Non-Spontaneous Human Combustion: How Do We Stop It From Happening to Mom?
January 8, 2009 2:21 PM   Subscribe

The short version: mom's morphed into a reclusive, depressive, heavily-medicated, quasi-narcoleptic shell of a woman. She's given up on life and herself. More disturbingly, she's burned holes in hundreds of household items (carpets, floors, computer keyboards) after falling asleep while smoking. It's a recipe for tragedy(s) - fires, skull fractures, etc. We want a better life for her (or hell, any life at all, given the fire hazards). What can we do?

The longer, far-more-depressing version (you might want to grab a coffee and a bottle of Paxil prior to reading):

My mom's falling apart... physically, mentally, emotionally, existentially. Her disintegration's been progressing for years. We've never attempted an intervention because we didn't know where to start. There were complications on complications (Ball of Yarn, meet Can of Worms).

We can't ignore it any more. Her life's in danger. We have to do something. But what? In order to help describe the extent of the issues, I'm going to kick it case history style. I'll describe a typical Day in the Life of Mom. Then, I'll provide some back story to help elaborate the factors which contribute(d) to the current miserable state of affairs.

The Problem(s):

She wakes up at noon, groggy and in pain. Bad pain. Where? Everywhere. Between the fuzziness and physical aches, tiny tasks take ages. By 1:00, she's managed to put on a robe, make a pot of coffee, take a pain pill and smoke the first half-dozen victims of a four pack-a-day habit. She spends some time shuffling between her heating pad and the coffee pot... flipping channels on the TV... nodding off and augmenting the carpet's array of cigarette burns. On a good day, this lasts an hour. On a bad day, it never really ends. Even on the best days, she's near-catatonic until the trifecta of coffee, cigarettes and morphine has worked its magic.

If it's a bad day, she'll go back to bed. If it's a good day, she'll putter from task to task, only sporadically finishing any of 'em. She puts on a load of laundry... then the phone rings!... she finishes her phone call, goes back to the laundry room, realizes she needs fabric softener. But the dog needs to be let out!... she lets the dog out, decides to sit down and watch some TV... but she still needs fabric softener!... but her car keys are next to the sink, and it's full of dirty dishes!... but she can't wash them, of course, until the silverware drawer is organized... oh, shoot, the dog's barking... forgot to let her in!... she lets the dog in, stops by the refrigerator to get a snack... and that nice roast is going to expire! Need to cook it! But the stove's covered in dirty dishes, too! Better organize the cupboards.

It's an unrelenting ADDeath shuffle, fueled by copious quantities of coffee, cigarettes and morphine. Not to feel good, mind you... to suppress the myriad of inexplicable aches and pains which would otherwise debilitate her.

At 5 PM, my father gets home from work. She says she's exhausted, that she's "been running all day!". She didn't even have time to shower! My father - an engineer of the "gentle robot" type - doesn't particularly care that the house is a crap hole, that dinner hasn't been made, that the carpet's a mass of charred polyester. He does the chores she requests. He fetches take-out. He calls in sick when she's too pained to get out of bed. He's supportive in all the ways she requires... and none of the ways she really needs.

Robo-Dad goes to bed at nine on the dot. Mom's day has barely begun. She can't go to bed! The house is a wreck! No one else is going to clean it! So begins the nightly suburban stations of the cross. She shuffles from room to room, chipping away at chores, trying (and failing) to fight fatigue. Falling asleep sitting in chairs (with her head pitched forward at a sickening, painful angle). Falling asleep at the kitchen table. Falling asleep on the toilet, falling off, hurting herself. Falling asleep standing up. Dropping cigarettes and burning holes in every surface imaginable. Eating sweets. Watching five-minute segments of movies ten times in a row because she keeps nodding off. Growing increasingly foggy, confused and incoherent.

Sometime before dawn, the inevitable wins and she passes out for an hour or two... sometimes in bed, sometimes on the couch, often while slumped over in a chair. She rarely sleeps for more than two or three hours before waking. When she wakes, she cannot/will not go back to sleep without taking another whack at the whole "shuffle around house, burn holes in shit" routine (she claims that sleeping for more than four hours at a time "messes up" her back). After two or three shuffle-interrupted blocks of sleep... surprise! It's noon again... rinse, repeat.

