Dear America,
Morphine (Photo credit: Wikipedia)
On Wednesday morning I sat with my nearly ninety year old mother as she lay unconscious in her hospital bed. At 5:00 a.m. she died in a relatively peaceful state because of a morphine drip that had been feeding her that ultimate analgesic for about twenty four hours. She suffered from osteoporosis and her spine was bent and stooped to the point that she could sleep only on her side. She was in pain every time she moved in her bed, and had been for a week since she had been hospitalized for a blocked bile duct. The blockage had caused her gallbladder to engorge with fluid resulting in pressure that had made it painful for her to walk, or even to get out of her bed when she was still at home, and by the time she died, she had had a permanent drain in her gallbladder for two days. You should know that my mother...health failing to the point that living each day was a trial for her...had wanted to die for some time. She had told us all many times that she felt that way, and while we all tried to encourage her to go on, it had become increasingly obvious that nothing was going to change, and I for one had begun to hope that she would get her wish, just to relieve her pain. At that moment early in the morning on Wednesday when the night was just about behind us and the day was beginning to come in through the window, she quietly took three shallow breaths and then stopped breathing at all. Twenty or thirty seconds later she took one more shallow breath and then it was over. She was finally where she wanted to be.
Of course, my mother's death was a loss to everyone left in my family, but we all had known it was coming, and for a week that it was imminent. We had been there--all together at first and then in shifts at the end--for a week and we were exhausted, but not just by our death watch. There had been the problem of dealing with the medical establishment at the hospital as well. The doctors seemed concerned that allowing my mother to progress too quickly toward death was unethical, illegal, imprudent or something else...or maybe all of those things. So the movement toward making her comfortable was at a snail's pace. Initially she was put on increased doses of oxycodone, which was the pain medication she had been taking for months after being on vicodin for years. In fact, it was the pain medications in general to which I attribute the painful quality of her life in that the body becomes inured to its effects, requiring ever increasing use of the drugs with lesser and lesser effects. It's paradoxical, but we just don't know enough about pain to obviate the ever-increasing reliance on pharmaceuticals in chronic pain cases. And in the hospital, the treating doctor we saw last made it plain that the increasing use of the pain medications was adverse to any chance of recovery for her, but he also made it clear that the chance of such recovery was extremely small, and there would perhaps never be any possibility of relieving her pain...even with surgery for her back...because her heart would not tolerate surgery. She had had a small heart attack a month or so earlier and she had been in heart failure for some time. So the end was ineluctable and imminent, and as a family--in consultation with a doctor in the hospital whose specialty was "palliative care"--we agreed that the best course was to make her comfortable and wait for events to take their course. That was on Sunday. From there, the doctors only allowed progress toward full sedation...taking small steps one at a time...and I understand why, but I can't help but regret that my mother had to suffer more than necessary in order to satisfy the aversion to the relief of death that our fundamentalist constituency has forced us all to live with...at least in New York State. Mind you, I am not even suggesting that my mother would have been better off if we had euthanized her, though I must admit that I was open to the idea by the end, but the fear of providing too much pain relief in such an imminently terminal case resulted in unnecessary suffering.
For the last 36 hours of her life, she was on the morphine pump with an attachment that allowed an extra dose twice an hour if the pain made it necessary. The morphine kept her asleep for the most part, but she would occasionally stir and grimace and groan as she tried to move. Some of the nurses were attuned to her suffering and they took the affirmative step of checking with us on the half hour...giving her the extra dose if we thought she needed it. But other nurses were reluctant and resisted, citing the fact that such powerful analgesics also suppress breathing, implying that doing so might hasten death in a way that they either felt prohibited or immoral. Of course, it was only the less experienced nurses...even on the oncology ward to which she was moved because it was the closest thing the hospital had to a hospice unit...who resisted providing the relief that our poor mother needed, and I believe they were sincere in their reservations. But the result was unnecessary pain in what we all knew was a futile effort to avoid imminent death that would finally relieve my mother's earthly suffering. And it is not unworthy of mention that the constant struggle to get some of the nurses to give our mother the only thing that could help her was traumatic and taxing for all of us who loved her, though our mother's well being was paramount to all of us.
My point is not to vilify those who have an aversion to the decision by human beings as to when life should end. I have my opinion, but I respect the right of everyone else to have his. However, the timorous doling out of relief to the dieing who are beyond other help seems unconscionable to me, and the only way to prevent it is to fashion something in the law that is between permission for euthanasia and an outright prohibition. We need to infuse the law that relates to the final days and moments of life with some compassion and realism such that the medical profession can provide relief without fear of prosecution. When a loving, concerned family decides in accord with a loved one's previously expressed desires to allow life to end, it shouldn't be necessary for them to watch, nor should it be necessary for their loved one to suffer, a painful end that could have been avoided with compassionate ministrations of one kind or another. My mother's death was caused by time, not by her morphine use. The morphine helped, but it could have helped much more if it had been administered unstintingly. The only reason it couldn't be was that our law has not yet evolved to allow us to make the distinction between technical murder and compassionate relief of pain. There ought to be a law.
Your friend,
Mike
Leave a comment