Not yet time to go. With delirium, you lose communication with the patient. He could be in more pain but unable to tell you. And a family may have traveled many miles to see him. There are issues in the past, on both sides, that they usually want to discuss.
Patients are in a weakened state, and medications often have unpredictable side effects.
Morphine byproducts, for instance, can reach toxic levels and affect the nervous system after the drug has been pumped into the blood for weeks. Russell Portenoy, chief of pain medicine at Beth Israel Medical Center in New York City, recalls several patients who, like Gallagher, seemed more distressed the more morphine they got. Finally we realized what was going on, went down on the morphine, and gave them an antipsychotic. Overnight they cleared up. At times, switching painkillers can turn things around.