I have posted on here many times and answered questions every now and then. Dad passed away Oct 7th 2013 from Liver Cancer . He was in a hospice facility for 11 days until he died. The day before he was admitted he was in the hospital and was talking,eating and very clear headed but his ammonia levels were high and he had been very combative, not eating and wouldn't take his meds for 4 days at his nursing home. ( He was in for a Psych Evaluation.) The hospice worker talked to me about admitting him instead of returning to the nursing home. I agreed to this and arrangements were made. He was transferred later that day and was alert and in good spirits. The next morning he was unresponsive and stayed that way until he passed. They gave him morphine and ativan around the clock. He never got any water but they did cleanse his mouth and moisten it with swabs. It seemed like he could hear me the first few days because I would shake his shoulder and say "dad". His eyes seemed to be moving under his eyelids and his mouth would move slightly. I did ask about them lowering his dosages so he could wake up a little. The nurse said he was getting a very small dosage already. I just wonder if the drugs made him unresponsive and if less was used he could have ate and drank and lived longer. I know it was time for him to go but I'm kinda puzzled about his going from complete alertness and straight into unresponsiveness so quick. The nurses did a Great job. I myself don't know how they do it. They treated dad like he was their baby. So gentle and compassionate. I was just wondering if anyone else had the feeling that death felt a little rushed once their loved one was placed in Hospice.
Do I think there is a rare occasion where hospice might give patients medications to ease their pain and out of this world, perhaps, but never with the intention of actually murdering them.
I think it's unfair to put these sorts of thoughts in people's heads that hospice intentionally kills people. When in fact the opposite is true. They are there to comfort the patient, Comfort the family, and to ease the patient through the dying process. Hospice is an option, an option given to the family to help them, it is never pushed upon people, and people do have the right to refuse their services. You can always choose to go It Alone, take your family member home, and try to see them through to the end without any Aid or assistance from a Hospice care team.
My family's experience with hospice was wonderful, but it did take a lot of us to fall in line, and to help one another to help our mother through her journey to the end of her life.
I do feel very bad for the people who have had a negative experience with hospice, but I really don't think those experiences should sour others from choosing the hospice route.
My mother has terminal brain cancer and is in my home on hospice. I happen to be a nurse myself and am familiar with this process. My mom has 6 kids and they've yet to arrive, they will all be here tonight. It's been one week since she was discharged from the hospital. Pain has been an issue, pain management was a struggle in the hospital. She was prescribed oral morphine solution, (OMS) 1 ml (20 mg) every 4 hours, and Ativan 1 mg (0.5 ml) every 5 hours. For the first two days, I followed the medication schedule. By the third day she was lethargic and unresponsive. The hospice nurse said she had begun the transition. She was right, but why so soon? My siblings won't arrive in time. My mother wanted to be with her children, it's all she ever wanted. We live scattered across America. I told them all to get here asap, on day 4. She had to hold on for three days if she was ever going to make it. Day 4 was tense. She hadn't eaten or had any fluids, she wouldn't swallow and it just dripped out and I had to clean out her mouth to prevent her from choking. Her breathing pattern had decreased to around 6 times ( or less,) a min. She was fading, I was crying, rubbing her feet to keep her aware, I've never been religious but in that moment I started praying. I'd been up for two days straight, I was afraid she'd die if I wasn't right there. Stress always keeps me up anyway. That was a long dark night. I didn't give her the morphine or Ativan as scheduled, I backed way off. On day five, as the sun began to rise, she started moving again. The woke up, she nodded in response to my question, " are you thirsty?" She drank water and broth. She came back from the brink. Today is the morning of day 7. All my siblings will be here by tonight, 2 will arrive in a few hours. She is hanging on. I gave her some medicine and she isn't responding well again, I'm seeing the pattern.
My mother will not survive this, I will continue to medicate her as needed, I know she will soon be gone. Do I think the medicine is making her die sooner? Yes, but what is the alternative? I can't have her suffering. She has suffered so much already. I'm relieved that in my particular situation, I have the medicine for her. I'm also glad I knew enough about the medicine to know when not to give it. I'm not going to blame the medicine, the doctor, the hospice or myself when she passes. I blame cancer.
Tonight is the night we will all be together, my mothers final wish will be granted, I hope she holds on just a little while longer.
I sincerely hope that all your siblings arrive on time, and are able to say their goodbyes to your Mom, and that you get some much needed rest and support yourself! Please know that I will be praying for you and your family, as you say your goodbyes to your loving Mother. She will soon be in a better place, no longer in her pain rattled body, and with God. God bless you and thank you for sharing your story. Stacey B
I was always worried about losing control over her medical decisions and medications.
