders and ballooned over his chest. His belt had to be cinched around his waist to hold his trousers up. Even so they drooped and bagged over his shoes. His knees and hips showed through the trousers as sharp points.

My father asked me the time every five minutes. In between he issued minute instructions on preparing coffee and tea for his friends. In a way, I was glad that they were visiting. I didn’t care for either of them—they were too much like my father—but most of his acquaintances and former colleagues did little more than ring up to enquire how he was doing. If I or my sister asked if they would like to speak to my father, they usually begged off. ‘I don’t want to disturb him’ or ‘Let him rest. I’ll not bother him.’ If we protested that my father would welcome an opportunity to speak with someone other than ourselves or the nurse, they would reply, ‘He needs his rest. I’ll ring again,’ and then hurriedly break the connection.

On the few occasions when my father had his hearing aids in and could hear from our conversation that someone was asking after him, he would laboriously heave himself from his chair in the lounge and, using his walker, creep into the hallway, where the phone sat on a table near the front entrance. When the caller rang off before he could reach the phone, my father would ask who had called and then purse his lips in disappointment when we told him. One of the things we did for him that actually won his approval and a rare expression of thanks was to get a long telephone flex and move the phone to the table beside his chair. When Monighan and Jacob had rung separately the previous day, my father successfully cajoled them into a visit. Both of them had been protégés of my father and, up until my father’s retirement four years earlier, had seen him often. That was a further reason for my resentment—they were clearly what my father thought I should have been.

When Monighan arrived, he looked as if he would rather have been anywhere else. He stood on the front pavement, a couple of steps back from the door, running his hands along the brim of his hat. ‘How’s the man doing?’

‘He’s better today. The doctors said he had only a couple of weeks when they sent him home. But it’s now going on for five weeks. He’s that stubborn, you know. He’ll leave when he’s ready and not before. He’s looking forward to your visit. Thank you for coming. Come in. Come in. Here let me take your hat and coat.’

‘No, it’s fine. I’ll not stay long. I don’t want to tire him.’

I looked over his shoulder into the street. ‘Have you seen Jacob? He said he would arrive around ten as well.’

‘Ah, he rang earlier this morning. He can’t come. Something came up. Last-minute business. I’m to give your father his regards.’ Monighan looked at me out of the corner of his eye to see if I accepted that.

Both of us knew that was a lie. I nodded. Nothing would be gained by discussing it.

‘Patrick, you idjit, don’t keep Kevin standing outside. Let him in.’ My father spoke gruffly. His walker was nowhere in sight, and he was gripping the frame of the door into the lounge tightly.

‘Bram, you’re looking swell.’ Monighan swept past me and engulfed my father in his arms. The next second he found himself holding my father up. The few unsupported steps from his chair to the doorway had exhausted my father. His legs gave out, and he dropped towards the floor. Monighan nearly tumbled onto the floor himself as he struggled to keep my father from falling. I leaped forward, and the two of us managed to get my father on his feet again and support him back to his chair.

‘Don’t fuss. I can do this myself.’ My father was embarrassed at displaying his weakness before a friend and he turned his anger on me. He slapped at my hands and pushed me back. ‘You see what happens, Kevin. You get old and sick and everyone uses it as an excuse to pretend you can’t do things for yourself. They can’t wait to bury you. That’s where my daughter is—out checking with the priests about the funeral.’

‘Da, you know that’s not true. She has a doctor’s appointment this morning.’ I said the last to Monighan.

‘Don’t tell me what I do and do not know. Make yourself useful. Take Kevin’s coat and hat. You would think your mother never taught you any manners. She was always too indulgent with you. Spoiled you, she did. And Kevin could use a cup of tea. Or perhaps you’ll be wanting something stronger, Kevin.’

‘A bit early in the day for me, Bram.’ And then to me, ‘If the tea’s made, I’ll have a cup. If you have to make it, I’ll be fine. I’ll not be staying long. Don’t want to tire your father out.’ Monighan said this loudly so that my father could here. He sat down opposite my father. He put his hat on the table but kept his coat on.

‘Patrick, give Kevin a cup of tea. You’re sure you’ll not be wanting something stronger? I have a fine whiskey. Join me in having a glass. It may be the last one you’ll ever have off me.’

‘Da, you know you can’t have alcohol. It would interfere with your medications.’ This was an on-going argument with my father. He wanted a drink, and if he could shame Monighan into having one ‘last drink’, he could argue that he should have one as well.

‘The sooner I die, the sooner you can leave. A glass of whisky’d be a quick way to get rid of me. You should be rushing to give me one.’ My father pounded the arm of his chair.

‘It’s fine, Bram. I have a meeting after this with Tobin. I’ll need me wits.’

