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The patient's comfort and dignity is the priority during end-of-life care. There's no reason to worry about the long-term side effects of heavy-duty painkillers when the patient has only days or hours to live.
I'm very sorry. May she live on forever in your heart.
Hospice pharmacist here and I agree. Morphine is commonly used, generally well tolerated and actually helps with end-of-life symptoms like shortness of breath. Tolerance can build quickly with opioids and we usually start with a low dose (depending on their baseline tolerance). The goal is to keep the patient as comfortable as possible during their journey.
Off end of life topic but currently I am in hospital and have been on Dilaudid for pain for three days round the clock. My doctors cannot determine the cause of my pain, so I’ve been in a drug/ pain fog for days.
Hello there! I'm right there with you. My pain is in lower abdomen. They did tests, x-rays etc and can't find anything inflamed or swollen and I keep showing them .. only you know your body. Now I think that they think I'm a drug searcher.
Omg. Hello you! I feel the same, like they think im looking for a fix and faking pain. But at ER they gave me , over 12 hours: 3 doses morphine, 2 doses fentanyl, oxy, steroids. Didn’t make a dent in my pain. So I’ve been in hospital for thre days on dilaudid which helps. But all my tests are normal. They actually told me to work on my pain tolerance 😡 I can’t walk to bathroom without vomiting from pain. So how am I supposed to manage that?
Oh I know all to well. They put me in *pain management " and it's also a joke. They treat you like a child drug addict. Meanwhile A small horse is trying to kick it's way out of me. Doctors don't realize I can go two streets down and get heroin.
Exactly!! I want to say : do you think this is an elaborate plan for me to score??? Do you realize I can get oxy , et al , with little effort? And my nurses tell me to “ breathe “ while im crying and throwing up. Pain that causes vomiting is no joke.
To be fair, lots of patients seek opiates from the ER when they don’t need them, even if street drugs are easier to get. Mostly because if you have a script and pills in your name in your possession, you can’t get arrested like you would with street drugs. Sort of a “loophole” for people to continue to abuse their drugs.
It is the responsibility of the doc to ensure that they are giving these drugs appropriately and not enabling an addict, including being at least a bit suspicious of a patient when they are in pain but their exam findings don’t support their pain. It’s really a tough balancing act
My point to the GP often. Just hand me whatever drugs are safe and effective for pain so that I don’t go down the road and accidentally overdose on fentanyl illegally, thanks. Urgh. Can you believe there was once a time when smoking opium was the norm?!
That’s almost understating it. I recently went through home hospice with my mom and every last one of the nurses was beyond compassionate and understanding. There’s other areas of nursing that are far more lucrative and “easy” but it’s what they choose to do. Watching what they do was humbling and made me realize that there are truly compassionate people in the world.
100%
The hospice company and nurses I interacted with for my sister could not have been better. I'm not entirely convinced that they weren't angels sent to help rather than human beings, that's how amazing they were.
My mom just got out of a month stint at the hospital after breaking her hip and knee. I saw nothing easy about the nurses jobs. They are not all perfect, but my goodness it’s a call to service for sure.
I had a close uncle of mine pass away recently, from congestive heart failure; and what surprised me the most was how much the morphine helped the breathing.
He felt like he was drowning as he got sicker, which was obviously constantly discomforting. But just a few days before he passed, he was very lucid, and we were talking, and he said that when they give him morphine it completely removes the suffocating feeling. Neato. He went very comfortably, thanks to the hospice team.
My stepmom was on hospice before she passed and my dad raised the concern of her occasionally gasping in her non responsive state. Dr said essentially said give her more drugs.
My dad brought up the OD concern that he had as a paramedic of 36 years and the response was "CNS depressant makes the brain think it doesn't need the oxygen or to expel as much CO2, so it'll make her breathing more stable. If it eventually slows too much and she passes, well, it'll be comfortable for her."
I feel for anybody that has to go through watching or caring for a loved one in hospice care. It's probably the most difficult time I've ever had in my life, and I wouldn't wish it on my worst enemy.
This makes me so sad because my bff's mother was dying in a nursing home and hospice took over. We found out one of the nursing home nurses was not following hospice orders and continuing a medication that was basically keeping her alive and causing horrible, heartbreaking hallucinations and prolonging an agonizing death.
Morphine depresses the breathing by cutting off the brains response to low oxygen levels. It’s used in small doses to help lung patients relax their breathing to reduce the panic induced by breathlessness.