About a month before she died her primary care finally admitted to me that he had no idea why my Mom was having so much pain. We had done X-rays, MRI, etc. found nothing to point to acute pain.
Because hospice can administer morphine, Mom was moved to hospice care.
I can speak to the fact that mom was given 2.5 mg every hour to control this pain. Oh geez, what a god-send! Mom did not spend her final weeks in agony.
The decline Mom was going through was obvious for weeks. When the changes became very obvious from one week to the next....I knew the end was coming fast. Of course I was in denial. Even to that last day I was still fooling myself. Nothing prepares us for the loss.
It would be easy to turn my attention to blaming hospice care for her death...it would also be incorrect. But, I understand the need to blame someone, something. I still do not understand what that final decline and end was caused by. I do know that it wasn't hospice...because hospice was even brought in till the very end.
Why it seems like patients pass quickly is because some families wait until the last minute to finally decide to use Hospice.
Please be comforted by your good memories and know and understand that you did nothing untoward.
On the up side, I'm quitting the Per Diem hospice nurse position I have and have accepted a full time home health visiting nurse job (to help support my mom in memory care). Now I won't be one of the hated "killer nurses" anymore! ;)
I hope you like Home Care. I absolutely loved it and am thinking of going back into HC.
Good luck, sister!
I've done the visiting nurse job twice before. Only down side is the darn traffic in my area (southern California). Oh well, I only have 4-1/2 years to go before retirement. :)
Home care (visiting nurses) are for physical nursing care (dressing changes, blood tests, vitals check, patient teaching, etc.), NOT for custodial care. If your loved one didn't have a skilled nursing need, they would not qualify for home visits.
See Shane, they DO think we're killers!
To those of you who don't want your loved treated by hospice, then DON'T let them be admitted to hospice. You, as the family, can figure out what to do as they are screaming in anxiety or pain or having breathing difficulties but, God forbid, DON'T give them any medicine to let them calm down and be comfortable!!!!!
I'm done, I swear, I'm done with this thread. As a hospice nurse, I've seen families deny the dying person medication that could have helped them. I had one lady scream at the top of her lungs the whole 8 hour shift. Her son refused that she get any medicine because, he said, she became too lethargic. We agreed to lessen the dose but he still refused. He was worried that she wouldn't eat. After days of screaming and not eating anyway, he finally gave in. The woman finally got some rest and slept for half the shift. It's tragic to watch people suffer when they don't have to. But, to those of you who blame hospice for murdering your loved ones, you handle it. I feel sorry for the one who suffers.
The family was lead to believe she would be ok with it, we were innocent to what morphine does to a person who is in no pain. My mother had CJD look it up. Why were they not honest with us? It should be throroughly explained to patients family and it seems from this thread it never is. There should be a law requiring this! Yes my mom would eventually be taken by this rare disease, but not when a palliative doctor decides since there is no cure we can just take their life! Not acceptable!
It takes 200mg of morphine to take down a person. Hospice uses only 5 to 15 mg for each dose. If Hospice was at home, no way would the Hospice nurse leave a huge amount. If Hospice was at Assisted Living or a nursing home or Hospice facility, as Veronica said above, it is strictly regulated and inspected [its a narcotic].
I was so glad that both my elderly parents were under Hospice care, as their passing was very peaceful, not one of sheer pain and/or gasping to breath. And also note, one's time table for passing is no different whether they are on Hospice care or not.
Please note, when someone is on Hospice or not, the patient will rally to a point where everyone will think the person is going to be fine. This is normal. Then a week or two later that patient will start to decline. They usually stop eating because any food in the stomach becomes very painful. One's body organs start to slowly shut down and there isn't anything one can do to reverse that.
Being that your Dad has lost so much weight, that in itself can cause a lot of back pain. My Mom had also lost a lot of weight and during her final month had been in so much back pain that the nursing home tried everything. Once on Hospice, the morphine quieted her pain, thankfully.
This is usually our first rodeo dealing with a death of a parent. With Hospice, they have been on this journey hundreds of times. They can tell just by looking at a patient if that patient is in pain.... if the organs are starting to fail... and are pretty good at determining how soon death will come.
