BMJ  2005;330:137 (15 January), doi:10.1136/bmj.330.7483.137-c

Filler

A memorable patient

With a serene face

An 82 year old Chinese woman, a Buddhist, with a recurrent carcinoma of the stomach had been cared for by our hospice home care team for two months. On 8 August, she complained of increased pain in her back, and her condition had deteriorated considerably. After a discussion with her daughter, a Catholic nun working as a hospice nurse, we decided to give her morphine every six hours instead of simply increasing her existing codeine dose. A single dose was given at 12 35 pm, and the patient died that evening.

Having recently had a similar incident with morphine, when the patient's family reacted badly to the sudden death of their loved one, I was apprehensive when the patient's daughter asked to see me 10 days later. To my relief, she came with a thankyou card and a donation. When I asked her whether she was surprised that her mother had died after a single dose of morphine, she said no and told me something that was an eye opener. She said that she had spoken a few times with her mother about "letting go" as her condition worsened, but her mother had said, "How can I go when I am in pain?"

Being a Buddhist, she believed in dying with a serene face, and her daughter told me, "The morphine relieved her pain, and she left peacefully." She also said that her mother had wanted to die before 16 August, when the seventh Chinese month ("Hungry Ghosts month") began, and had wanted a seven day funeral. So she went when she was at peace, and her funeral could be completed on 15 August.

Hospice Care Association, Singapore (akhileswaran{at}hotmail.com)

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