Chapter 12 - The End

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"You have been asking us 'When' for a long time. I cannot tell you exactly when, but I do not think that he has long left to live. I have always said that you would know in your hearts when the time arrived and I feel that the time it is quite close. I would say that he has between three days to three weeks left. If he lasts three weeks then I suspect that he will be exceptionally ill."

She was right. We knew that his time was nigh and were not surprised by her announcement. There were no tears. The time had finally arrived. We knew Max was terminal, but this was the final reality. This was the last nail being hammered home. We now had to meet Death face to face. We took it very quietly. My previous worries about the morphine dosages became completely irrelevant. I had become worried when his dosage had increased to ten milligrams. He was now receiving hundreds of milligrams of morphine per day.

The tablets became difficult to administer. Max could barely eat and taking tablets was yet another imposition on his shrivelled body. A very good method of administering morphine is the morphine pump. This is a small pump which delivers the drug via a thin intravenous line and the dosage can be controlled by the patient when the pain starts to get out of control. In Max's case the disadvantage was the intravenous line. He had a deep dislike of intravenous lines and steadfastly refused this option. We tried to persuade him and explained that he would be better off if he used the pump. It was to no avail. Our prime desire was accede to his wishes and we did not pursue this treatment. Instead we were given the option of an experimental treatment. This was the use of morphine patches. These work like nicotine patches and provide a slow and controlled release of morphine. Their great advantage is that they are not invasive and are easy to apply. This was the medication which Max wanted.

The pain continued and everyone who saw him, the doctors, the nurses and ourselves thought that Max would die in a couple of days.

Three days after the initial downturn, Max had a sudden revival. He pulled out of his semi-comatose state and asked to eat and managed to watch a little television. We and the support team thought that this might be the last 'rally' which many people have before dying. He rapidly deteriorated again the following day and his pain increased considerably.

I had been given instructions on how much I should increase the morphine dosage but the patches did not seem to be working adequately. I rang the Royal Marsden Hospital to get further guidance on their use. I was advised to give another patch if the pain continued. The pain had subsided but I gave the patch anyway. The pain broke the through the morphine barrier a couple of hours later.

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