Scopolamine? Bring on the Crazy
I woke up this morning convinced that I had gone on a booze-soaked weekend bender. The kind where you wake up and find yourself sprawled on the dank floor of a bathroom in the early light of some empty bar. Or on your front lawn with no house key. Or in the trunk of somebody’s car. Which is confusing because I haven’t woken up in a stranger’s trunk since at least my early twenties. And yet, here I was with the kind of dry mouth — your tongue swollen and stuck to the roof of your mouth, your ability to speak all but obliterated – that can only be explained by massive amounts of rotgut liquor. And yet I have no memory of the kind of events that could possibly lead up to such an inflamed evening. I respect the fact that, with enough tequila, you can lose hours, entire evenings, to the black hole that becomes your brain. It is a gift of biology that protects you from the most humiliating acts of the previous night. I did what with a chicken? Are you sure it was a live chicken? That said, you usually remember what you were doing before going out. Getting dressed, gassing up the car, whatever. I have no recollection whatsoever of getting ready for, or actually participating in, a wild night on the town. And it’s not that I don’t have a memory. I remember everything, and none of it involves boilermakers. If I’d been off buying rounds for strangers in a bar, I’m fairly certain my wife would have reminded me of it — not just the next morning but for the next month or two. Maybe year.
So what explains the horrific dry mouth? Let me be clear: This is not a feeling of being dehydrated. Nothing so simple that it could be cured by a glass of water. I’m that poor dog whose been fed a tablespoon of peanut butter by some mean kids and keeps smacking his lips trying desperately to free his tongue.
Here’s what I do remember: Dena and I were in Baltimore for a meeting with our oncologist at Johns Hopkins. Dr. Hammers asked me how I was doing.
“Fine,” I said, trying to be polite.
“No he’s not,” Dena flatly contradicted.
Dr. Hammers looked back and forth between the two of us. I sighed. “Well, I’m still having trouble with obstruction in my airways, and it’s causing some very uncomfortable blockage.”
During the bronchoscopy at Georgetown Dr. Anderson, my pulmonologist, burned out a tumor that had grown within my left bronchus and had nearly blocked the entire main air stem. I felt infinitely better, but, unfortunately, it didn’t last. I haven’t reached the level of danger I was in before, where my lung threatened to collapse, but the obstruction that remains somewhere still deep in my lungs is causing me a degree of discomfort. Think of when you suffered through at chest cold and you had that incessant need to cough up mucus secretions (also known as gunk in more sophisticated medical journals). These secretions are usually unnoticeable, and are in fact your ally in fighting off viruses. Healthy bodies produce one to one-and-a-half liters of mucus every day in the mouth, nasal passages, throat, lungs and intestines. These tributaries of snot operate like flypaper, trapping and killing bacteria. Which you routinely swallow and eliminate without realizing it. Until, that is, a major onslaught is faced. Say, allergy season or a virus. Then the body floods with histamines that thicken the mucus, making it stickier and more effective but also nastier and more intrusive. As the pooling builds, you find yourself in no mood to say, Thank you, oh viral fighters. Instead, you use every tool in your physiological arsenal to expel the gunk. It starts with nose-blowing and advances to coughing. The kind of hacking, slurpy cough of old men on park benches that prompt mothers to grab their children and walk quickly away with no eye contact.
I am the old man on the park bench. Indeed, I am on the short list for Patron Saint of Park Bench Hackers. I have been coughing up so much gunk that my entire body is in rebellion. It starts with a deep chestcough, unrelenting in its effort to expel excess mucus, hacking and hacking until it’s tough to catch your breath and the ribs grow sore and aggravated and call upon the stomach to get off its ass and join the fray and the stomach, happy expectorant warrior if there ever was one, leaps into the melee full force, turning over and over like a failed ignition until, without warning, everything comes up … your breakfast, the medications you swallowed that morning, perhaps some dessert from last night and, yes, even some of that distasteful viscous secretion that started this whole ugly confrontation in the first place.
While I’m grateful to my abdomen for all of its hard work, I find this process an unpleasant way to start each day. It doesn’t make for a good Kellog’s commercial.
