Pain management is always fraught. Photo: Getty
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Jill thought she knew best for her father so she kept the morphine coming

Whatever her motivations – and whether she had even been aware of them – she had been hastening his demise.

The call came on Sunday evening, flagged as urgent on the computer. I rang the home number, which was answered by a woman.

“My father is dying of prostate cancer with bony mets,” she explained. “He’s in a lot of pain.”

The medical terminology struck me. “Are you in health care?”

“I’m a nurse. I don’t mean to tell you your job, but I think it’s time for a syringe driver.”

As death approaches, medication taken by mouth can become unreliable. In order to control symptoms, drugs are administered subcutaneously by a device known as a syringe driver. The siting of a driver often heralds the final hours of life. As well as relieving pain and mental distress, the potent drugs used can depress consciousness and respiration, which more often than not hastens the end. This is not euthanasia: it is permissible as the price of effective palliation, the “doctrine of double effect”.

When I arrived at the house, Frank was alone with his daughter, Jill, a neatly dressed woman in her forties who had travelled down from her Northumberland home to nurse him in his final illness. She described how, no matter how much morphine she gave, she didn’t seem able to control his pain. Frank was indeed in a bad way – semi-conscious, markedly confused and rambling – but he didn’t appear objectively to be suffering. There was one brief moment when he did wince. Jill responded instantaneously, spooning in a dose of liquid morphine as a parent might feed a baby.

“How much has he been having?” I asked.

Jill shrugged. “I give him some every time he’s in pain.”

When working out of hours, one has no access to patients’ records – all information has to be gained first-hand. I asked to see the rest of Frank’s medication. In the depths of a laden carrier bag I found plenty of paracetamol and diclofenac, an anti-inflammatory.

“Is he having these?” I asked.

“Oh, no, he’s just on morphine now,” she replied.

Bone pain doesn’t generally respond to morphine alone. One usually prescribes anti-inflammatories and paracetamol; these potentiate the effect of morphine, allowing far less opiate to be used.

I wrote out a schedule, specifying regular doses of the two abandoned drugs, and insisting that Jill note down every dose of morphine given.

It had all taken a long time. Leaving, I bumped into two other women coming in at the gate. They turned out to be Frank’s elderly wife with another daughter. I’d had no idea there was a spouse around. She seemed equally bewildered to meet me, saying that her daughter had taken her out for an evening drive. It was midwinter, and dark outside.

The overdosing on morphine was one thing; quite another was the removal of Frank’s wife before calling the doctor in. Safeguarding children is a familiar concept, but in recent years there’s been a growing realisation that adults are sometimes in need of protection, too. I contacted Frank’s GP first thing in the morning and he convened an urgent safeguarding conference. A troubling picture emerged. Frank’s four children had a lifelong history of rivalry, division and competition for paternal attention. Jill and her sister were allies against the other two, and against their mother. The wider family reported that Jill had descended on the home, taking control of Frank’s treatment and shutting the others out, pulling rank by virtue of her spell in nursing some 15 years earlier.

The conference prohibited Jill from further direct involvement in her father’s care. Treatment optimised, Frank came off virtually all morphine. His confusion resolved completely, and he had another five months of good-quality life. Whatever her motivations – and whether she had even been aware of them – Jill had been hastening his demise. How easy it would have been for an out-of-hours doctor unwittingly to have colluded, taking things at face value and acceding to Jill’s suggestion that the time for a syringe driver was nigh.

This article first appeared in the 16 July 2015 issue of the New Statesman, The Motherhood Trap

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The SATs strike: why parents are taking their children out of school to protest against exams

Parents are keeping their children away from school to highlight the dangers of “over testing” young pupils.

My heart is beating fast and I feel sick. I force myself to eat some chocolate because someone said it might help. I take a deep breath and open the door…

The hall is silent except for the occasional cough and the shuffling of chairs. The stench of nervous sweat lingers in the air.

“Turn over your papers, you may begin.”

I look at the clock and I am filled with panic. I feel like I might pass out. I pick up my pen but my palms are so sweaty it is hard to grip it properly. I want to cry. I want to scream, and I really need the toilet.

This was how I felt before every GCSE exam I took. I was 16. This was also how I felt before taking my driving test, aged 22, and my journalism training (NCTJ) exams when I was 24.

Being tested makes most of us feel anxious. After all, we have just one chance to get stuff right. To remember everything we have learned in a short space of time. To recall facts and figures under pressure; to avoid failure.

Even the most academic of adults can find being in an exam situation stressful, so it’s not hard to imagine how a young child about to sit their Year 2 SATs must feel.

Today thousands of parents are keeping their kids off school in protest at these tough new national tests. They are risking fines, prosecution and possible jail time for breach of government rules. By yesterday morning, more than 37,000 people had signed a petition backing the Let Our Kids Be Kids campaign and I was one of them.

I have a daughter in reception class who will be just six years old when she sits her SATs. These little ones are barely out of pull-up pants and now they are expected to take formal exams! What next? Babies taught while they are in the womb? Toddlers sitting spelling tests?

Infants have fragile self-esteem. A blow to their confidence at such an impressionable age can affect them way into adulthood. We need to build them up not tear them down. We need to ensure they enjoy school, not dread it. Anxiety and fear are not conducive to learning. It is like throwing books at their heads as a way of teaching them to read. It will not work. They are not machines. They need to want to learn.

When did we stop treating children like children? Maybe David Cameron would be happier if we just stopped reproducing all together. After all, what use to the economy are these pesky kids with their tiny brains and individual emotional needs? Running around all happy and carefree, selfishly enjoying their childhood without any regard to government statistics or national targets.

Year 2 SATs, along with proposals for a longer school day and calls for baseline reception assessments (thankfully now dropped) are just further proof that the government do not have our children’s best interests at heart. It also shows a distinct lack of common sense. It doesn’t take a PhD in education to comprehend that a child is far more likely to thrive in a calm, supportive and enjoyable environment. Learning should be fun. The value in learning through play seems to be largely underestimated.

The UK already has a far lower school starting age than many other countries, and in my opinion, we are already forcing them into a formal learning environment way too soon.

With mental health illness rates among British children already on the rise, it is about time our kids were put first. The government needs to stop “throwing books at heads” and start listening to teachers and parents about what is best for the children.

Emily-Jane Clark is a freelance journalist, mother-of-two and creator of stolensleep.com, a humorous antithesis to baby advice.