Carolyn Alessio
CONTRAINDICATED

My mother once found opiates in the bottom of a used necklace box. She’d heard a clicking sound while lifting out the gold-plated necklace she had just purchased at a dying mall near her home. A half-dozen pills sat hidden under the box’s pressed cotton, like a priceless masterpiece that had been painted over with a trite landscape.

“Someone’s going to be looking for those,” my mother told me over the phone. “I’m glad I used a gift certificate so they couldn’t trace me.”

The idea of my elderly mother in her condo being a target for drug runners was a stretch, but she had always loved mysteries and police procedurals.

“What’s the code on the pills?” I asked. “I can look it up—there’s an app.” Pill Identifier it was called, part of Drugs.com and with (Pill Finder) in parentheses.

My mother paused. “I’m sorry,” she said. “I flushed them down the toilet before I remembered you’re not supposed to do that anymore.”

Looking out my gray city window, I remembered reading a report about the most common medications found in public drinking water: Birth control, anti-depressants, and pain opiates. The blend might alarm some, but it had sounded surprisingly soothing to me.

Six years later, when my mother was diagnosed with metastatic cancer during the end of quarantine, we started out using Days-of-the-Week dispensers for her many medications. During the first few months, she would call me at home so we could check potential interactions. Sitting at my kitchen table, I’d put her on speakerphone, pull up the Drug Interaction Checker app. Results showed up as Minor, Significant, Serious, and Contraindicated.

“How come the next level up from Minor is Significant?” I remember her asking. “Shouldn’t there be a gradation or something in between?”

Sometimes I heard my mother’s labored breathing as I typed in all the information, and I wondered silently if I could have detected this clue to lung cancer much earlier.

The hospice pharmacist took an extra-long dinner break the day we moved my mother into a unit. My brother and I brought all her prescription vials, but the young nurse urged us to take her Dilaudid and other opiates back home; they were fully stocked, she said. Foolishly, I sent it all back with my brother.

Four hours passed and my mother was starting to twist on her bed in her white nightgown, like a hungry infant shifting around in its bassinette. She still wasn’t quite conscious, but I could see the tension in her neck and jaw. Soon she began to mutter.

I couldn’t find a buzzer for the nurse, so I hurried down the hall to the desk to tell her my mom was ready for her next doses.

“I’m sorry,” the nurse said. “The pharmacist’s on dinner break.”

Back in her room, my mother’s face was gray, and she was saying words that sounded like epithets I’d never heard from her before.

“Soon, Mom,” I said. “Soon, I’m so sorry.”

Freed from numbing opiates, the tumors in her lungs, liver, and bones were throwing off their weighted blankets for the first time in months. I paced, tried to stroke my mother’s hair, but even my soft touch was too painful.

A light at the top of my mother’s bed illuminated a panel of mute medical instruments. The reason we had finally agreed to transfer my mother to the unit was for more ease with medication—we’d been promised subcutaneous injections and fentanyl patches. Now that she was here, however, my mother’s pain was even more ragged and uncontrolled than at home. Anyone would’ve called it Contraindicated.

Back at the desk, I asked again, citing urgency, but the nurse tipped her head to the side. “I’m sorry,” she said. “He didn’t leave a key.”

Now, two years after my mother’s death, I sometimes think of that elusive key, unfathomably the only copy at a healthcare facility that prided itself on pain management, as they proclaimed in the hospice brochure.

Soon, the pain had forced my mother completely awake; her good eye was open (the other had a tumor behind it and had remained shut for some time). “Jesus,” she whispered, a name I’d only heard her use respectfully. She repeated it and hissed the “s.”

I paced, ran crying through the halls to find any staff member. Didn’t other patients there need pain medication? I even called the 1-800 number for the hospice company, but everyone just urged me to wait a little longer, and we remained marooned in the bland, gray office park. That morning when I rode with my mother in the back of the ambulance, she had been jostled as we wound through the labyrinthine road.

A soft knock on my mother’s open door announced the entrance of an older nurse. Wearing yellow gloves, she came inside and set up her equipment. Soon she pressed a fentanyl patch on my mother’s leg and injected her with Dilaudid. Even before the nurse left, my mother was resting, her body so relaxed and her skin so smooth I could even see some of the freckles covering her cheekbones. The following two days, her last, would be similarly serene, but I didn’t have that consolation yet.

“Would you like a blanket for the couch?” the nurse asked me after she placed one on my mother.

I thanked her, my body feeling weaker than it had after a last-minute Caesarean years before. When I went to close the curtains, I peered out in the dim light at the desolate patio just outside the sliding doors. It looked familiar, and after a moment I realized I’d seen it in the hospice brochure from months before, with a built-in barbecue promising feasts of glistening vegetables that we would share, laughing. State-of-the-Art Palliative Care, the company had boasted. I blinked at the top of the grill anchored to the ground, its shiny cover firmly shut.

Carolyn Alessio lives and writes on Chicago’s southwest side. Her work has appeared in The Pushcart Prize Anthology, Sweet Lit, America, and elsewhere. She has received a fellowship from the National Endowment for the Arts, and her novel manuscript was a finalist for the PEN/Bellwether Prize for Socially Engaged Fiction.

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