Case 1

A boy with congenital rhabdoid tumour of the face received palliative care at home for progressive disease. The tumour grew to involve almost half of his face, with inferomedial displacement of his palate. He presented with pain seven weeks before his death. Initially the pain was controlled with codeine and simple analgesics, but it eventually intensified. He was then treated with morphine. The dose was gradually titrated upwards to relieve his pain. He stayed normally alert and interactive as the dose was increased.

Two days before his death, he developed sudden signs of obstruction to his airway, with stridor and respiratory distress. He had been prescribed lorazepam in anticipation of such an event. This was titrated until it helped. He was sleepy but could be roused, and he no longer seemed anxious, despite visibly laboured breathing. …