Both my parents had passed in the wee hours of the morning. At the nursing home there was a head nurse who was able to confirm that my Mom had passed. For my Dad, he was in Assisted Living and we had to wait for the doctor to arrive to confirm my Dad, and that took an hour. We realized that my Dad wasn't their only patient to see, so the time frame was understandable.
As I have said many times on this thread, a patient will die on the same timetable with or without Hospice.
As I posted a few weeks ago, 200 mg of morphine, given at once is considered a fatal dose. 5 mg is not anywhere near that. You would need 40 doses of 5 mg of morphine, administered at once, to cause death.
You eased your loved one's pain, anxiety and breathing difficulties, if there were any. I wish you relief from your dreadful anxiety that you did something wrong.
I would like to suggest, gently, that it may be time for you, if you haven't already to get in touch with a counselor or therapist, to see if you can get some relief from the psychic pain that you are clearly in. Grieving is hard and hard work. It's more painful and complicated if we get bogged down in thinking that somehow we did something wrong, or that we, magically, could have made things " better".
Please be well and comforted in your good memories.
I've been a nurse for 38 years and have given a lot of Morphine over those years. It is a narcotic. It deadens the pain centers in the brain, slows respirations, slows gastric movement in the gut, relaxes muscles, can make you sleepy and can give a feeling of well being.
The doses used after surgery (for pain control) range from 7.5 mg-15 mg every 4 hours, depending on the size and tolerance level of the patient. By giving your mom 5 mg (a low dose), there is NO WAY you could have caused her death. Maybe your dear mom was finally able to relax and her passing COINCIDED with the medication given. Be GLAD that she didn't have to go through an agonizing death (screaming in pain, screaming in fear, severely short of breath, thrashing around, etc.).
You can now relieve your mind that giving her the prescribed amount of medicine could NOT have taken her life. It's just not possible with that dose. Please stop beating yourself up. NOTHING would have prevented her passing away at exactly that time. That's the time God had planned for her. You just made her more comfortable for the journey.
As Barb said, you would benefit from some counseling. Hospice has follow up counseling for the family for up to a year. Maybe you'd feel comfortable talking to your pastor, priest, rabbi, etc.
Do NOT doubt your actions. You did nothing wrong. Everything you did was for her benefit. You loved your mom until she crossed over. I know she's grateful that you were in her life.
Thanks so much for your thoughtful insight into an issue that is causing me a lot of agony. Yes, I plan on seeing a therapist with the hope to work through it. When I agreed for my mother to enter home care, I requested that it be palliative - that she would continue to take her regular heart meds and eat. And that she did. But they sent a hospice nurse because Medicare does not pay for palliative. They told me to give my mother a small dose of morphine if she had pain/breathing problems. I gave her two doses (5mg) over a ten-day period. But it was the second one that was on her last day that bothers me. Even though the dose was 5mg, it came from a bottle that noted, "opioid tolerant." I was completely ignorant about all of this. Nevertheless, I will speak with a counselor. Thanks for the good advice.
It sounds as though the thing that is bothering you the most is the fact that the bottle was labeled "Opiod Tolerant" How the bottle was labeled is of no importace at this time it is the actual dose that matters. You only gave what was prescribed which you had done prior with no ill effects. Morphine is Morphine whatever the bottle says and the dose was reasonable. Drugs by mouth are not as effective as those by injection or IV By those routes the starting dose is usually 2 mg but is often repeated in less than an hour if the pain is not controlled
FF suggested that it would take 200 mg to kill someone. There probably is not an exact amount but that is certainly more than would be used. I saw one patient who was routinely taking 6mls every four hours because he had become so tolerant to it. But a dose of 200mg did not kill him.
Give yourself a break Karen you did not hasten Mom's death it was her time . Set this aside and concentrate on healing giving with assistance of a therapist or make use of the hospice bereavement councillor which is free for individual or in groups whatever you need. this is available for 12 months after a death.
As for the morphine given to your Mom, the dosage is similar to that one gets after they have had surgery. I remember having a morphine pump to help cut the pain. Once I was off the morphine pump there were zero withdrawals.
And it is not unusual for a patient to rally for a day or a month after being in a coma like state, both my parents did that.
When your Mom had to have her arms and legs held down, that is called delirium, which 90% of elders have when they are in the hospital. It is around 20% of much younger patients usually those who had major surgery. My Mom had delirium and she wasn't even on Hospice at that time.
The Hospice group taking care of your Mom 24 hours a day, you were quite lucky, as the majority of Hospice groups do not do 24 hour care... one would need to hire Agency Caregivers. I needed to do that for my Dad.