I knock gently, and walk into the room.
She sits on the side of the bed, elbows resting on the tray table, shoulders hunched, head in hands.

95 years old. Spanish.

Too breathless to speak, she looks up at me and we gaze into each other’s eyes.

“Hola”, I say gently.
“I am a nurse, and your doctor has asked me to come and see you”.

She nods.

“Can I sit down?”

Again she nods.
I pull up a chair.

Her sons hover nearby.
I turn and introduce myself, and tell them I am a palliative care
nurse practitioner.

They say they were expecting me.

I turn back to her, reach out to touch her hand.
It is cold. She is pale.

30-40kg, at best, I think to myself.
So frail.
Her lips are dry and blue.
There are dark circles around her eyes.
The oxygen thereapy is hardly helping.
I look at her feet and legs.
So. much. oedema.

Heart failure, end stage.
A cruel and debilitating chronic illness.
A long hospital stay – IV frusemide.
Minimal improvement.
The doctors have told her there is nothing more they can do.

She knows that death is just around the corner, beckoning her.

The GP has charted morphine and midazolam in a syringe driver.
She doesn’t want it.
This is why the nurses referred her.

We sit in silence for a moment, just looking at each other.

“Is your breathlessness the thing that bothers you the most?”
She nods.

“Any pain?”.
A shake of the head.

“Are you frightened?”
A nod.

“Of dying?”
Slight shake.

“Of how you might die?”
She nods, and a tear courses down her cheek.

Ok. Let’s talk about that.
She has gripped my hand, squeezing it hard.
I gently put my other hand over hers.

Her sons creep closer.
“No morphine”, one of them quickly says.
She nods.

I had been warned about this, and was ready.
“That’s ok. We can talk about other things that might help.”

“Could we open the window a little bit to give you some extra air?”
She nods.
One of her sons opens the window. A gentle breeze blows in.
Instantly the room feels better.

“Are you able to rest in bed and sleep?”
No, she whispers.

“Is that because you can’t get comfortable?”
A nod.

“Do you feel like eating and drinking much?”
She shakes her head.
Teaspoonfuls only. Struggles to swallow.

“Can I ask why you don’t want morphine? It can sometimes help with breathing.”
She looks up at me with her big brown eyes.
They are so sad, and another cheer rolls down her cheek.

The softest whisper…it killed my husband.

“I’m so sorry, that must have been so difficult for you”.
She nods.
Her husband died within minutes of having a morphine injection.
She also watched a son die after receiving morphine.
Two people she loved dearly.
The association, for her, is real. She has carried this burden and fear for many years.

I ask what is the most important thing for me to know about her now, so that I can try to help her.

She is too breathless to find the words, but she holds my gaze.
I am momentarily lost in her beautiful big, brown, sad eyes.
I notice the gold cross around her neck.
“Would you like some prayers?”
She nods.

Her sons tell me she thinks her strong faith requires her to suffer in silence.
It is a sign of weakness to ask for help.

This lady is going to REALLY suffer, I think to myself.
Her sons will suffer with her.
She is already suffering.

I gently explain to her that as she gets closer to the end of her life, she will sleep a lot. That the breathing might become more difficult as her heart struggles to pump blood around her body.

She nods, and understands.

“If you are really struggling, and your sons are distresed by that, would you take another medicine which might reduce your anxiety and help you breathe?”

Not morphine, she says.
“No. Not morphine. I understand you don’t want it. It is your body, and your wishes, and I respect your decision. I promise no-one will give you morphine, unless you ask for it. I promise.”
Her grip on my hand eases.

“Can we give you something else to relax you, just a little bit, to see if it makes breathing a bit easier?”

She looks at me, and for the first time I see a glimmer of hope in her eyes.
No needles, she says.

“Just a little tablet that sits under your tongue and dissolves. Would that be ok?”

She nods.
I can see the relief in her eyes.
“Can I visit you again?”
Another nod. She squeezes my hand.

I see a smile begin to form.
Thank you, she whispers.

I leave the room, and cancel the orders for morphine and midazolam that the doctor has written.

The nurses panic.
I explain that sometimes, healing comes with trust, honesty and faith.
It is not necessarily about the medicines.
I ask them to call her priest
and get him to visit today, if possible.
She doesn’t have long.

I have done what I can.
It is enough.
For me, and for her.