In my hazy recollection and self-made myth, mum was given 3 'doses' of diamorphine (heroin) between 12:00am and 12:40am. This was meant to ease the pain and the suffering that is very likely with such a high level of lung scarring/excess fibrous tissue.
As can be imagined, everyone in the room wanted to believe (and left lodging this thought in our minds) that mum knew nothing of the experience, and was very happily lost within a cloud of extremely pleasant soft gentle nothings…
But as far as I could imagine, none of us in the room have ever really danced with heroin, let alone had 3 doses, in addition to some Midazolam (benzodiazepine) and high levels of CO2 in our blood streams. So, none of us could discuss the reality of how she felt or what happened from her perspective. As a scientific sort of knowledge seeker, I've trawled the net for some answers…
A blog on Erowid by Silver explains his experiences of heroin:
it was a tide of relaxation creeping up on me, slowly taking me from behind.. (this is snorting it)
And goes on to explain that he's *very relaxed and that after half an hour he felt like he had felt this way 'for eternity'. In the next part of the passage, Silver then decides to take the needle:
People say it's like being hit by a truck. No. It's nothing like that. It's like standing on a rock, on the coast… and having a tidal wave of warmth, of security, of absolute *apathy* come over you, it surrounds you, it goes into your mouth, it drives down your throat, and deep into your soul. The first thing I realize again, is the cold. But I no longer care. Not at all. In fact, I remember being GLAD that the cold was there… it gave me pleasure to think that the cold was TRYING to do something to me, was TRYING to make me uncomfortable, the cold was TRYING to hurt me…and it made me happy because I knew it couldn't.
Nothing could touch me. I was invincible, without the energy of being invincible. I hear her place the syringe on the table, but I can't bring myself to open my eyes yet. As she places it on the table, I notice how odd it sounds. It doesn't echo, it's not a sound like when i'm tripping.. It's a mocking sound. The syringe is trying to laugh at me… the syringe is trying to make me feel bad too… but it can't, nothing can. People always try to put into words the feeling smack brings you.. that's just the problem.. it doesn't.. It was the most intense nothingness there ever was.
Which is a scary, but beautiful thought. The most intense nothingness there ever was.. and for mum, creeping into this intense nothingness was… the real, unequivocal nothingness.
Someone called Voyager (from the same site) calls it 'opening the uncloseable doors' which strikes me to be similar to Huxley's Doors of Perception. Which is a nice thought, it seems like some sort of expansive inner-mind experience, that Huxley notes here as:
"Each person is at each moment capable of remembering all that has ever happened to him and of perceiving everything that is happening everywhere in the universe."
Which again is a really comforting and somewhat idealistic point of view. I expect it's more likely to be a massively enlarged version of our ego, and a release from the introverted self-consciousness. This is summed up by William Blake
"IF THE DOORS OF PERCEPTION WERE CLEANSED EVERY THING WOULD APPEAR TO MAN AS IT IS, INFINITE. FOR MAN HAS CLOSED HIMSELF UP, TILL HE SEES ALL THINGS THRO' NARROW CHINKS OF HIS CAVERN."
(font is from where I found it, it's nice and I'm keeping it!).
I rather like what's coming through on this cursory search: besides the damage heroin can do, it's bloody nice!
But the question that was posed to scientists at John Hopkins University in '72 was why do our brain's neurons have specific receptor sites for opiates? and further, why would nature put receptor sites in for a plant?
The scientists soon reasoned there must be some other function for these receptors sites. They figured out that the active ingredient in all these opiates (morphine) had a chemical structure similar to endorphins, a class of chemicals already present in the brain . Endorphins are feel-good chemicals naturally-manufactured in the brain when the body experiences pain or stress. They are called the natural opiates of the body…
Endorphins flood the space between nerve cells and usually inhibit neurons from firing, thus creating an analgesic effect. On a lower level they can excite neurons as well. When endorphins do their work, the organism feels good, high, or euphoric, and feels relief from pain (analgesia). So, endorphin levels go up when a person exercises or goes into labor, or is stressed out. Although they seem to be triggered by stress, endorphins can do more than relieve pain, they actually make us feel good.