At this reminder that others still had an active life, my father sat silent for a minute, brooding in his own thoughts. When he didn’t speak, Kevin Monighan looked at me for guidance.

‘Are you all right, Da?’

‘Of course, I’m not all right. I’m dying. Why do you ask such stupid questions? Where’s that tea? Kevin wants a cup.’

I was glad of an excuse to leave the room. I disregarded Monighan’s protests that he was fine and didn’t want anything to drink. Again he said that he would have to leave shortly. My father ignored him and launched into a story about his own dealings with Tobin. The last time I had heard this story of one of my father’s notable victories, his adversary had had another name. I waited in the kitchen for the kettle to boil. I was quite happy to leave Monighan to entertain my father. Not that my father needed anyone else to entertain him once he was well and truly into one of his stories. He had spent his lifetime honing a few favourites and, once started, he ran on like a clock. Monighan must have heard all of them many times during his association with my father. Undoubtedly my father could have stopped at any point and Monighan could have picked up the thread of the story and finished it.

This time, however, the story was interrupted. I heard my father began to wheeze. Monighan called for me in a panic. I rushed back into the lounge and found my father doubled over, unable to catch his breath. Monighan was on his feet, uncertain what to do. I ran into my father’s bedroom and got the portable oxygen apparatus and brought it back. The tubing had to be secured first under my father’s chin and then looped behind and over his ears and the nose piece brought forwards and positioned under his nostrils. When I tried to place it on my father, he grabbed it from my hands. It took him several attempts to get it into place. When he finally got it strapped on correctly, he slumped backwards in his chair and motioned weakly with his hand for me to turn the air on.

‘I’d better be going. I’ve tired you out. It was good to see you again, Bram. I’ll let myself out, Patrick.’ Monighan said the words in a rush and then fled. He was out of the house within seconds. In the kitchen the whistle on the kettle began to shriek.

When my sister arrived two hours later, my father was still dressed in his suit and tie and sitting in his chair. After an hour or so, he had removed the tubing and turned the oxygen flow off. He refused to answer me when I spoke or even to acknowledge my presence. He simply sat and stared into the distance.

My sister entered the house through the kitchen. She peeked into the lounge and watched my father for a few minutes. I don’t think he registered her presence. She drew me aside and asked, ‘How did it go? Did he have a good visit with Monighan and Jacob?’

As I was explaining what had happened, my father heard us talking. ‘Niamh, where have you been? I’ve been waiting for you. Come in here! I want to go out. I want you to drive me.’

‘Out?’

‘Yes, out. Do you not understand English? I want to go out? I want to see the old places. You’ll see the last of me soon enough. You can do me this one final favour. A favour to your old father.’ He spat the last of the words out as if he regretted having to beg one of his children to provide a service or to acknowledge his dependency on others.

‘I just got in. I haven’t even taken me coat off.’

‘Good. Then you won’t have to put it on again. Help me up. I’ll need my coat, Patrick. Get my good topcoat from the hall closet. And my good hat. The black one.’

It took the two of us almost twenty minutes to get him into the car. He resisted and defeated our every attempt to help him. My sister finally abandoned the effort to fasten his seat belt. He wouldn’t hear of my going. He didn’t want me. I know only the rough outline of where they went. My father was too exhausted by the time they got back to say anything. He was so tired that he didn’t protest when I helped him undress and put him to bed.

My sister was furious. After I got my father settled, I found her in the kitchen with a water glass half full of whiskey. She spoke in a whisper to prevent my father from overhearing. ‘All his worst traits are coming out. He had me drive down Nassau and Kildare streets. It took forever. The traffic was impossible. We were stopped for minutes at a time, and every time we stopped he would start shouting at me to move on. He forgot that Grafton Street is closed to cars now, and he blamed me when I couldn’t take him down it. He wouldn’t listen. Every time he saw a pub, he would remember the people he knew who used to drink there thirty–forty years ago. He kept telling me to stop and let him out. He wanted to talk to his old friends and buy them a drink. I was supposed to let him out and go on. He would find his own way back. Each time I had to explain that half of his old friends were dead and the other half weren’t sitting in pubs along Grafton Street. I told him that all he would find was tourists. He even wanted me to stop at Breeker’s. It’s been closed for years and there’s some sort of music club there now. I tried to tell him that, but he just shouted at me to take him to Breeker’s. He had me drive by his office. He didn’t recognise the building when he saw it. That area’s all up-market shops and boutiques now. There’s a posh Italian restaurant on the ground floor of the building. When I finally convinced him that was where his office had been, he started moaning that “they” were changing things and ignoring all that he had done. They were destroying his life’s work, and him not dead yet.’

