Hospice and Morphine

Question

Mom passed away yesterday evening - peacefully....though the multi-day process was not always that way. I am worried the hospital gave her too much morphine making her unresponsive quicker than necessary. She was admitted last Saturday for sugar levels near coma state - besides CHF, stomach, colon, pacreas inflammation - dx with auto-immune hepatitis and liver failure. She did not want extraordinary means - nothing invasive, etc. just IV, oxygen, meds, etc. She had not eaten much for the past 2 weeks and was very frail and weak ( barely talking). Hospital removed over a liter of fluid from her stomach. She did not want a feeding tube, etc - doctor said a 1-2 weeks before her systems would shut down and death would come. Wednesday she was in pain and we had the discussion. She agreed but was too weak to be moved so we had to stay in the hospital - luckily they moved us to a private room where I could stay with mom 24/7. My concern is that Wednesday she could talk - though weak and very little. Once the morphine started, she rarely was cognizant -only a few moments of recognition and response. By Thursday night she was restless and agitated - seeing and talking to relatives who had already passed on - but not aware or talking to me or the nurses. There were some "Help me" cries and her calling my name, but I could not figure out what she wanted --she wanted to be repositioned every few minutes constantly for a few hours - which we did. By Friday, she was quiet, mostly sleeping - the nurses kept a steady dose of morphine to keep her pain-free...doses started every 6-8 hours then increased 4-6 , then at the very end (after death rattle had started), up to every 1-2. Mom was tiny (about 93 lbs) and I am worried that she went from being awake and aware and talking on Wednesday, to most out of it by Thursday afternoon/evening. Sometimes I would ask them to check Mom for pain (I stayed 24/7 in the hospital since Wednesday) - sometimes they let her wait for a dose, other times they would administer it - the first few days through IV, then orally when 2 veins crashed. I am very glad Mom did not suffer in pain (my Dad died of colon cancer and suffered horribly), but I am afraid her death and "semi-consciousness " may have been expedited and hastened by the continual morphine doses in the hospital...please give me your experience/opinions...thank you....

Grandma1954 · Accepted Answer

The fact that she was breathing comfortably was an indication the morphine was doing what it was supposed to do. It relaxes muscles that can become so tense that a person can not breathe easily. Limbs can become contracted (more so than what is typical) And agitation can cause more distress to the patient and the family.
The Hospice nurse told me after I told her I was afraid I gave my Husband to much the night/morning he died, that it would have taken more than what I had in the house to cause him to become "comatose" or to die with the amount I gave him. That did make me feel better, after all she has been a Hospice nurse for YEARS and before that an Oncology nurse.
What I am thankful for is that he was relaxed and comfortable. When I gave him the first dose of morphine earlier in that week I was actually able to move his arms that had been so contracted for so long. He actually looked like he was comfortable.
I would not worry that she was "over dosed" or that she was hastened to semi consciousness.

AlvaDeer · Answer

As an RN who often was present at end of life, when it is clear that this is an end of life situation, then morphine is given liberally. We try to keep a patient below the level of agitation, below the level of confusion, below the level of breathelessness and air hunger, below the level of pain, and even below the level of dream states. That is to say we virtually keep the patient "at rest". The end of life is not pretty without medication. Patients are confused and agitated and not knowing where they are or what they want. They begin to pick at covers and clothing, are agitated but unable to respond. The morphine is not given to "kill people". There is no reason on earth to do such a thing. But it IS given to keep the person COMFORTABLE. I am not going to tell you that, if morphine was held back, your mother would not have had one or two more days. I am going to tell you that you nor she should have had to suffer more those two days.  Having spent my entire life as an RN I can tell you we did not always give MS to this extent; we did not give it if there was any fear it might hasten death. And people SUFFERED enormously. There are many elders who can assure you of that.  I will tell you as an RN I have ZERO fear of death, but I sure do fear that RN who will decide I cannot have morphine.

willnotorcannot · Answer

I truly felt the same way.  I felt like the meds given to my dad to get him from hospital to hospice were excessive and he was out for a long time.  He only weighed about 100 pounds.  He passed the next night after medicine was administered for pain. It is a very hard time losing a loved one.  I appreciate your questions and the answers here.  I know that I would not have wanted him to be in pain - but was just not ready myself to let go.

Sunnygirl1 · Answer

I’m sorry for your loss. The morphine did not cause her death. She was terminally ill and kept comfortable with the medication. According to your posts, that was her request. I would be grateful that she died according to her own wishes and had adequate pain relief.

BBS2019 · Answer

Anything that makes the dying person more comfortable is appropriate and merciful care.  Anything that keeps them alive longer (for a few hours or days,) but in pain, anxiety and agitation is not appropriate or merciful.  Since we are all on the path to death, I'm unclear why "hastening the passing" is a deviation from the natural process.  There are no medals handed out for those who hung in there conscious for a few more hours while in discomfort or fear. What would YOU want for yourself?

