My views and experiences on analgesia for terminally ill patients.
Please note that this entry dates back to 2000. Things have improved significantly in the area of palliative care since then. This entry is also only my opinion.
I was a State Registered Nurse for over twenty years so have seen my fair share of death. I am not afraid of death. I never have been. I am, however, petrified of dying in hospital in pain. This stems from my experience as a nurse.
As a nurse, looking after terminal patients, I did my job and went home. I never took my work home with me. I did, however, become angry when I would see a patient in agony being prescribed an inadequate amount of pain relief.
I would become angry when a doctor, usually a junior doctor, would enter a patients room and prescribe them the lowest dose of pain relief (about 1mg morphine) without even looking at the patient, let alone assessing them. This would leave me to do what I could and try to console and calm the patients upset and angry family.
On one such occasion I gave this minimal dose with nil effect. The doctor just happened to walk past the ward half an hour later. I rather abruptly took the doctor to the patients room and pointed at the patient who was still writhing in pain. The doctors face went bright red and he immediately prescribed a higher dose of morphine. Fifteen minutes later the patient was pain free and lucid. Their family members were much more settled too.
I would like to see a prescribing doctor be inflicted with the same agony as some of their patients for half an hour. I guarantee that their pain relief would be much higher.
I recall one occasion where a terminal patient was prescribed a morphine dose of between 1mg and 10mg to be given dependent on their level of pain. Unfortunately I was a junior nurse. The senior nurse that I was with decided to give 1mg of morphine and work our way up if it didn’t suffice. My philosophy is start on the highest dose and work down. On this occasion I was right. The small dose of morphine didn’t work so the patient was stuck in agony until their next dose of morphine was due 4 hours later.
When their next dose was due the senior nurse got the hint that I wasn’t happy and asked me what dose we should give. I said 8mg morphine. It worked within minutes and we now had a baseline to work with until their condition deteriorated.
I did experience one incident that infuriated me. A senior nurse, of all people,stated that she had concerns about the morphine dose prescribed for a patient who only had a few days to live. “What if they get addicted?” they said. I couldn’t believe my ears. Addicted? So what? This poor person only has days to live. Addiction isn’t an issue.
In this day and age, nobody should die in pain. Cannabis and heroin for hospital use is not legal globally. Why not? It should be. It’s cruel. Cannabis has been proven to be a more effective painkiller for bone cancer than heroin. Why isn’t it available where necessary? I’ll tell you why. Drug companies but don’t get me started on them.
I’m probably going to get shot for saying what I’m about to but if you spent one minute in my nurses shoes you just might understand. I believe that euthanasia should be legal globally. I don’t advocate ‘bumping people off’ at random. The decision must be that of the patient. If they are unable to make this decision it should be a family decision. This can cause conflict so in such cases the decision should be made by the doctor. Ideally the decision should be documented by the patient while they are still in a fit enough state to make such a big decision.
As mentioned at the beginning of this blog, I am not afraid of death but am petrified dying in hospital in pain. If I have the misfortune of seeing my life end in hospital, I shall be requesting as much morphine and cannabis as I can get my hands on. I will not suffer and will ensure that euthanasia documentation is attended.
Spend one minute with a terminally ill patient in hospital receiving inadequate pain relief and you might, just might, get an inkling as to where I’m coming from.
I saw people in your situation every week, Ron. Frustrating doesn't sum up my feelings. I ended up burning out after 22 years. Euthanasia is illegal in Australia but I have heard that it happens. Is it legal in any state in America? I have no doubt that it will be legalised one day....as people continue to suffer unnecessarily as we speak.
I agree with you 100%. The Hippocratic oath is hypocritical when it comes to the appropriate time for death. Many experienced doctors have given abortions and euthanasia secretly to avoid repercussions almost forever. It is only stupid religious people who have no pain who stick to such outlandish/archaic/torturous practices that result in brutalizing and bankrupting the less fortunate.
Twice in my life I came close to death without any pain. I was given the required dose of morphine to fend the pain off, allow me to relax (if not to sleep) and to eat. After receiving too much anesthetic on the operating table 53 years ago, I was awakened there to see if I was alive as a result of the injury inflicted on my spinal cord when my spinal column hemorrhaged during exploratory surgery.
It was only when I was being weaned from morphine 10 days later that I began to experience excruciating pain from returning feeling to nerves in my arms and hands. Without morphine, I would have been in pain during both hospitalizations for days. I left both without pain to begin rehabilitation.
After surgery on his heart valve and a bypass, my 85-year-old father was recovering well until he acquired one of those deadly hospital bacterial infections that gave him pneumonia twice in the next four months, leading to his eventual death. In the meantime, he had tubes down his nose and throat preventing him from speaking or eating and acquired bedsores from not being turned adequately. After three months, his Medicare and his supplemental insurance ran out. He was transferred to 100 miles away from where my mother and he lived and my mother had to divest all remaining assets so that he could get Medicaid to pay for the last month's hospital bill. I don't know if he was given palliative treatment just before his death or not--I hope so.
My brothers complained about his treatment, but it fell on deaf ears as the hospital continued to get its daily money from dad's insurance while he suffered. I don't want that to happen to me, and I want my death to be swift and painless through euthanasia. As soon as my only function would be to eat and stare at the wall or television with pain increasing, it will be time to go.
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Please note that this entry dates back to 2000. Things have improved significantly in the area of palliative care since then. This entry is also only my opinion.