The morphine molecule locks onto the endorphin-receptor sites on nerve endings in the brain and begins the succession of events that leads to euphoria or analgesia. This imposter is more powerful than the body's own endorphins because the organism can actually control how much of the feel-good chemical hits the brain.
Which is all very understandable, and strong evidence to support the idea that in her last half an hour, mum would have probably just been on auto-pilot, zooming around the spaces of her mind…
As with the previous 'Heroin' post, I'm going to look at Midazolam, as it was administered to mum to help ease the suffering and struggle.
Midazolam is a short acting benzodiazepine, used for reducing insomnia, seizures and for inducing sedation and amnesia before medical procedures. It is used for procedural sedation and sedation in intensive care, and the anterograde amnesia properties are useful pre-medication because they can inhibit unpleasant memories.
Through looking on patient-centred (i.e. not massively evidence based, but still useful) websites that the amnesia aspect of 'versed' (one of the brand names for Midazolam) is reasonably effective, with one person saying they'd felt tricked by their anaesthesiologist. This same site (medical news today) expresses that the 'extreme mental reactions' (you can tell a non-medical writer…) last for a very long time.
Another site notes that the strength of Midazolam is reasonably high, with as little as 0.3mg being effective. Further, this same site has someone state that it has nasty side effects and withdrawal symptoms that can last up to a week. This is clearly not a drug to be messed with! The forum I'm looking at (drugs-forum) appears to have a load of recreational users who see Midazolam as a step-up from your standard benzo (lorazepam, diazepam… etc.). A website that goes some distance to assure patient's that they'll feel nothing, there's nothing to be scared of, it's only a drill! has testimonies, one of which says
"Nothing happens for several seconds and then you begin to feel light-headed (a little drunk) for a few moments, which is not unpleasant. Then instantly several hours have magically passed and everything has been done. Its like the flick of a switch which turns your brain off for an hour or two. You feel fairly dopey and woozy afterwards where you may want to go and sleep it off."
Which sounds lovely..
And it doesn't lessen in it's loveliness for people who don't want to come back, as wikipedia (font of all reliable knowledge) tells me that toxicity levels for Mid are increased when added to another Central Nervous System suppressant, such as an opioid (say, diamorphine – heroin). Bear in mind that recreational users and dental patients have noted a strong sedative/amnesia effect from normal range amounts, the Palliative Care Guidelines for Scotland note that distressed patients should be given between 20-30mg and 40mg-80mg of Mid over 24hours.
It also recommends that 2mg of diamorphine should be given hourly, but a look at the advice on the Liverpool Care Pathway notes that between 2.5mg and 5mg s/c can be given (mum was given 3 doses of diamorphine, in addition to the Mid), so either will give an indication of the effects when added together.
So, again all of this goes to support the idea that mum had no idea what was going on at all. In fact, there appears to be a chance that once given the mixture of Midazolam and Diamorphine (not to mention others), she would've experienced a 'nothing' sensation (and had great difficulty recalling it, if there were an afterlife in which to do so).
The Liverpool Care Pathway is an interesting thing, and I can see where the controversy comes in, but with such high amounts of doctors who note they would like to be put onto it, if the need came up, then it can't be ignored. I think someone said to me that we live in a society that will happily 'put down' animals in pain/with no quality of life, but will keep human's going whatever the cost. Obviously, this is the blithe nonsense you can hear in all hospital wards, and it's devoid of all Shipman context, but the point is an interesting one. We should have something like the LCP, but the language used (which at times was almost euphemistic) was almost misleading. It is what it is, a neat way of side-stepping the rules, and letting people die in a hazy happy drug fuelled trip…