‘I think that’s what upset him about Monighan’s visit this morning. He realised that the world was going on without him, without even consulting him.’

‘I don’t know how much longer I can put up with this.’ My sister took a large drink of whiskey and refilled her glass. ‘He micro-manages everything. You would think I had never driven before. He kept giving me instructions on what to do. He does that for everything. He tells me how to cook. He tells me how to make a bed. He tells me how to mop the floor. Yesterday he even gave me instructions on how to change a light bulb. Does he really think that I don’t know how to do these things?’

‘No, he’s worried that you do know how to do things. That you don’t need him. That no one needs him. I think he’s been hoping that the world will end when he dies and that he realised today that it won’t. That we will go on. And, at least on my part, without much regret at his passing.’

My sister barely took in what I had said. She shook her head at me for interrupting her with explanations. ‘The worst is that I go home so angry. I lose my temper with Michael every night now. Everything he does is beginning to annoy me. And I know that he’s not at fault. It’s Da and his beastly behaviour. Michael’s beginning to grumble. He says that I need some rest, that we should hire someone to take care of Da.’

‘Da wouldn’t tolerate that. He’d make that person’s life hell. We’d be lucky if anyone lasted a day with him. It is tempting, though. I haven’t been able to sleep more than a couple hours at a time since I’ve been here. He wakes up and starts yelling for me. Then he gets angry at me when I come. I keep telling myself that he won’t last much longer. That it will be over soon enough and that I just need to put up with it for a few more days and try to make his remaining time as good as it can be.’

‘You don’t have to lecture me. It’s bad enough when he makes me feel guilty. You don’t have to remind me that we owe him.’ She glared at me.

‘I didn’t mean that. I just meant that we’ll be released soon.’

‘There are times I feel that day can’t come soon enough. Why does this have to be so difficult? I know I should be thankful for every day he lives, but he’s making himself miserable, and he’s making everyone around him miserable. Why can’t he accept the fact that he’s dying?’ She wiped her eyes with the back of her hand.

‘I’m half-tempted to give him his pills with that glass of whiskey he wants. That hospice nurse said that the important thing now is to make his last days comfortable, and the whiskey would help. We should give him one of the painkillers at the same time. That and the whiskey should end all our pain, yours and mine as well as his.’

I spoke in jest—at least I tell myself that—but my sister looked at me speculatively. ‘I’m glad you mentioned that. I’ve been meaning to bring this up. I think he is in a lot of pain. He’s just not admitting it yet. He can still hide it. But any day now he’ll need the pain pills.’

‘Perhaps. He knows they’re there. If he wants one, he’ll ask for it.’

‘It might help him to have a good night’s sleep and not wake up every hour. You would be able to get some sleep as well.’ She paused and then looked at the wall clock. ‘What time is it? Is it time for his evening pills yet?’

My sister pulled the basket that held my father’s medications towards her. She doled out his evening medications into a small saucer, carefully checking each bottle against the list of dosages and times. When she reached the bottle with the painkillers, she paused and asked, ‘Do you think we should give him one of these? Just as an experiment to see if it helps him sleep. He never looks at the pills. He just takes what I put in front of him. I know he doesn’t want us making decisions for him, but it’s fast reaching the point when we will have to do that. He’ll be more comfortable if he can sleep.’

I stared at the bottle for a moment. It looked no different from the other bottles. Surely one would not hurt. Then I nodded. My sister unscrewed the cap and placed one of the painkillers on the saucer. It was a round green gel capsule, plump and swollen looking. It lay there among the other pills, white, pink, blue, red. There were so many of them, different sizes and shapes, but it was the largest, as if more of it were needed to be effective.

My sister reached a glass down from the shelf and set it on the table in front of me. She nudged the whiskey bottle closer to me. ‘It shouldn’t hurt him to have a bit of whiskey. That will help him sleep as well. And it might improve his mood. I know the doctors said no alcohol. But what could it hurt at this stage? They’re just being cautious.’

There it was. Neither of us spoke. We knew what we were doing. ‘Do you think he will want soda with it?’

‘Let’s put it on the tray. If he wants it, we can add it.’

I retrieved the soda siphon from the lounge and placed it on the metal tray alongside the bowl of pills. I opened the bottle and poured a couple of inches of whiskey into the glass. After a second, I added another inch. ‘We need to take his blood pressure and check his pulse rate. Remember—he’s not to take his medications if his pulse rate is below sixty.’

‘Let’s not bother tonight. He’s tired. He won’t want to sit still long enough for us to check.’

We stood there for several seconds not speaking and then my sister picked up the tray. ‘Come along. You’ll want to wish him a good night.’