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.