In my last installment
, I mentioned that my dad died of multiple system atrophy (MSA). In the words of the incredible Bill Cosby, “I told you that story, so I could tell you another one.” For those of you who missed that day in pharmacy school (which are few because there is no drug treatment), MSA is a rapidly progressive neurological disease that has been compared to getting MS, ALS, and Parkinson's Disease all at the same time.
In my dad’s case, it started with tremors, progressed to mobility issues (Dad wound up not being able to walk a step), total incontinence, crescendoed into feeding needs and loss of speech, and ended in respiratory failure. The fact that I couldn't treat my father pharmacologically once again demonstrated for me the Universe's cruel sense of irony. I could only do one thing as a pharmacist. I could help him die. I did.
At the very end, Dad was a closed-eyed heap of breathing. That was it. He sounded like Darth Vader running an uphill marathon. Hospice gave us a “comfort pack” for the end of the journey. In it were acetaminophen suppositories for fever, prochlorperazine supps for nausea, haloperidol for anxiety and oral secretions, lorazepam for anxiety, and oral morphine 20mg/ml for “air hunger.” Dad was redefining “air hunger.”
Hospice normally comes out to administer the knockout punch of lorazepam and morphine, but they got snowed in. Having a feeling that I would need them later, I had them in my pocket. I produced them and after a community decision to “help Dad along,” I placed 2 lorazepam 0.5 milligram on his tongue and dissolved them with 4 mils of morphine.
I knew what I was doing. Respiratory depression is an oft-discussed side effect of opiate abuse. Dad went very peacefully in the end. As a pharmacist, I administered the medication that ended his life.
Patient euthanasia is far more socially acceptable today than it was 25 years ago. In my upbringing, I was taught that life is precious from the time when you’re a glint in your parents’ eyes to the time you close your own eyes. For the most part I agree, but nothing can stop the death throes once they start. In my opinion, putting a stop to them can be easier both on the dying and on those at their bedside. If we are humane enough to “put down” our beloved pets, why do some balk at doing the same for their loved ones?
I have a patient who is an absolute cancer warrior who has been in hospice care for far longer than most. She beat the odds when her family thought they were going to lose her. I gave the family my card with my cell phone number. If they wanted the meds given and couldn't find anyone to do it, I would go to their house and do it for them. I would, however, offer them the opportunity to do it. When the time came, I found it loving and cathartic. I have no problem with that.
If you do have a problem with it, by all means, stay out of this sort of situation. That is what the conscience clause is for. My conscience, however, is clear. Peace.
Jay Sochoka, RPh, would do it all over again if he had to.