End of Life:: Morphine starting as needed.... is this step called "actively dying"?

Perseverence,

I just hold you in my heart! {{{hugs!}}}
It is hard to go through hospicing or caregiving a loved one, helping them birth into a new existence.

Yes, it sounds from your post like the end is near.
How near, none can predict--none of us have expiration dates on the bottoms of our feet! But there are signs and symptoms to watch for.

I am amazed you had to fight so hard to get her into a Hospice program, given her condition. They should have gladly come in, evaluated her, & immediately set things up.

Breathing tends to get wet when the end is near--the person has trouble breathing effectively, & fluids in the body are migrating to the wrong compartments, as systems start to fail more.
When breathing gets "wet" [rattly, bubbly], it is common to stick on a little Scopalamine patch [often used for motion sickness], behind one ear--these get changed periodically, & swap sides.
This helps dry up the fluids in the lungs, to help ease breathing a bit.
It's also a bit of a sedative.

Anti-anxiety meds help keep a person laboring to breath, feel a bit calmer... hopefully.
Morphine is formally used to reduce pain--however, it fails to do that for some folks.
It's also a very good relaxant, even in those it fails to relieve pain for.
Good hospice staff know, that using anti-inflammatory meds are a better 1st use against pain, since pain stems from inflammation; then if the anti-inflammatory cannot do the whole job, it might be time to adjust the morphine dose--but using the anti-inflammatory meds first, means less morphine is needed--lowering side effects, and helping keep breathing comfort levels.
The usual rules that apply for narcotics use: it's important to watch that breathing rate stays at 6 breaths per minute -or more-. That may not be appropriate in Hospice at times like these...breathing rates are declining, usually, anyway. There's a fine line between giving the drugs that help relax them despite slowed breathing, or withholding them because of the slowed breathing, and having them be more agitated. You will have to decide.

Stopping eating is an indicator--they're bodies are slowing, things just don't digest; putting food in a system that cannot handle it, is unpleasant--it can trigger nausea, vomiting or diarrhea, etc. .

Getting fluids into the person may, or not, be a comfort measure.
It's very uncomfortable to have a dry mouth & body.
But, if fluids don't sit well in the digestive system before they get absorbed, that can be uncomfortable.
Sometimes, hospice staff may OK an IV just for fluids, & then it's a matter of keeping the mouth moistened--though most believe doing IV fluids prolongs the inevitable--as do feeding tubes.
It's comforting, usually, to use a moist wash cloth to put on their forehead, etc., maybe massage their feet & hands gently, perhaps with a nice lotion or creme that helps sooth dry skin, but avoid perfumed ones.
--Though, some folks do well with real essential oils; some of those can be very soothing--sandalwood, frankincense, etc. depending on the person.
If there are bad odors in the room, it helps to use peppermint oil--maybe on a light-bulb to diffuse it.

When breathing is not effective, circulation is also less effective.
Caregivers may start noticing changes in color--particularly pale/bluish/purple at toes, feet, fingers. Lips may become pale to bluish. So might ears.
Hands & feet can become quite chilled; as the body starts shutting down, it withdraws circulation from the extremities, to feed the core organs as long as possible--it's kinda like birthing backwards.
Usually once a person has gotten to that point, it may be a matter of hours , but it could as well last days.

It's common for someone going through the dying process, to also have a period of rebound, or "rally"--can be hours, days or a few weeks ahead of their dying---when their health & demeanor perk up, as if they are fine, sometimes....this "rally" can fool most family into thinking they are on the road to recovery.
It varies widely, how this manifests; sometimes there can be multiple rallies, but usual is one.
But it's not a recovery. I don't think anyone knows exactly why there is this feature to the process, so often. It seems like a great time to have wonderful memory conversations, & say final lucid goodby's, more lucid conversation, hugs.

Please also understand, unless the person is profoundly deaf,
hearing is the first sense to develop in the womb, & the last sense to quit when one dies.
Speak your sweetest, encouraging words for them to walk to the light, assure them their loved ones are waiting to help them along, that you will meet them when it's your turn later. Time in that place does not exist--time is only something we have here.

It is common for people who have believed firmly in their spiritual truths--regardless of what those are--to suddenly become afraid, suddenly unsure if their lifetime beliefs have been all wrong--please reassure them of the love, continuity, peace!

Sometimes, a person fears letting go, or they're stuck in pain.
These need permission to let go.
Sometimes they cannot hear it from a loved one
--sometimes another person needs to simply tell them it's OK to go to the light, to see their loved ones who've already gone there.
Bend to their ear that might still hear you, & simply, lovingly tell them: it's OK--they are OK, & those left behind are OK--you will miss them, but will be fine, & will remember them dearly.
No doubt, your mom held you when you were scared, as a child--
--this is doing that for her, now--hug, pat on back, reassuring words.
Everything will be OK. I love you; I will see you later when it's time!

It IS emotional!
Allow it, be gentle with yourself, make no apologies for your emotions!
It's part of life.
{{hugs!}}

I am a newbie here, but I have been where you are and I have much compassion for you. I believe actively dying is when a person takes no food or drink and is barely conscious or not conscious at all and can't communicate. Since you recognize that Hospice Care comes in as life goes out, the best that you can do is keep her comfortable. If she is unconscious, you can and should still speak to her. She may hear you. I used to wet my Dad's lips with a sponge on a stick and he responded positively to that. Pray at her bedside and speak from your heart. Persevere in the faith, and God bless you.