It's no way to live. Yet she has been, for years. And now her daily hours of lucidity have begun to wane. We're sad and scared.

What We Want, Ideal-World Version:

- We want her to stop endangering her life and those of her family.
- We want to help her address the sleep issues which are so detrimental to her life.
- Ditto the depression issues.
- We want a better life for her than the one she's living. She deserves it.

The Background Info:

- Let's set a few things straight. She's a wonderful woman. She's damned intelligent, hilariously funny, incredibly supportive, one of the few genuinely moral people I've ever met. My entire concept of ethics and decency comes from her. Hell, the bulk of that which is good in me comes from her. Hence my desire to sift through this clusterfuck and help her.

- She's in her early 60s. She's suffered from clinical depression for over fifty years. It's ebbed and flowed. SSRIs currently keep it from spiraling out of control (though they don't make it much better). She's also had intractable feelings of worthlessness and failure - they've always been there, and always been incredibly painful and shameful. She was bright enough to have gone to medical school... instead, she became a secretary, then a homemaker. Wasn't encouraged by her parents.. wasn't encouraged by Robo-Dad... wasn't confident in herself. As such, she never achieved... well, much of anything, by outside standards. She's lived a good and decent life... but it's done nothing for her ego.

- My siblings and I are grown. Two of us have moved out. The youngest, Former Junkie Sister (now Suboxone Sistah), lives at home, works part-time, has little direction, spends a lot of time fighting with mom. Due to Former Junkie Sister's issues (as well as those of her other children), mom believes herself to have been a huge failure as a parent.

- Per my father, mom's always had issues with insomnia/resultant narcolepsy.

- For the past 15 years, she's experienced a series of inexplicable, increasingly-severe physical complaints. She's been pegged with fibromyalgia, osteoarthritis, you name it. Nothing's quite fit. Factitious? No. Psychosomatic? Quite possibly, at least in part. Her "treatment" has been limited to morphine sulfate, dispensed by a kindly but clueless local physician. The morphine suppresses enough pain for her to be mobile. Due to increasing tolerance, she's worked her way up to 8 to 12 60mg tablets per day (enough to euthanize a lesser mortal). Due to bad experiences with several specialists ("chronic nonspecific pain" = problematic patient), she's reluctant/unwilling to pursue other treatment options.

The physical ailments and their ensuing limitations were a nuisance... then a problem... then, once her kids were grown, the defining feature of her life. She has no real hobbies, few friends, no goals or ambitions. She doesn't feel she's worthy of these things. After all (in her mind), she's stupid, worthless and, above all, sick.

- Any suggestions regarding her problems are met with denial, incredulity and/or anger. Usually anger. "You kids have no idea what it's like"... "I have a pretty good life, most of the time"... "It seems like you're all turning on me"... etc.

- Aging has made her increasingly depressed/despondent about the course her life has taken. Hopelessness and helplessness are the themes of the day, "it's too late for me" a common refrain.

The Request: what do we do? We have no idea where to start. Psychiatrist? Life coach? Sleep clinic? Family doc? Any course of action has to be pursued very, very carefully; if she thinks we're betraying her, she'll be devastated. We want to help... not destroy.

Any suggestions, stories opinions and errata would be greatly appreciated. We're feeling clueless and desperate over here.
posted by julthumbscrew to Human Relations (23 answers total) 4 users marked this as a favorite
Hire a cleaning lady/organizer/housekeeper for the house and to make meals so your mom can sleep - getting a decent nights sleep would seem to be the first step.
posted by zia at 2:33 PM on January 8, 2009 [3 favorites]

Where are you?
posted by small_ruminant at 2:37 PM on January 8, 2009

I don't have any suggestions, only sympathy. I think it's great that you care enough to help her improve her life, and I think that will go a long way no matter what course you take. :)