LS2234 · Answer

We had kind of the same thing when my husband went to hospice Dec 2018. There were arguments over whether letting him be comfortable hastened his passing, but honestly, he was in such misery that it was kinder to let him go. He had cancer. Stop second guessing yourself, let it go. Would a few more hours or days of them living, but in agony, really have been better? For whom, you or them?

dogparkmomma · Answer

Morphine works to control pain and it also decreases anxiety. It of course suppressed the central nervous system in order to do that. So yes, it did contribute to making her unresponsive although not eating and the process of dying also was involved. Did it hasten her death. That is likely but her death was inevitable so if the morphine helped her be asleep thru it, that is not a bad thing. What would you want to have done differently?  Stop second guessing this and thinking about it. You were fortunate to be able to be with her. This will get easier.

MAYDAY · Answer

You will get through this. It will take time. Absorb and think about the fun and happy times. I keep telling myself this.. And sometimes I do remember.

It's okay, this what happens to all of us at sometime, ready or not, here it comes...
I had a friend who always said that, death is okay... He was right, or hopefully is right. I haven't spoken to him in years.
This is an important time with this Pandemic. BE NICE BE KIND
SHOW AND HAVE A LOT OF PATIENCE...
GOOD BRAKES too. Yes, people are trying to show kindness and being polite, but sometimes, they need to look in their rear view mirror.. One person stopped all of a sudden for someone inching into traffic. This driver came to a complete stop for no reason.. The incher was waiting for traffic to pass before proceeding, and my friend had to slam on brakes on his truck and slammed the horn down to wake up the driver who decided" this morning it will be a good time to show kindness while a truck is driving the same speed just behind me. Oops, do big trucks take longer to come to a complete stop?" WELL Yes, they do.
At least he is getting his brakes looked at tomorrow.. Thank goodness - no accident either..

The situation seemed almost like telling a dog; SQUIRREL !! huh? squirrel? I got to go chase it.. it's just what I need to do at this moment I hear SQUIRREL

MAYDAY · Answer

Letting go and finding peace is a wonderful answer.  Finding those 2 things? Hopfully sooner than later.  I am sstill looking.. I'm finding it in my yard. Can't say garden, it's a yard of plants.. I see something, I plant it. Mom like her garden and so did my aunt, so I talk to them while gardening. It's fun. I dig in dirt.  That's my therapy, and walking the dog.

MAYDAY · Answer

I am sorry for your loss. I am glad she didn't have to live longer than necessary, being in pain is not always the best. And you were not ready to let go, but her body was.. Having the end expedited by someone else other than you, is positive. She had you by her side. She was taken care of with professional and love. You were there, by her side, you did not have to partake in her passing.
My Hospice on board the night my mom was going was not my Team. It was someone I never met before. She instructed and showed me how to crush morphine pills and slide it in my mom's mouth. Talk about a death scene.. I guess I have PTSD after that. another nurse came in early in the AM and showed me the other half of the potion I should have been giving Mom. That first thing of a nurse, she couldn't stay to go over everything, for got to tell me about the ativan. Wanted out as quickly as she came into the house. Think it was her first week. And the send her to us... Wonderful. Angel was quite the caretaker. He got mom relaxed, cleaned, comfortable, and relaxed... He was great, professional, and he knew I needed him.. since the first gal had to leave so quickly, I thought he did too. I told him to show me how to clear her passages, get her situated on her side with pillows and asked him what I needed to look out for. I told him, I have it, I can take it from here... He stayed, God Bless Him !!
Long story short... She doesn't need to suffer any longer. Now you get to know she is looking down on you, and laughing, dancing. She loves you, do not forget it.
Have you heard about dimes and/or pennies turning up in odd places? The other day, dimes and pennies were popping up all over the place...:) I believe it was from my loved ones. I talk to the all the time.

golden23 · Answer

((((((laurabelle))))). This is a hard time and many people second guess the treatment their loved one had at the end. The morphine was there to ease her pain and agitation - to make this final transition easier for her. In doing so it may have made her less responsive. The choices we have at the end of life are fairly limited. Less morphine may have allowed her to be more responsive, but also would have meant more pain/agitation which I am sure you did not want for her. They were treating her condition appropriately from what you say. She was largely at peace. To me that was a blessing.

My mother and others I know had morphine at the end. Did it hasten their death by a short while? Possibly. Would I rather they had lived a few hours or days longer in pain/agitation/discomfort. No, I wouldn't. Medical people were treating their symptoms and keeping them as comfortable as possible, At that stage of life it is all that can be done for them.

97yroldmom · Answer

I am very sorry for the loss of your mom. I’m glad you asked your question as it allows me to check in on how I’m dealing with my own loss.
My mother had a similar passing in that she became agitated at a certain point and the medication appeared to both calm her and perhaps allowed her to slip away. I’m not sure one is possible without the other.
I was grateful she was no longer suffering. I’m sure you relate to that from your father’s passing.
We are not ready no matter what. We are tired. But we are not prepared for the finality of death.
The description you give of your mom’s condition sounds like she was in a lot of distress.
Sometimes we try to save them from a bad situation only to have them suffer through a worse one.
It will take awhile for you to accept her passing and to understand that you did all that you could.
Let her go and be at peace.

Hospice and Morphine

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