Yes sweetie, this is what they give someone who has very little time to live, so sorry, will keep you both in my prayers, take comfort that soon she will be an angel and be with our Lord, God Bless

My mother died this past May 2013 in a compassionate caring nursing facility of which she had been living for five years. Hospice brought in measures of morphine, and as a pastor myself, I watched her facial expressions and movements of her body. I was looking for any signs of discomfort. I never saw them, and I believe it had much to do with the morphine. Keep telling yourself where your loved one is going, and I also mentioned to my mother as many people as I could think of that she loved that have gone before her. I told her how much I loved her, and I gave her compliments when they surfaced. The hearing is the last to go, and I was very careful to keep her room as peaceful as possible. I did my best to not have the phone in use. I played on a CD soft instrumental music that happened to be familiar hymns sung in church. The facility where she was happened to have the CD and the player. I asked the nurses if they would mind making sure that the music played continously even when I wasn't there. The staff kept asking what they could do to help, and that is why I ended up asking if they would make sure the CD played. It played over and over, and one of the nurses when she left the room said, it is so peaceful in here. That is what I wanted. I continued to pray for the nursing facility, the nurses, my family and my Mom. Also, please note that some people do not want their loved ones in the room when they die. I don't know why that is, but if she passes away and you are not present, please do not feel guilty. The dying process is a very sacred and holy time especially for the Christian. I believe that our loved ones are going between this earth and heaven as they are dying, and what I will always remember is how my mother looked after she died. Her face was at peace. I pray that all deaths would be like this.

Yes this is what they refer to as pallative care, they will do everything possible to keep her comfortable as she enters a new journey. The rattling is one of the first signs that the end is near. She will soon be at peace and heaven will have a new angel. But she will still walk beside you through out your life, just watch for signs you'll know. You're in my prayers.

all of us going through or having gone through these things. We have a lot to share and can support each other. But for the AZ patients it feel like the end will never come! It seems to go on forever. I just wish there was a way for it to end before the patient has to succumb back to being a baby again. It is humiliating for me to watch this process and even though he doesn't know it now he would not like being a baby again either. I have promised I will never leave him until it is time.

I am so thankful for everyone's kind, helpful, and thoughtful responses...we are all in this process together, aren't we, and such is why we meet together and share our stories, seeking comfort, consolation and help... Bless each of you and your loved ones.

Mom is still eating her pureed foods and drinking when she wants to... but the other night she vomited for the first time... I've been with her each time she's been on morphine after asking Mom if she is in pain and she indicates so (usually an hour or more after she's given her usual tylenol and it is not working). I am beginning to see that if I don't advocate for her, the NH home medtechs, as sweet as they can be, are not really probing her for her level of pain...

Mom is so endearing in this stage of her life. I am so blessed to be a part of this process. My only concern is for her comfort and that Mom knows she is deeply loved. I hold her hands, pray over her, often prepare her for bedtime when I am there (taking out dentures, washing face, putting facial cream on, massing her hands, and changing her clothes) because I choose to... and she appreciates this. The caregivers are wonderful towards her... but I find I enjoy caring for her when she is so needy and dependent.

I do grieve that my siblings and her grandchildren are not more attentive towards her. Some hold grudges. Mom made some mistakes... she didn't know the LORD most her life (only coming to faith less than a year ago) and she could be rather self-absorbed and cutting... But she is so different now... and I wish they could see this.. and make peace with her... sometimes I wonder if this is why she is holding on...

Nonetheless, I celebrate my time with her and rejoice for each of my precious experiences with her. I love my Mom. I always will.

I'll continue to share updates with you. Thank you for reading, asking and praying for me and for all of us here. We all need strength and courage for this passage of our life and those of our loves ones. Hugs to each of you.

ive read many times that labored breathing can be assisted with a small fan pushing air into the patients face. this does amount to slightly pressurized air and is said to be at times a better solution than oxygen.

My mom passed away yesterday at around 3 p.m. She was in pain by around 6 a.m. & when I called Hospice and described her symptoms (and her decision to stop taking all of her CHF/PH meds), they suggested giving her the max dose of morphine hourly. Which is what I did. I know that my mom was not in pain at her death and she died holding the hand of me and her best friend, in her house, surrounded by her things, her husband, her cats & her memories. It was just the way she wanted it.

Hospice was incredible & I was lucky enough to have my Case Manager arrive literally moments before she passed. She did EVERYTHING (called the funeral home, called Mom's doctors, informed the hospital, etc.). Plus, she was the most kind and amazing person and was right there with strong hugs and soothing words. I could not have held up at all without Hospice.

And, I was very grateful to the morphine for easing my mom's transition.

R.I.P. Mom (1938-2013)

When there is terrible pain, it needs relieved.
And sometimes, getting that pain relieved, means the person can relax and let go.
I feel so sad that you experienced this; it is so hard to sit watching someone die, wanting to be with them for each possible moment, to help and comfort them....then not be there when they do go.
Morphine can be seen as 'expediting death' in some circumstances.
But it is primarily used, and authorized to be used for, stopping pain...though, for many, it fails to stop pain...instead, stupefying them into inability to speak to say they are still 'in there', and hurting. When doses of morphine seem to be failing to control pain, there need to be other remedies to help that, be it other drugs, or sometimes alternative measures.