dreamland

time is a gypsy caravan

steals away in the night

to leave you stranded in dreamland.

distance is a long range filter

memory a flickering light

left behind in the heartland

- dreamline by n. peart

Perhaps against my better judgement, I left my brother's home in Dallas this morning to drive down to the Houston med center to take a final exam in microbiology.  Five hours on the road and about two thirds of the way through the three hour exam, I started feeling dizzy and my eyes wouldn't focus quite right.  I was then struck with a very lucid and clear picture of what might happen if I were to just pass out right here and now?  What would the surrounding people do?  The irony of a large group of doctors-in-training taking a scantron test faced with a real life emergency was rich to me.  I was probably subconsciously acting out my brother's scenario with everyone around him.

The wooziness passed and my thoughts moved onto my brother.  My sense of disconnectedness was the briefest of moments.  His has lasted much, much, much longer.  Friday and most of Saturday were spent chasing the pain.  For the rest of my life that Saturday will forever be etched into my consciousness as well as my soul.  His daughter had a soccer tournament and the family was off to cheer her on.  Life goes on and all that.  My brother would wake up complaining of pain.  I'd drop the 40 mg of morphine solution under his tongue and count the 10 seconds before offering him the straw to the gatorade bottle to swallow the rest down.  He'd lose consciousness and then 20 minutes later he'd wake back up.  He asked me, "do we have any relief yet?"  I'd reassure him, "it's coming.  It's coming.  Stay with me.  It's coming."  We just couldn't get ahead of the pain.  In less than 8 hours, we'd given him over 500 mg of morphine.  Just a day or two prior, he only required about 400 mg over an entire 24 hour period.  Suddenly we're blowing past that in less than 8 hours.  And during those few days before which seem like eons ago, he experienced moments of lucidity and was able to carry on meaningful conversations.  A day or two later, though, and you're overwhelmed.  It's like a tsunami.  It strikes with no warning and you're in a strictly reactionary posture trying to play a desperate game of catch up.  It's terrifying to be the one calling those shots.  How much morphine constitutes an overdose?  How do I balance that with pain?  I constantly monitored his respiration rate and pulse to make sure he was safe from an overdose.  I'd be damned that if after all this, I'd be the one responsible for his passing due to an opiate overdose.

At one point I finally asked him, "what can I do?"  His voice trembled and his speech was slightly slurred but the meaning was absolutely clear.  "Make the pain stop."  I hear you loud and clear, my brother.  By Saturday evening, we finally accomplished that goal, nearly exhausting his liquid morphine in the process.  In the end, he required over twice his normal dose of opiates to get the pain controlled.  As a reward, though, his wife was able to gratefully spoon feed him two helpings of Blue Bell vanilla ice cream.  He was able to give his special handshake to his son before going to sleep.  And as a bonus, his grammy got to witness the cherished exchange between her son and grandson.  That was probably his last precious moment of lucidity.  Sunday he spent in dreamland, his memory a flickering light.  He'd briefly wake up and talk about various snippets from his subconscious.  To those of us in the waking world, it held no physical manifestation but in his mind it made sense.  My wife adamantly assures me of that.  He was preparing for a trip somewhere and we needed to get the suitcases.  "I need my wallet.....Are they at Breckenridge? (it's a nearby soccer park where his daughter plays soccer).....Are you ready?.......It's a hard trip.....................I'm halfway there.....It's a hard trip........."  During this exchange, I stood there holding his next dose of morphine.  His wife agreed with him about the difficulty of the trip and reassured him that we were ready.