Two Drops of Relief

Just as one never forgets a first kiss, one also never forgets a first house call. And specializing as I did in geriatrics included becoming a specialist in house calls.

At the university where I did my fellowship, the university contracted with a hospice company, which provided me with my first exposure to house calls, as well as to interdisciplinary teams—including social workers, chaplains, and volunteers. The hospice case manager was Nurse R, a seasoned 30-year veteran. She invited me to ride with her, zipping through Chicago’s narrow streets in her station wagon and parking in impossibly tight spots.

Our first patient, Mrs. B, a 70-year-old woman with terminal breast cancer, looked decades older. She lay quietly in a dark bedroom tended by her loving husband. She barely spoke, gazing at him with sad eyes while he did the talking. She was in horrible pain with every breath or movement. He brought her tiny meals that she barely ate and a bedside commode because walking was agonizing. Mrs. B looked like a wounded bird in a dark cage.

Changing the dressing on her breast was torture. The tumor’s stench of rotting flesh remains vivid in my olfactory memory. The nurse offered liquid morphine, but Mr. B feared it would kill her instantly. Mrs. B looked just as frightened. She screamed through the five minutes of bandaging.

We eventually helped her to the sofa, and Mr. B sat beside her. Nurse R sat on the floor holding her hand, gently asking about her family and grandchildren, slowly easing the conversation toward hospice philosophy: that even when cure wasn’t possible, pain relief remained a priority. I saw them begin to relax.

She then asked why morphine frightened them so much. They said a neighbor had died from opioids and clearly equated them with death. Nurse R patiently explained their risks and benefits and the principle of double effect. “When her time comes, it will come,” she said. “Why endure excruciating pain when there’s a remedy? Would you let a fire burn your home because you’re afraid to use a fire extinguisher?”

She hugged them when we left. The next day we found Mrs. B in the living room, hair combed, smiling. Mr. B sheepishly said, “I gave her two drops last night and she slept like a baby. I was afraid I’d kill her, but she walked herself to the bathroom. Thank you.”

My first house call was deeply affirming—the first of over 10,000 that I’ve made since.

Neeta Nayak
Richardson, Texas