Decision

Mum's eyes were open wide and behind her eyes I could see feelings of discomfort. It has been six hours since the last morphine injection (into mum's IV port). "What's wrong? Are you in pain? Are you feeling bloated? Is something bothering you?" I kept on asking mum, but there was no response.
Mum lifted up her arm, took a long look at it in the air. I saw her arm was trembling slightly. Then she proceeded to lower her arm and  her hand reached for her lower abdomen. She scratched that area for a while. "Is there something wrong there? Are you feeling discomfort there?" I asked. Weakly, she nodded.

I went to the nurse and asked for another morphine injection. The evening nurse began to explain that with mum's condition her body needs to rest, and the discomfort and pain she may be feeling as soon as the effects of the morphine wears off is disturbing her sleeping pattern. "She is so weak now, on her last reserves. Her body needs good, deep sleep. Every few hours when the morphine wears off, she wakes up and has to fight against the pain. It takes a lot of energy and strength." Earlier today, brother was alarmed by how much mum has been sleeping ever since the regular morphine injection began last night. The doctor then suggested to go back to a "need" basis, whereby morphine would only be administered when mum feels pain.

The evening nurse is a lady in her fifties, with greying hair and a kind motherly face. She explained to me, from her experience, it is more important that the patient gets good rest, and having to wake up to pain, or wake up because of pain, is very difficult on the body. "The morphine will make her sleep better. It may be that she is sleeping so much because her body has reached that stage. But the morphine will ease the pain, and also help the patient to breathe easier as well less the patient's anxiety." Sometimes, if the body has rested enough, the patient may wake up feeling refreshed and can be very clear minded.





"From your experience, do you think mum has reached that end stage?"

"It is very possible. But sometimes you have to let go. And it may not necessarily be a bad thing that she is sleeping a lot. The morphine will keep the pain controlled so that your mother is comfortable. Sometimes we have to think of what the patient would like, and not about what the family wants..."

I understood what she was saying. Though I am wary that the regular morphine injections will make mum more and more drowsy and less and less coherent, the bottom line is I do not wish mum to be in pain or have unnecessary suffering. I told my brother if he has anything he wants to say to her, do it soon, otherwise there may be a point when mum cannot respond any more. Now, she barely answers when you ask her a question. The nurse said it's because she's using every ounce of energy left in her body to deal with the pain and discomfort she is feeling that she does not have the energy to respond.

"But she can hear you. She can still hear what you say, so you can talk to her. And her mind is still very clear and conscious. There are a lot of things we do not know yet, but the brain is still functioning and inside her mind she is dealing with a lot of issues and emotions, even though she is silent and does not respond when you talk to her," the nurse said.

I discussed with the nurse for a good while about whether to go back to regular injections of morphine. My feeling is yes, but it is too big a decision to make on my own. I know mum would like to be as pain free as possible; she told me that before many times. "I still need to discuss with my brother..."  I said.

I called him. He picked up and was very anxious, for he thought something was wrong. He has been very edgy (and moody) these days because of mum's continual decline. It is really affecting him a  lot, I can see that, and he does not seem to know how to deal with his emotions, so he gets frustrated and angry easily. Plus, he has a kid to take care of, and doesn't really sleep well because the baby wakes up during the night.

I explained to him mum's pain and what the nurse recommended, and he agreed to the regular morphine injection. He wanted to come back to the hospital, and asked if I wanted to return home to sleep, for I have not spent a single night at home since my return two weeks ago. "It's alright, I'll stay here," I said. I feel safer and more certain this way. And without passing judgment on my brother, I think mum also feels more comforted having me around, because I am more caring and attentive, and I touch mum a lot to reassure her. "I will call if there is anything..."

Mum is sleeping again. Sleeping and not feeling much discomfort anymore. Just as the way it should be...