Chapter 12 - The End

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"I know Dad. My mind wants to go but my body won't let me."

These are the words of a child who was gaunt from the ravages of his cancer. These are the words of a child who was expected by the experts to die within the next couple of days. All through his illness and up to his death Max had shown an immense strength and a gritty determination to carry on whatever. He tried so hard and drew on all his reserves and resilience. He suffered during his last days and yet, despite the abuse of his body, the cruel irony was that at in the end his mind was so very strong and he just would not let go. His spirit dragged his body screaming and kicking to the end.

No-one could believe how much he had improved. On one hand it was a beautiful sight to behold and on the other very difficult for us as a family. In the previous days he had become more and more comatose, and just lay on the bed moaning and writhing in pain. During those pain racked days he became less and less conscious and was mostly unaware of our presence. Sara and I felt that we had seen the last of Max as a cognisant human being, and had reconciled ourselves to this fact. Suddenly he was back, quietly smiley, a shadow, but still the Max we knew and loved

The morphine dosages flattened out. I had increased his morphine intake to about one thousand two hundred milligrams. This was two hundred and forty times the initial dose, the increase of which had caused me such concern a couple of weeks previously. Again, steep learning curves. I talked to the Royal Marsden Hospital who pointed out that the dosages which I had used were radical. They told me that I had taken him into regimes which would not be tolerated by many children. I told them was that he was going to die anyway and that I was not prepared to see him suffer.

The risks of high morphine doses should be qualified. Morphine is excellent at numbing pain, but has many side effects, one of which is the depression of the respiratory system. If the morphine is metabolised by the body because it is needed to overcome the current levels of pain then the dosage will not cause death. Overdose occurs when the body cannot metabolise the morphine. There is also no 'standard' dose of morphine. It is administered to cope with whatever levels of pain are present at the time. The concern regarding the dosages I administered to Max arose because the morphine patches were experimental and had only just started to be used with children. The manufacturer set a prudent limit and I had breached that level. In addition to breaching the recommended dose, I was also told by a doctor from the Royal Marsden Hospital that my very rapid increase of the dose was very high for a child to tolerate.

The morphine also caused Max to hallucinate but not badly.

"Dad why does that fly keep flying across the room?"

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