The son of a cancer patient asked me, “Why is my mum not dying? How long more do I have to wait?” I was disturbed by these questions as it is not normal for a family member to want to hurry death. She had very advanced stage of colorectal cancer with spread to the liver and the lungs. She had been started on morphine tablets but refused to take them. When I asked regarding her reluctance, her reply was, “Jesus suffered more pain than what I am going through. I want to feel that pain.” For a moment I did not know how to respond. Then I informed her that her suffering was causing pain to her only son and if she did not want her son to suffer too, could she please take the morphine to ease her suffering as well as her son's. I requested the nurse on duty to monitor her compliance with pain medication. The nurse reported that the patient has been cooperating and that her pain had reduced. During my next visit, I sat with her and merely asked if she found it easier to pray when she had less pain. She said “Yes”, with a smile.
I explained to the son that I understood why he had asked those desperate questions and I encouraged him to spend more time with his mother so that when the end came he would have a good feeling about all the time spent with her and have no regrets.
Dilemma Faced by Doctors
Doctors are trained not to interfere on religious issues so I had to strategize carefully to ensure the mother’s pain was under control. By linking her pain control to her prayers and the son’s pain, may have made her to take her medicine. Hence the son got to spend time with her without having to watch her suffering in pain. Many times he would pray with her. As simple as it may sound, a good deed for another does help the person doing good. So the son, by to spending time with his mother and feeling he was doing a good deed, managed to remove his frustration and keep himself happy.
This was a complex scenario but by no means unique and this solution is not as simple as it seems. In the first place why did the son ask such a question? Did he really want his mother to die? Or was it that he could not bear to see her in pain? Did he express his frustration because of his mother’s suffering?
Twenty years ago morphine was associated with drug addiction and it took many years of public education to remove the stigma and convince normal people that morphine had medicinal uses too. However the stigma still persists in a different form. Being religious, perhaps the patient felt that morphine was a drug and therefore taboo. Besides she thought she would be a better Christian if she endured the pain. She was suffering both physical as well as spiritual pain.
If we doctors can see beyond the surface and understand the source of the pain and the links between physical, emotional and spiritual pain, we can achieve better results in our pain management. Besides, using our insight and skill to relieve pain for another human being is an act of kindness which benefits us too.
It is not only the patient who suffers pain. The immediate family undergoes much distress and spiritual and emotional turmoil as well. In addition doctors have to be alert to these signs as that would enhance the doctor’s skill in managing not only the physical pain but other aspects of pain for the patient