My Grammy was in a similar situation recently (still is I guess). My Gramps left her several years ago- well into their senior years and long after all the 6 children were grown and having kids themselves. She had to move out of the house her whole brood grew up in, and she lost touch with all her friends. All her children eventually moved away all across the country. She has the same insomnia sleeping issues (well I don't think she falls asleep in her chair all the time, but she stays up late doing crosswords and then sleeps in late and gets into a night schedule). She's very overweight, so she has diabetes, but she stopped going to the doctor (too much of a hassle, she can't walk very far) and filling her prescriptions. And her place went to hell because she stopped doing chores. She's got depression too. The doctor finally told her there were no more meds he could prescribe her to make her feel better; she had to go out and DO things to stop being depressed.

Anyway, so my aunt visited her recently and saw how bad things had gotten, and her and my mom made the decision to move her out of Ohio and close to them in Hawaii.

She's only been there a month, but her demeanor and outlook has changed drastically. She's hopeful her health will improve, even if it's maybe not in tune with reality at this point, but I think attitude goes a long way! :) My aunt and mom have to go with her to all her doctor visits and stuff though, because otherwise they don't know what to hold her accountable to (and she usually glosses over her problems and acts like everything's ok). And they check everything with each other to make sure she's not playing them against each other or anything. ("The doc said I can have hot dogs once in a while...")

So anyway, I think regular face-to-face contact with her family will help restore a lot of what she's been missing, and also they can help her out and hold her accountable to her health goals and plans.

My mom's not too happy about the added responsibility (and of course Grammy's driving her crazy), but I'm really relieved because I was worried about Grammy. It's nice to know they're caring for her now and that she's not all alone. :)

My best wishes to you and your mother, and I hope you guys are able to help her! :)
posted by thejrae at 2:54 PM on January 8, 2009

- Per my father, mom's always had issues with insomnia/resultant narcolepsy.

Please get your mother in for a sleep study. (This is also a neutral, easy first step...very hard to interpret this as saying, "you're crazy, lazy, bad" etc.

Not getting sleep will not only make someone feel "stupid" and scattered, it's also a tremendous source of wear and tear on your physical health (and a source of physical pain as well, in many cases).
posted by availablelight at 2:54 PM on January 8, 2009 [4 favorites]

I'm sorry that this is such a short answer to what is a painful question, but it truly is the first thing that came to mind.

Check the smoke detectors. Make sure they are loud enough for your dad to hear when he's home and, even better, install the kind that link to a security system that sends help immediately (usually through a house alarm system like ADT). This is not getting to the root of the problem, I realize, but maybe it can help alleviate some of that immediate fear that the house is going to burn down and harm your folks.
posted by meerkatty at 2:55 PM on January 8, 2009 [3 favorites]

Also, I don't think you're anywhere near this step until you get some of the physical symptoms under control but: a steady volunteer gig will allow her to use her smarts, feel like she's contributing something, and add social stimulation and structure to her weeks. All of the happiest people I know ages 60+ are all still either working or very involved in community organizations, church, etc.
posted by availablelight at 2:56 PM on January 8, 2009

Oh yeah, you might've already tried this, but maybe the best place to start is tell your mother your concerns, as listed above, let her know how much you love her and that you want to help, and then ask her what she thinks she needs help with or wants to improve? I think it will be a lot easier to help her if she's on board and if you start with little problems first to help build her self-esteem. Baby steps! :)
posted by thejrae at 2:58 PM on January 8, 2009

First, you've got to realize she's severely addicted to morphine. High as a kite from dawn till dusk. No shame in that but most of the problems you mention - 'narcolepsy', 'nodding off', 'insomnia', 'sleep issues' - are directly related to that. Also, after 15 years on the stuff it will take a competent professional experienced in addiction and pain management to disentangle the symptoms caused by whatever underlying condition she might have from the symptoms of opiate withdrawal which are debilitating. As difficult as it might be to think it you need to realize your mother is probably a more hardcore junkie than your sister ever was.
posted by otio at 3:00 PM on January 8, 2009 [5 favorites]

