The poor old lady had been through a lot in recent years. Cancer had treated her harshly, and had spread through major organ systems, her liver, lung, and most of the bones in her body. A cruel disease that robbed her of her independence, and dignity. The years that she had the cancer had been relentless, multiple lines of treatment including chemotherapy, radiotherapy, targeted therapy. Despite all of them the cancer continued to progress, to cause havoc, and to ravage her body, and eventually her mind.

The past month had been the worst time of all. Her final decline started with a fall, it was not clear why she fell but she ended up fracturing her wrist. A painful injury that caused her to cry in agony. Her lower arm was placed in a cast for comfort and to give it the best chance to heal. Three days later she fell again, with her other hand outstretched, causing another wrist fracture. Two forearms were now encased by fibre-glass casts. This rendered her unable to wipe her bottom or wash herself. Increasingly dependent she had trouble feeding herself, the casts were of the light weight sort, but when your illness has stolen away precious muscle, the additional weight made brushing her teeth impossible.

Pain was not controlled well, and this led to great distress for her family. Her daughter a nurse tried her best to advocate for her mother, but the staff at the residential care facility were unable to respond appropriately to mother’s needs. A truly stressful time for the family. Visits from her elderly husband were also difficult as he was deeply lost in his personal black forest of dementia. He couldn’t express himself well any more but could sense that his wife was unwell, and he was trying to help but this only created extra distress for patient and family.

Things were tough enough already, then the nausea and vomiting started, as soon as the bowel motions had stopped. In complete bowel obstruction. The acceleration at the end of life in all its awful glory. Nature was trying to take her away, she became sleepier and less responsive. Progressively more unwell, and in greater distress and suffering. There was only so much a body could take.

Admitted into hospice for end of life care. A last ditch trial of medication to see if it would help, but this was thought to be unlikely. The concern I had was that our treatments were no longer prolonging life, but were actually prolonging dying, and the suffering that it wrought. I talked about wanting to do the right thing by our patient. To not let her suffer any longer than necessary. “That’s what she would want too,” she said that, “she had enough, and was ready to die.”

Active treatments were discontinued, and our patient would be for comfort cares only. The nurse was asked to let our staff do the caregiving, that it was important for her to be family. “Tell your mum what you need to, she can hear you but might not be able to respond. Keep on loving her. We’re going to get mum through this, and get you all through this too. If there is anything that we can do for you, please let us know. “