More Certain Than Taxes, and More Painful

In a few days I’ll be at a Cambridge University event, speaking to students who look forward to careers in the media.  But today I’m looking back at a serious topic.  My piece last month in The Sun newspaper went a bit like this…

Life is complicated, but dying is even more so.

As a doctor I’ve seen many patients whose lives are utter misery.  They’ve reached a stage where nothing can relieve their suffering and make their days bearable.   Some of them beg for death.  But assisting a suicide is against the law in England and carries a sentence of up to 14 years.

If it were the beloved family pet, the answer would be clear and compassionate.

It’s heart-breaking to have a relative who longs to die, and I really feel for the families, especially as my own mother is now suffering horribly. 

My mum’s spine is deformed and broken from severe osteoporosis.  She howls in pain, and in anticipation of pain before even being touched.  She’s incapable of doing anything now.  Every single thing the devoted team of nurses do for her hurts acutely. 

Sometimes she lies in bed yelling that she’s in agony. Or else she shouts over and over “Please help me, please help me.” Mum and me crop

No longer the person she was, she weighs 35kg and stares with blank eyes.  Everything she has been through in the past two years, including a major op that she nearly didn’t survive, has left its mark.  The pain is literally causing her mind to go, but she is still aware of how bad things are.  I sit by her hospital bed and hold her hand, and she sometimes tells me she wants to die.

Increasing the painkillers makes her more confused.  Some of the drugs make her paranoid.  I’m still hoping there’s an answer because it’s so awful to watch her suffer.

Don’t get me wrong.  I was never immune to the suffering of patients in situations like this, but when it’s one of your own you can appreciate the back-story and see the whole perspective of their lives.

Medicine has a lot to answer for.  Many people wouldn’t be alive had it not been for doctors.  On the other hand, medicine isn’t a perfect science and never will be.   I’ve been a doctor long enough to know at first hand that medicine is good at prolonging life, but not so good at sustaining its quality.   

When quality of life is appalling, or treatment too awful to bear, then the balance of pros and cons may suggest that treatment doesn’t benefit the patient.  In making that decision to withhold treatment, the relatives and patient’s wishes are vital.  If the patient can’t take part in the discussion, his previously stated wishes are taken into account.

Withholding treatment is totally different from deliberately hastening death, whether or not it’s with the patient’s consent.    

But there is what’s called the doctrine of double effect.  This makes a distinction between acting with the intention to kill, and performing an act where death is an unintended effect.

For instance large doses of pain-killers can shorten life.  But doctors give them only with the intention of relieving pain. The doctrine of double effect says that’s morally right, even though the primary effect (pain relief) comes with the risk of a harmful side-effect.  Sometimes that harm can even be foreseen, but according to the doctrine it is still OK, as it achieves the main benefit, which is relieving pain.

However the double effect isn’t often the get-out clause it appears to be.  Nowadays there is a huge range of pain-relieving drugs, and dosage changes tend to be tiny, so they rarely shorten life.

Medicine has come so far now that we need an urgent way forward on that most basic event, death.  Not all doctors are agreed on the right course of action.  If assisted dying is introduced in any form, we’d need strict safeguards against abuse, greed, negligence, incompetence, and probably a few other things as well.

Some doctors are vehemently opposed.  Personally I fear that legalising assisted suicide could change the doctor-patient relationship forever.  On the other hand, there’s also the hope that it would help medics honour Hippocrates’ order: “To cure sometimes, to relieve often, to comfort always.”

Since then, my mother has died, ending our suffering, though it continues for other families.  

 

How are you today, Granny?

old persons crossingNo matter how good a doctor you are, if you don’t look after your own, you’re right at the bottom of the class. That’s the opinion of Geoff, a 30-something general practitioner from the pages of my novel One Night at the Jacaranda.

Granny shuffles to the door in furry Elmo slippers. ‘I haven’t been for three days,’ she says, adding, ‘I’m 92 you know.’  Geoff is pretty sure she’s only 90 but Granny often adds a year or more for effect.

She doesn’t see her friends anymore.  Yet today she insists she sees them daily and plays bridge.  ‘Elsie even brought me chocolates this morning.’  When Geoff looks at the box, he sees the sell-by date is 2011.