I went through something similar with my mother (she was diagnosed with polymyalgia rheumatica). First, make an appointment with her regular doctor and go with her. Take a list of questions and get answers. Take a shoebox or paper bag with all her medications in it, OTC as well as Rx.
posted by Carol Anne at 3:34 PM on January 8, 2009

It is very bizarre that she's nodding all the time because if she *is* on a *stable* dose of morphine, she should be tolerant to that effect by now. Which suggests that she's taking irregular doses and "getting high" but DOES NOT NECESSARILY MEAN SHOULD SHOULD BE VIEWED AS AN ADDICT AND TAKEN OFF THE OPIOIDS. IANAD but it could also mean a liver problem or some other metabolic issue if she is taking her doses regularly and this is still happening.

You need to be very careful about finding a compassionate specialist who can recognize that addicts are humans too and may need opioids and that not all drug-related problems are addiction and that sometimes, coming off *is* good but that has to be the patient's decision if you want it to occur without potentially backfiring. opioids also have an antidepressant effect in some-- and a pro-depressant effect in others, so this is an important part of the issue.

A longer-acting opioid which can be taken once a day and can be used with shorter acting drugs for "breakthrough" pain could help but the doctor would really need to assess whether the problem is addiction or pain or both before you even considered this because if she's taking irregular doses or "forgetting" and taking the drug twice, that could be extremely dangerous with a long-acting drug.

Bottom line, she needs to get to a doctor who specializes in both pain and addiction and really knows what he or she is doing, someone who knows psychopharmacology.
posted by Maias at 3:45 PM on January 8, 2009 [1 favorite]

I am so sorry.

It sounds as if your mom has multiple issues that collectively create a horrible situation for her.

Everyone above has wonderful ideas. And they all specifically and clearly address different aspects of this situation. I recommend writing them ALL down into a numbered "to do" list so you can address all the issues/actions to take without getting overwhelmed yourself. It will also help clarify the whole situation.

A housekeeper sounds awesome, but maybe present it to her as a gift, or "just for a little while", or some other way, so she doesn't read 'failure' into it.
posted by Vaike at 4:12 PM on January 8, 2009

Any chance a part of this is a deep-seated wish that if she's in enough trouble, your gentle robot father will have to rescue her? Or at least notice in a non-mild, non-robotic way?

In case, when is former-junkie sister going to leave the house?
posted by Lesser Shrew at 4:24 PM on January 8, 2009

Many posters have already offered excellent recommendations: specifically, having your mother's medications (particularly the morphine) reassessed, requesting she visit a sleep clinic, and finding affordable household help for her.

Additionally, I'd add that your mom seems to be stuck in a deadly-dull rut: every day a repeat of the one before. This is a recipe for chronic illness, depression, mental dullness, and perhaps even serious disease.

Is there any possibility she can have a long vacation away from home? Perhaps she can visit family, old friends, or stay somewhere relatively inexpensive for R&R, diversions, and mental stimulation.

She may rebel vehemently against the suggestion, but it could save her life -- and markedly improve your family's dynamics, too.
posted by terranova at 4:36 PM on January 8, 2009

First, I second otio. Her issue is morphine and if it is not the issue, you will never find the issue until she is off for some period of time enough to find the issue.

Second, agree with the housekeeper for cleaning and a nurse for monitoring her.

Third, your sister is no help. She is a living reminder of what your mom does not like about herself and thinks is her failure. Also, sounds like your sister is a problem unto herself. Get her out of the picture somehow.

Fourth, your father has to be on board for this. He needs to get tough and demand changes also.

Good luck. Patience if progress no matter how slow. No progress no patience.
posted by JohnnyGunn at 4:37 PM on January 8, 2009

Sleep study. And have her screened for sleep apnea.
posted by St. Alia of the Bunnies at 4:54 PM on January 8, 2009

Yes, yes, DEFINITELY have her screened for sleep apnea!

