11:30 pm

My brother's pain management comes in three forms.

1. Fentanyl patch - an opiate that can be absorbed across the skin.  It releases a steady stream of fentanyl 24 hours a day.  Each patch lasts three days.  We increased his dose by 25% in the last day.
2. Morphine extended release (ER) - a pill form of morphine that is slowly released in the GI system to get a somewhat steady level.  It's to be given every 8 hours so that an even amount is present 24 hours a day in the blood stream.
3. Morphine solution - a liquid form that is to be held under the tongue or against the cheek to be absorbed across the mucosal lining and directly into the blood stream.  When done this way, it bypasses the GI system and gets into the system quickly.  It's for breakthrough pain events.  Ideally, if options #1 and #2 are working well, the necessity of #3 is minimized.  We're not dealing with ideal circumstances anymore.

I just got off the phone with the hospice nurse.  My brother's pain started spiking horribly and uncontrollably today.  To make it worse, he no longer swallows pills.  We found two ER tablets from earlier in the day between his teeth which we had thought he had swallowed.  So we needed to see what options we had.  The first one is to load him up with the morphine solution every hour on the hour.  We're trying that one first but it necessitates the need for working in shifts when you're delivering a med every hour all night long.  I volunteered for the first shift so his wife could get some sleep.  She was up with him quite a bit last night.  So here I sit writing until the next dose in about half an hour.