‘I WAS WITH a young father recently who told me he felt like he had won the Lotto. He knew he was within weeks of dying of cancer, but he had his family around him and his relationships were doing so well that his quality of life was actually enhanced rather than poorer.”
Palliative medicine consultant Dr Dympna Waldron says that despite the despair of an advanced illness such as cancer, there is an adaptation that can occur in a person which allows an improved quality of life as they near death once the significant relationships in their life have been dealt with.
“The philosophy of our palliative care service is that by helping patients to live both pain and symptom-free and with good subjective quality of life, we empower them to live as whole and independent a life as possible, maintaining and enhancing rich relationships. By living well with maximum support, our experience is that patients die with peace of mind surrounded with serenity and dignity,” she says.
This experience of Dr Waldron and others working in the relatively new specialty of palliative medicine has been bourne out in research carried out by her and her team at Galway University Hospital. A new study carried out by Dr Eileen Mannion reveals that lung cancer patients in the west of Ireland reported that their quality of life improved rather than deteriorated as death approached.
This is the latest in a series of papers published by Waldron’s team to show the pivotal importance of relationships to people in advanced stages of terminal illness. The research was presented at the Cuisle Beatha (The Pulse of Life) international palliative medicine conference, which took place in Galway at the weekend.
Dr Frank Brennan, a palliative medicine physician of Irish descent from Sydney, addressed the conference on the ethics of the human right of every individual to pain relief and palliative care.
Brennan, who is also a qualified lawyer, lost his younger brother Tom to bone cancer at the age of 11 at a time when there were virtually no bereavement or palliative care services. The profound effect of this great tragedy on his parents led to his lifelong interest in how people were cared for at the end of life.
“Over the past few years, I have been writing stories of the moments when I have been humbled, challenged and moved by the patients and situations I encountered. I have seen that good palliative care can add so many benefits for patients with serious illness and their families.
“Firstly, palliative care provides very good symptom management, but it also addresses the emotional and spiritual dimension of what they are all going through.”
Dr Brennan points out that when physical symptoms and stresses are attended to professionally, this gives the patient and their family time to prepare for going.
“That sense of how the death occurs remains in the family narrative forever. The longer I’m in this, the more I realise that the work we do prior to death is so important in preparing the family for bereavement. If a patient has a good preparation for a dignified and peaceful death, it can have a profound effect on bereavement and the opposite is also true,” he says.
One full day of the conference was devoted to the exploration of cancer pain versus chronic, non-malignant pain. Waldron argues that cancer pain is an acute constant pain which is very different to chronic pain and more akin to post-operative pain.
She is adamant that cancer pain can be killed 100 per cent by giving patients the appropriate dosage of drugs – morphine in most cases – without turning them into “zombies”or opiate addicts.
“We would hypothesise that the spinal chord mechanism is not altered by cancer pain in the same way as chronic pain and therefore cancer pain can be killed quickly and effectively and a patient should not go on to develop chronic pain. Cancer pain is more akin to post-operative pain and by treating it as such, we can get it under control quickly,” says Waldron.
Many patients have a fear of becoming addicted to morphine, but Dr Waldron points out that if the dose is individually titrated to each patient, as it should be, this does not happen.
In fact, the average dose of morphine she gives to her patients is probably half the amount she was giving 10 years ago because she is getting in early and on top of the pain quicker now, she says.
