I was lucky to only have hallucinations.
I don’t often write serious stories. There is enough pain and tragedy in the world, and I choose not to add to it. But after a recent experience when stopping tramadol, I had to share so others will know what to expect.
First, tramadol did not kill my mother directly. But it was the catalyst. She had been in pain for years from a neck surgery in her 50’s, and with what was probably the onset of arthritis in her 60’s. She divorced and remarried in her 60’s, and moved with her husband to his home state of Florida, a place where the doctors rub their hands in glee to see an older person walk in. Perhaps she also doctor shopped, I don’t know, but I do know when she died at a very young 72, the M.E. said she had an unusually large number of prescriptions in her overnight bag.
She had become addicted to tramadol, but 15 years ago opioid and tramadol addiction was not a mass media touchstone. We saw changes and considered that she might be addicted, but since everything she took was prescribed, we didn’t argue with the doctors. Plus we, her children, were in Texas with no access to what she was taking.
She was late to my sister, Debi’s, wedding. We almost had to start without her. As she made her way into the church on her husband’s arm, she said, “Nobody understands how much pain I’m in.” She was 68. At the reception she was disinhibited, telling uncomplimentary stories about my sister at her wedding reception. She was a funny woman. We all get our dark humor from her. But she went too far that day, and I had to steer her to different topics.
Once when my son and I were visiting her in Florida, she seemed unusually confused. Blake and I had gone to the beach, and when I called her to talk about dinner, she said she was making spaghetti. When we arrived 45 minutes late, she hadn’t started cooking. When I asked her why, she answered, “It’s Randy’s favorite, and he won’t be here for dinner.” Randy is my stepbrother, who lived with them. She had no alternative plan for dinner. My stylish mother was wearing the same mumu she had worn all day, and had on no makeup. This alone was cause for real concern, since she never stepped out the door without full makep.
Over the spaghetti that I made, her husband made some remark that would at least have brought out her dark humor. At the most, she would have challenged him. She said nothing. I looked at him and asked, “Who is this woman and what have you done with my mother?”
Towards the end, she drove a rent car from DFW airport to spend a couple of weeks in her home, which she had kept when she remarried, and to see her children and grandchildren. Her home was over 2 hours from us, so she made the drive several times to see my son perform in his middle school talent show, and to be with some of us for Mother’s Day. She seemed her former, true self again. She wasn’t confused. She was funny, blowing kisses across the auditorium to my son, who had requested she not kiss him in front of everyone.
She and I shared a powerful moment when she told me how sad she had been when she was in the hospital and thought flowers had arrived from me, then realized someone else sent them. I told her how she had responded via email to my invitation to my 50th birthday dinner party that she “was going to be very busy that day.” I reminded her that I had replied, “Not nearly as busy as you were 50 years ago that day.” She didn’t remember the exchange at all. (She did remember attending the party). We both apologized and hugged.
She told her life story to my niece’s boyfriend over Mother’s Day lunch, and was vivacious and entertaining. When she went back to her home town, she followed her son-in-law around as he worked on her house, telling him the same stories. She was animated and alert. We all told each other it seemed she was off of her pain pills.
The rental car she drove was a complicated one. I tried to drive it one day and had difficulty getting it started. She called me at work when she was leaving my house in it, to ask how I had gotten it started, even though she had driven it for two weeks by then.
The night before she was to drive back to DFW from her house, she had talked to my youngest sister, Elaine, for a long time about whether to go back to Florida at all. She loved her Texas home and missed us all. She and her husband weren’t getting along. I believe this is because when she wasn’t drugged up on tramadol, she was her true, assertive self, and he didn’t really know that person. My sister assured her that she had every right to not return until she was ready. Mom was concerned about wasting $400 dollars for the airline ticket. My sister told her it was just money, and her happiness was most important. They talked until midnight.
The next day, Mom texted Elaine that she was coming. Elaine planned to follow her to the airport to return the rental, then take her to the gate. After that, Mom turned off her phone. A neighbor helped her load her car at 12:30 the next day. The flight left from DFW, three hours away, at 3:30. It was impossible to make that, but she chatted with the neighbor as if she had all the time in the world. She was driving 80 miles an hour (not at all unusual for her) when the rental car left the road and flipped in the air after hitting a water grate in the median. She never applied the brakes. Fortunately, no one else was injured. She died on impact.
It wasn’t a heart attack, or anything the M.E. could find other than blunt force trauma. But there was a travel case full of medication.
We will never know if she began taking tramadol again the night before, or the morning of, but her confused state seems to point to that. On the other hand, withdrawal symptoms from tramadol are such that they could have contributed to her sleeplessness the night before, and to any number of other outcomes leading to the wreck.
Because of her experience, none of us have ever taken the drug. Until recently, when I began having debilitating knee and back pain related to 20 years of martial arts, and genetic arthritis. Still, when it was first prescribed I refused. Finally, in desperation, I agreed to a short trial of tramadol, with the understanding I would be pursuing physical therapy as well. All went well for the six weeks of use. And then I stopped.
That night I experienced sleep disruptions that were hallucinatory. I “felt” someone get in bed with me and wrap an arm around me. Twice. I live alone. I “saw” my dog on the bed. She is old and unable to get on the bed. I “heard” noises of someone in the apartment. The next morning I felt not just tired, but heavy and groggy, and that continued through the day. I was better by the next day, except for ongoing brain zaps, similar to ones that happen when I miss a dose of Cymbalta. It turns out tramadol affects the reuptake of norepinephrine and serotonin, as does Cymbalta. It also affects dopamine, which gives the mild high feeling that people get addicted to. Your brain likes it so much, that, like opioids, the brain convinces the body it is in pain so you will take more or continue taking it.
Tramadol may not have directly killed my mother, but it most likely contributed. And it is NOT the harmless drug Big Pharma and doctors would have you believe.