My doctors are unsure whether the secretion buildup occurring in my lungs is the result, as before, of another tumor lodged within one of the bronchial tubes, or a byproduct of the many mets that are surrounding the air passages, irritating them and prompting their natural defenses to kick in.
Dr. Hammers had an idea, however, as to how to deal with the secretions.
“We could try Transderm Scop,” he said.
Uh oh. Another scope. I wondered which orifice would be violated this time.
“It’s a patch that fits behind your ear. Scopolamine is used for sea sickness. It does come with some side effects, though. Like altered mental states.”
“Sea sickness? But I don’t own a boat. Not even a kayak.”
“Uh, what kind of altered mental states?” asked Dena.
“Scopolamine is an anticholinergic,” said Dr. Hammers. “It tends to dry up the body’s secretions. I’m not sure it will work, but it could be worth a try as a way to deal with your congestive problems.”
“I’d wear it like a nicotine patch or something? … On my neck?” I had visions of my neck tattooed with a two-by-two inch swatch of cheap plastic. I’d known a guy in college who had tattooed his neck with a copy of the label for Dixie beer. It had seemed daredevilish at the time but we soon realized it had merely branded him an idiot for the rest of his life.
“Psychosis,” Dr. Hammers said. “Hallucinations sometimes.”
“Well,” I said, “if it may help dry out this awful congestion, anything’s worth a try.”
I caught up with Dena’s side of the conversation. Some talk about psychosis or something. She was wary.
“Look, my husband is crazy enough already. I’m not sure we need any extra crazy,” she said.
“I’m not totally familiar with all the side effects,” said Dr. Hammers. “I don’t prescribe this drug very often. I just thought it might be worth trying as a way to deal with the lung secretions.”
“What are the other side effects,” asked Dena.
There was an awkward pause as Dr. Hammers scrambled and failed to come up with an immediate answer. “You’re going to make me look it up, aren’t you?” he said. He didn’t wait for an answer and started tapping at his computer.
“I just want to know what level of crazy we’re talking about,” she said.
I could see some terror in her eyes, her mind scrambling behind them, imagining me running stripped naked down our neighborhood street, canned goods in hand, pronouncing the end of the world was upon us. Or writing furious letters to my congressman offering to testify about how the Russians were using satellites to beam their destructive messages though my teeth. Or me astride the roof of our house, a fresh batch of Kool-Aid at my feet, declaiming myself the last of the great prophets (alongside Oprah) and willing to take questions.
“So, we’ve got dry mouth, blurred vision, dizziness, rash and drowsiness as more common adverse reactions,” Dr. Hammers read aloud. “Some of the more severe – but unlikely – side effects include swelling of the mouth and lips, difficulty urinating, irregular heartbeat, hallucinations, altered mental states and trouble speaking.”
I could tell that Dena was torn. On the one hand, it would be irritating and inconvenient to have to deal with my hallucinations; on the other hand, the possibility that I might not be able to speak much … well, that certainly offered some promise.
“So, this business about psychosis is rare,” she confirmed. “What we’re really talking about is dry mouth and dizziness, maybe some blurred vision?”
“Yes,” Dr. Hammers said. “You could look up just about any drug and scan their pages of potential side effects and often see some very scary but highly unlikely adverse reactions. The FDA requires that drug companies list every side effect ever experienced.”
“Might I offer a suggestion?” Dena said. “The next time you start listing side effects of the drugs you’re prescribing, you might start with the less severe and more common rather than the freakiest and least likely.”
Dr. Hammers seemed to take this advice to heart.
My own advice would be to the drug makers. Instead of listing “dry mouth” as a side effect, they may want to describe it as “Sawdust Syndrome” or “Dog with Peanut Butter Disorder” or “Desiccated Mummy Mouth.” Not even a Lost Weekend of booze, drugs and rock ‘n roll could rival the kind of dryness I’m talking about. Even without the more severe side effect of “trouble speaking” Dena is getting her wish, as I can barely open my mouth most of the time. It’s as if she snuck a spoonful of Super Glue under my tongue during the night. She laughs when I ask her about this … but she doesn’t actually deny it.