In Palliative Care settings you often see many things much worse than death. Death can be a natural release from suffering. Over many years of working in this specialty, I have witnessed many forms of suffering. Most of these situations involve severe pain. Everyone reacts differently to their symptoms. Some people can handle pain, but can’t handle nausea. Others can’t tolerate any loss of their cognitive abilities. Each individual must have a bespoke management plan designed for them.

I knew my patient could handle pain, he had put up with a lot of it over many months. He didn’t complain, he wasn’t angry at God or Jesus. In fact, his faith was stronger than it had ever been. Maybe it was his religion that allowed him to cope with his many pains. We managed to control his back and leg pains well. He was able to sit in his power wheelchair again. Something he had missed doing over the past month due to severe pain. His power chair meant freedom, he could take himself outside to smoke. He was able to go to the local convenience store to buy some sweets and other supplies.

One weekend I had trouble tracking him down. Every time I went to visit him he was out of his room. I finally caught up with him after his return from our hospice shop down the road. He had purchased a hoodie, a small wall hanging, and a little succulent plant to look after. He’d also bought enough instant noodles for midnight snacking over the weekend. He was doing well, and we managed to discharge him back to his residential care facility after the weekend.

He returned five weeks later. The pain had worsened, and he was unable to sit in his chair anymore. Something had changed for the worse. He was glad to be back, he knew we would take care of him. He was relieved to be back in hospice. Each day things worsened. We had trouble keeping up with his worsening pain and tried various medication changes with limited success.

“Doc, why do I have blisters?”

We weren’t sure, but he had small red blisters over his arms and abdomen. Then they spread to his legs and back. Soon his whole body was covered in painful red blisters. We treated him for infection, but things worsened. The blisters joined together to become huge blisters, the size of a fist, then two fists. They became huge painful skin lesions. We increased his pain relief but he was still in agony.

Then the blisters started bursting, releasing litres of fluid. Our staff kept on changing the bedclothes but they became constantly wet. Any movement would hurt him. We couldn’t control his pain. We went in to see him, just as another huge blister ripped apart releasing almost a litre of serous fluid. He winced in pain as super-hot magma broke through his mantle layer. I asked him how he was.

“I’m good Doc. How are you?”

It took me a few seconds before I could answer him, I almost had to leave the room. I gulped before saying, “I’m good man. I’m sorry this is happening to you. You are really unwell, I think this might be it man. I think you are dying.”

“I don’t feel good, I’m really sore.”

“We’re having trouble controlling your pain, we’re going to keep on trying, but we might not be able to control it man. If we can’t control it, we can at least make you not feel it, by making you sleepy.”

“Okay Doc, you guys know what you are doing. You’ll look after me.”

“Yeah man, we will. You take care.”

“Thanks, Doc, see ya later.”

After prescribing the medications we took a short break as all of us had been affected but the rush of emotions, including our nurse who had been working in palliative care for decades. One of the worst cases of suffering she had ever seen. We went upstairs for a quick cup of tea before continuing the rest of the ward round.

We tried everything else we had for his pain, but his pain couldn’t be controlled. We had to give him sedation therapy to make him unaware of his symptoms and he died two days later.