28 June 2012

Restlessness

Brother was crying on the phone. "It is such a difficult topic to bring up..." he said amid tears. I told him calmly I understand. How do you tell someone you want to up the dosage of the morphine, knowing very well that it may hasten the coming of passing? It is not that we want to kill her quicker. We just want to make her feel more comfortable and feel at ease, and go in a calm and peaceful way. I know mum would want the same, for she is suffering, in pain, in agony and trapped in a body that is dying ever so slowly. Must the suffering be unnecessarily prolonged, and for how much longer?

I told my brother I'll speak to mum about it. Mum may be dazed and confused, somehow when I ask her something in Taiwanese she seems to hear me and she does respond.

The doctor came by today and said mum may never leave the hospice ward. I knew this somehow already. I had a feeling. And I saw it in my dreams. The doctor gave us an excerpt from a book loosely translated as "Life's compulsory 10 lessons in life and death". In it, the chapter talks about what a person goes through mentally and physically a few weeks, few days and few hours before death. Within a few weeks, a "spiritual death" occurs, when the person becomes so tired and the body because exhausted. The inability to walk and the inability to go the washroom independently, and in many cases incontinence, will often cause the patient to question the meaning of life.

Within a few days of dying, the patient sleeps more and more, and in those brief waking moments the patient feels a lot of physical pain. Morphine is often used to reduce the pain at this stage, and partly because of the effects of the drug, but also partly because the body is getting ever weaker, the patient has more difficulty expressing herself, and is easily confused and forgetful. There may even be hallucinations, and nonsensical talking. This is where mum is now, I believe.

The doctor said she's going to go from six-hourly injections of morphine to a steady drip into her body. This way mum will feel more comfortable, and will be less susceptible to pain and discomfort, which can wake her up and disturb her sleep. Her body is "changing", as the nurses and doctor like to call it and I figured after so many times of hearing it, the word is just an euphemism for dying. As it "changes", the body rests more and more. Waking up every so often from pain or discomfort is a painful struggle for mum, for she has to expend what very little reserves she has left to fight the pain. A continuous flow of morphine will keep her continuously at ease.

The doctor recommended a dosage of 15ml per twenty-four hours. And an hour or so after the new regime went into effect, I could see mum become very agitated and restless, more so than ever before. Something was bothering her, but nobody could figure out what. Perhaps the dosage is not strong enough. Later the nurse revealed to me that specifically in mum's case, there are increase signs of internal bleeding that are related to progression of mum's cancer. This most likely is causing mum even greater discomfort and pain.

Calmly, I sat down next to mum. "Mama, brother and I discussed and we would like to increase your dosage..." I said to her. I held her hand as I said those words. Held her hand so that she feels the real intentions behind what I'm saying to her, so that she can feel and know that what I am proposing is out of our genuine concern for her wellbeing. "it's not that we want to make you go quicker, but we want you to be more comfortable. You've struggled long enough..."

Mum looked at me in the eyes. From the look I could tell she understood. From the look she agreed. Her nod and a very weak "Ok" confirmed it. Her agreement lifted a heavy burden off of my shoulders. I am her son, her own blood, and never did I imagine there would be a moment when faced with having to decide, or at least influence, my own mother's final moments...

I held her hand even tighter. "Let go, mama. Let go of this body, and let things take it's natural course..." These words were so similar to what I said to dad the moments before he left this world. The memory of that scene, four years ago, at this very hospital, merely a few storeys below where mum and I are now, made sadness swell up deep down. "This body is not ours... Relax. Let go of anything in your mind, let go of this body. Let go..."

Whatever happens in the next days or so, I will be by her side. And I will take her by the hand.

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