Relieving the Pain

One of the goals of writing this blog is to explore end of life decisions and to try to understand the necessity of thoughtful pain management. In preparation for writing for this site, I have read various comments from families about the pain management done for a family member. Some of those comments have been quite negative.

Several felt that too much medication had been used and that the goal of the hospice team was to keep the family member sedated even when it wasn’t necessary. Sometimes the person writing the comment felt that pain management had hastened death. While I can’t answer questions as to whether or not the pain management used in those instances was appropriate, I can write about three clients for whom pain management definitely made a difference in their last days.

Greg was a relatively young man in his forties who was transferred from home to the in-patient hospice unit where I worked. He was suffering from stage 4 lung cancer that had metastasized to his bones. The first few days he was there, he was conversive and able to talk about his life and what was happening. He was on high doses of morphine. Other pain medications were added as his level of pain intensified. I can clearly remember the afternoon I took care of him when he was writhing in pain and begging for help. He was pleading with us and with God to help his suffering.

All of the physicians on the staff of the in-patient unit were certified hospice and palliative care physicians. They understood the necessity of being aggressive with such intolerable pain. With Greg’s permission, he was placed on thiopental, a drug which brings on general anesthesia and slows the activity of the brain and nervous system. He became unaware of his surroundings and the pain. He would be brought out of the anesthetized state every few days to see if there was some improvement in his pain levels. Each time, he begged to be anesthetized again. He didn’t want to die conscious of the horrible pain. He was in this state for about a week before he died. I remember well the peaceful days he was able to have at the end. His family was grateful that they didn’t have to see him suffer as they were with him those final hours.

Bill was another man who was also in his forties and suffered from metastatic bone cancer. He was transferred from home because his pain levels were too severe for his family to handle at home with the amount of pain medication they were able to give. Bill was also placed on thiopental and experienced great reduction in his pain levels. He was able to have some days without the thiopental and was able to interact with his family while taking other pain medications. Before he died, he expressed thanks for being able to spend his last days with minimal pain with his family beside him.

While Greg needed to be sedated, another client, Zach, was able to have his pain levels reduced to a level that allowed him to participate in one of the most important days in his and his family’s life. He was the father of two young girls, one of whom was twelve and looking forward to her Bat Mitzvah the weekend after he was admitted to the unit. His only goal in life was to be able to celebrate with her.

Pain management was carefully planned with him and his wife so that he would be able to leave and be present at the ceremony. He left the unit the day before the ceremony and was able to spend the night at home. He made it to the Bat Mitzvah to be with his daughter on this important day in her life. They returned to the unit after the ceremony. His family surrounded him the next day as he slipped into unconsciousness and died that evening. I spent time with the family as he was dying. They talked about how this experience was able to help them have some hope for the future. They were suffering, but the joy that their husband and dad experienced that day would live with them forever.

Every person’s pain is unique. There is no “one size fits all.” When someone facing the last months, weeks, or days of life is experiencing pain, it is hoped that they are able to have medical personnel that understand the uniqueness of each person. With thoughtful care, it is possible not to have the last days be concentrated on the pain. This will have a lasting effect on those left behind with the memory of those days.