Easing the pain

5th in a 12-part series

She kept her arsenal of tablets within easy reach. Vicodin, Lortab, Percocet — Vicki Atkin took one every two hours, rotating them to avoid side effects. But as her cancer progressed — creating excruciating pain in her bones and muscles, swelling her legs and belly until her skin felt several sizes too small — the painkillers were no match for her agony.

The 43-year-old mother of two children, ages 18 and 4, had melanoma that moved into her ovaries, her spleen and throughout her abdomen. A malignant mole was removed in 1992 and her family celebrated a win. But 18 months ago, the cancer came back. After four failed rounds of chemotherapy and experimental treatment, Atkins died on Tuesday.

But she did not die in uncontrollable pain.Two weeks ago, Applegate Hospice began caring for Atkin. They put her on a morphine pump, and brought in gel that could be rubbed on her wrists to combat nausea and anxiety.

Patients need not suffer, according to doctors who specialize in what has commonly become known as "pain management." Yet pain is undertreated, says Dr. Gary Garner, a physician with VistaCare Hospice. "Fifty to 75 percent of people with chronic pain live with too much pain."

Unbearable pain in the here and now — more than thoughts of the hereafter or death itself — is what most people fear when they imagine dying, according to the Partnership to Improve End of Life Care in Utah.

Pain is Michaelene Pendleton's most vivid memory of her mother's death two years ago. Jeanne Smith had been ill but undiagnosed for a couple of years, then doctors said she had lung and liver cancer. Before her misery was given a name, she went to doctors who advised her to change her diet and get more exercise. One suggested she was a hypochondriac.

Eventually, the hospice near where she lived in Colorado put her on a morphine patch, augmented with high-dose morphine given under her tongue every four hours. When the pain was still intense, morphine suppositories were added.

But Pendleton wanted her mother with her. So she brought her home to Utah — and they had to start over. The new physician said no one needs that much pain medication. Though eventually she got some relief, her pain was never completely controlled again.

"Pain's a killer as much as disease," Pendleton sighs. "It's part of all the things that contribute to giving up."