Apart from her bowels, Granny’s life now revolves around food and meal times, but she only picks.  Geoff checks her fridge and throws out rotten pears and expired cheese.

Today she demands a haircut.  ‘You were going to be surgeon,’ she reminds him.  He’s not sure he was training to cut the three strands of white hair left on the old girl’s head, but he gives it a go.  She stands in the bathroom, clutching the sink and bending down so he can reach even though he’s no longer the small boy she read stories to.  He’s 5’11” and she’s shrunk to about 4’10”, so he practically has to kneel.

Although it’s August, there are Christmas decorations all over the bathroom, or rather the bits she can reach.  Granny has never before celebrated Christmas.  Now she reaches out with a sinewy hand to adjust the tinsel on the towel rail then looks at him proudly. ‘I’m 93, you know.’

Today is a good day because it’s only her shoulder and her constipation.  Last week it was her knee and a rash.  The week before, it was her ankle, which she sprained on VE Day 1945.   He said it was just wear and tear, so she poked him with her walking stick and called him stupid. Geoff can’t understand why her mental state fluctuates so much.  Obviously dementia has a vascular component, but how can it possibly change to that degree?

‘I’m going to do Big Poo,’ she announces.  This reminds Geoff of his son.  The difference is that five-year old Davey’s brain is still making new connections between cells.  In Granny’s case, the opposite is happening.  He imagines her brain full of holes, like Emmental cheese.  He’s glad his mother died before she got like this, even though it meant Granny lost a daughter.

She installs herself in the toilet, legs not touching the ground.  Geoff knows this because she won’t let him shut the door.

So he waits in the darkened living room, where there’s a pile of plastic bags, all neatly folded on the sideboard, a stack of old envelopes which could be useful for making lists, and electricity receipts going back to 1988.

Alte kakers.  Only Granny makes Geoff want to break into Yiddish.  She makes him want to break into the Bristol Cream sherry too.  There must be an unopened bottle in the sideboard.

Geoff remembers that alte kaker means ‘old shitter’.  As he waits for Granny, he thinks of the words patients use.  Faeces.  Number Two.  Dump.  Crap.  Ploppies.

He’s sure an hour has passed, but when he checks Granny is still on the throne, with her legs sticking straight out.

‘You know I love you, Bubala,‘ she calls out from the toilet, voice still strong.

‘I love you too, Granny.’

elderly hands

 

Related posts: 

An Evening at the Proms

Hospital Tests: Has the Doctor Got it Right?

Germs and Geriatrics

Six Characters in Search of a New Year’s Resolution

The only child is forever

Corfe Castle 3One child is the ideal number, says writer Lauren Sandler.  In her book The One and Only (and in quotes all over the media) she reckons having more than one child gets in the way of success, especially for women writers.

Why?  Kids don’t necessarily stifle creativity.  But I agree that they eat time.  My three children, all born within two and half years, needed constant attention.   To carve out time for writing, I’d put the twins in the car and drive around till they dozed off.  It was a lesson in churning out copy quickly.

Today, interruptions still come thick and fast.  My elderly mother just asked me for the third time whether she took her painkillers.  And she’s uncertain of the dose: ‘It says one twice daily on the box. How many should I take?’  She dithers about what to wear and what to eat, and she’s increasingly impatient, but most of all she forgets.  She can’t even remember that I’m getting married.

I loved it when I read my kids, when they built tepees from fallen branches, or when they just laughed.  They kept me on my toes, like the day one of them trapped his twin’s head in a bucket.  One morning, another son made off with his big brother’s school tie.  How was I to guess he’d shoved it out through the cat flap?

Now it’s my mother’s things I search for, her lunch I prepare, her hair I cut, her bandages I change.   She checks with me whether she had a shower this morning, but she doesn’t hear my answer.  When I repeat it louder, she accuses me of shouting.   It’s tough looking after elderly parents, and I’m not as young as I was either.  But there’s nobody to share it with.

My eldest son wanted siblings, and here was one clue: as a toddler he’d hide his friends’ shoes when they came to play so they couldn’t go home.

I too longed for brothers and sisters, but I never got them.  It was no fun playing board games against myself, though at least I always won.  I look back on my childhood as a lonely time, but it’s a lot worse now.  You never grow out of being an only child.

Back to the ideal number of children.  What do you think it is?