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

Niina Tamura
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“Anyone can do it, I promise you!”: meet the BBC’s astronaut-ballerina

Why science needs to be more open to women, minorities - and ballet.

Whether dancing on stage with the English National Ballet or conducting an experiment for her PhD in quantum physics, 29 year-old Merritt Moore often appears a model of composure. But in last Sunday's opening episode of BBC2's Astronauts: do you have what it takes? we got to see what happens when high-achievers like Merritt hit breaking point.

Merritt is one of 12 candidates attempting to win the approval of Chris Hadfield, former commander of the International Space Station. Along with her fellow competitors, who include mountaineers and fighter pilots, the dancer has had to face a series of gruelling tasks designed to measure her potential to operate well in space; from flying a helicopter, to performing a blood test on her own arm.

Many of these tasks left Merritt far outside her comfort zone. “I’ve only failed my driving test three times and crashed every car I’ve gotten into - but I think helicopters are different?!” she joked nervously before setting off to perform her first-ever helicopter-hover. Yet after a shaky start, her tenacious personality seemed to pull her through. “I’m good at being incredibly persistent and I don’t give up,” she told the space psychologist when asked to name her strengths.

Merritt also believes it is persistence (and hours of practice) that have allowed her to excel in two disciplines which are typically seen as requiring opposite traits: ballet and science. While studying for her PhD at Oxford, she has continued to perform as a professional dancer around the world. It's a stunning feat by any measure, and when I talk to her on the phone this weekend I ask whether it’s only possible because she’s some kind of genius? “No!” she exclaims, with a winning mix of genuine shock and self-deprecation. “I’m as far from a genius or a natural dancer as you can get - everyday I just feel like flailing mess! My thought process is that if I can do it anyone can do it, I promise you!”

But there is one thing that Merritt thinks might be holding back others from pursuing a mixed career like hers – and that’s the way the scientific world is run.

“They kind of self-select themselves,” she says of many science-professionals she’s met. "You get some people who are not incredibly understanding of those who perhaps approach [physics] in a different way, or who need a different type of schedule," she says. "They look down on people who are different from themselves, which is really difficult; I think that’s why women have difficulties, and I think that's why minorities have difficulties."

A report from the Royal Society on Diversity in Science would appear to support Merritt’s conclusions. It showed that women are significantly underrepresented in senior scientific roles, and that black and minority ethnic graduates are less likely to go on to work in science than their white peers.

So how can these trends be reversed? For Merritt the answer lies as much in schools as it does with targeted scholarships and support groups. Science education needs to be re-branded, she says, so that thinking creatively is actively encouraged from a young age; “It makes no sense to divide it up and say everyone either has an analytic mind or a creative mind." Simply leaning a set of very technical facts from a textbook drives her “bonkers” - but “when there’s passion behind something then anything is possible.”

If she could one thing about physics education, Merritt says she would switch things up so that the “exciting bits” get taught first - such as the latest thoughts on quantum computing or DNA repair. Then if students do choose to continue, they’ll know why they need to study the boring, rigorous parts too. “You’re like right, I need to learn about a harmonic oscillator because that’s how I’m going to understand this quantum computer.”

More cross-fertilisation between science and arts could also help the ballet world, she believes. “I can visualise my centre of mass, how gravity is working on different parts of my body, and how the torque effects my turns – and I think that’s a massive help,” Merritt says of her dancing.

But that’s far from all. When performing she often finds herself thinking about the more bizarre and “mind boggling” sides to physics: “Why is there all this dark matter in the Universe? What is that?! - when that’s going on in my mind, my legs become free because it means I’m not thinking about whether I look bad, or if something is right or not. I’m just inspired - and I want my dancing to be inspiring rather than self-critical all the time.”

Focusing on actions rather than self-image was definitely something Merritt's parents encouraged from a young age. Her dad’s work as an entertainment lawyer in LA meant he was particularly alert to the stereotypes that were being laid on young girls. And, as a result, Merritt and her sister grew up without TV or fashion magazines. Her dad was even initially worried about the mirrors in ballet classrooms

But self-criticism is also very hard to avoid when your antics are being broadcast to the nation on Sunday night TV.

“When you see yourself on screen you just feel incredibly vulnerable,” she says, “they are getting the raw emotions of how you’re reacting to stuff that you’ve never done before in your life!”. What Merritt’s episode one journey showed however, is that knowing yourself makes it easier to bouceback from nerves and self-doubt. And that perhaps more of us should be encouraged to believe that you don't have to choose between the stars on stage or the ones in space. 

The next episode of BBC2's Astronauts: have you got what it takes? will air on Sunday 27th August at 9pm.

India Bourke is an environment writer and editorial assistant at the New Statesman.