Morphine increases risk of sleep apnea. And daytime sleepiness and inability to concentrate are classic symptoms of sleep apnea.
posted by selfmedicating at 6:31 PM on January 8, 2009

One of our regular mefites is docpops, who is actually a doctor, and can probably speak to some of the medication issues.

Other than that, I have no much to offer but my sympathies and best wishes. Hugs!
posted by dejah420 at 6:38 PM on January 8, 2009

Johnnygun and Otio, you really *don't* know that the morphine is the problem. I am an addiction expert and ex-junkie and health journalist who has written extensively on pain treatment and addiction. It is a common misconception that all problem drug use is addiction and that stopping the drugs always solves the problem.

People hear "morphine" and "nodding" and assume addiction and that taking away the pain meds will sort it all out. Well, not necessarily. For one, addicts can have pain too-- and pain patients can look like addicts and there are all sorts of medical complications like metabolic issues and sleep issues and depression.

There are many doctors who would be happy to solve this situation by viewing it in black and white and referring you to some uneducated addiction "interventionist" who will probably also support avoiding all pain meds even if you have heart surgery and will put your mom in rehab.
Suicides have resulted from "tough love" like that in these kinds of situations. It is not simple.
posted by Maias at 7:45 PM on January 8, 2009 [2 favorites]

Everything Maias said. The way your mother is acting is very likely due in large part to side effects of morphine BUT if she needs the medication then she needs it and the problem is to find a way to get it to her more safely and more effectively and will less negative side effects.

Also, and I hate to say this, but I am more than a bit suspect of your ex-junkie sister living with your endless-supply-of-morphine Mom. Just sayin'
posted by fshgrl at 8:36 PM on January 8, 2009

I think the suggestions of a cleaning service (plus maybe a dishwasher) and a sleep clinic are a great idea. I've had trouble with insomnia all my life but have never fallen asleep on the toilet. The morphine might be the cause but it's still pretty extreme. I also wonder if a pain clinic might be able to find some medication that helps control the pain without all the side effects she has now. Maybe they could at least help her cut back on the morphine. A clinic would probably have experience with people becoming addicted to medications.

The lack of any real social activity worries me. My mom got really down about life for a while and I'd suggest things to her which she ignored but she did listen to my advice about needing to find something to do to get out of the house. My mom joined the YMCA and now runs into someone she knows almost every time she's out. The Y has water aerobics classes which are a big draw for the over 60's set. You put less weight on your joints since the water makes you float a bit and I'm pretty sure I remember reading something about this type of exercise being used to help reduce pain (fibromyalgia?).

if you suggest this as a way to lessen pain, hopefully your mom might be willing to give it a try. Would your sister who lives at home would be willing to drive her? I'd be worried for your mom to drive much with the amount of morphine she's taking. They have family memberships so your sister could work out too. There's no age limit. You just have to live in the same house. By the way, I don't go to the YMCA myself but it really has helped my mom be less negative and much more social.
posted by stray thoughts at 1:52 AM on January 9, 2009

I would recommend enlisting your dad and contacting a lawyer and possibly her doctor. It sounds like she may be at the point where legally she may be incapacitated and may need to be hospitalized for a time to get some of these issues under control. The drugs she's on aren't working--maybe she's not taking them--but I think she might be better served in an environment where this can be treated as a crisis as opposed to an ongoing problem.

Sixty is not too old to start having a decent life.
posted by A Terrible Llama at 3:58 AM on January 9, 2009

Second the suggestion of getting someone in to do cleaning. Even if it isn't an ongoing thing, getting caught up can be a huge help.

You mention a heating pad and back pain. These are not as compatible as people think. My back is way better since they persuaded me to give up the heating pad. When the back has an acute problem, cold is better. Sounds stupid, I know! But it works.
posted by Goofyy at 5:46 AM on January 9, 2009

The comments above, particularly what Maias said, are all great starts. I wanted to chime in on one thing you said in your Request, though: I am a life coach, and a life coach isn't what your mom needs right now. Once the medical and psychological issues are resolved, then maybe, but if your mom came to me, I'd be referring her to medical professionals ASAP.
posted by catlet at 2:05 PM on January 9, 2009

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