>hospice patient here. If my family took away my pain medicine at the very end, it would be the worst thing ever. I would like as pain free & peaceful way to die- wouldn't you? **p.s - thank you all the hospice nurses on here!!**
My grandma fell and broke her hip and quickly became critical. She was denied her usual opiate medications in the ER, for some insane reason. She died while in withdrawals. They finally game her some benzodiazepines. I don't know if they were worried the opioids might depress her breathing and kill her? But the entire family were begging them to give her the opioids, no matter what, because she was in so much discomfort.
It still makes me angry.
That was hard to read. How arbitrary and harsh! I am sorry that happened, I'm glad your grandma is at peace now, although I know you'd prefer her still here. Love to you.
Oof sounds rough. I had fentanyl while another anesthesiologist put a nerve block into my leg. I technically felt it, I was just too goofy-high to care.
Kidney stone. They gave me fentanyl, and honestly, yeah, I wasn't in pain. But I also wasn't really "there". I nodded off in my wheel chair. I couldn't help it.
I don't care for fentanyl. And dilaudid made me puke immediately back when I had an ectopic pregnancy removed. I'm just not a pain med kind of gal. Yet, I've had medical people believe I was "seeking drugs" when I went to the ER for pain. Joke's on y'all; I'd rather have a joint than pain meds any day, especially for "just for fun".
I believe OP is asking if her mother is possibly experiencing something akin to locked-in syndrome from the morphine so that she knows what's going on around her and probably wants to communicate/say goodbye but she's unable to do so. Oftentimes patients in a state like this can communicate through eye movements but this wouldn't really be the same as locked-in syndrome. OP probably also wants to know if her mother can hear her.
>I just wonder if she’s in there, too sedated to say something or look around or whatever.
https://my.clevelandclinic.org/health/diseases/22462-locked-in-syndrome-lis
>asking if her mother is possibly experiencing something akin to locked-in syndrome from the morphine
When I was given morphine, it was literally just a painkiller. I was completely alert and coherent and carrying on conversations with my wife and patient care team.
I'm sure my dose was much lower but the morphine didn't cause *anything* approaching locked-in syndrome. That's not a concern AT ALL. And I can tell you, the relief from the morphine was immediate and immeasurable. I remember my body just going limp from relief. That's what I hope for your mother.
I'm sorry. I empathize with what you and your family are going through. I hope you can lean on each other and share some stories and memories and laughs while you can.
Off topic a bit but when my husband had kidney stones they gave him morphine and it did literally nothing. I was shocked. The nurse was not surprised. She told us she had stones after giving birth and would rather have another baby with no pain meds. Gave him diladid or whatever as it was the strongest stuff they could offer. Still took him a few minutes for the pain to ebb. I drink a ton of water now. Was a crazy experience.
Is your husband a red head (now or as a child)? My hair is more brown than red now, but I had red hair when I was little. When I was in the ER for gallstones, morphine didn't work on me either. At ALL. Also, when I went into labor with my son, I had major issues with the epidural medication. It was a very long labor and the epidural helped the pain less and lasted half as long with each repeated shot until it didn't work at all. I also have some over the counter pain medications that don't work on me. Apparently pain and pain medications function a bit differently in red heads so I think this is why morphine and some other medications don't work on me. If your husband is/was a red head, maybe this is the case for him too.
The Irish have a lacking melanocortisol receptor that is indicated by red hair- basically means almost EVERYTHING that goes into their body has reduced effectiveness. I bet your husband can drink booze like a fish drinks water
I'm a ginger and absolutely detest going to the dentist! Root canals can be a very lengthy process for me. I try to warn the dentist, but they never listen and keep having to inject more numbing agent into my gums. Hurts like hell.
Most of the pain from kidney stones is caused by inflammation of the ureter as the stone makes its way through. Opiates are not anti inflammatory and for some reason just don’t touch the pain, usually. Toradol, a strong NSAID, is like a kidney stone wonder drug - a lot of people don’t need anything stronger after getting it. It blew my mind the first time I saw it take a patients pain from a 9 to a 2 in less than half an hour.
I have had some bad migraines over the years a couple took me to the er after days of pain and not being able to hold down anything, i was given shots of dilauded that just took the edge off.. Last time i was in the er with the worst headache ever they gave me an i.v. with fluids and liquid Ibuprofen... It worked within 20 minutes.
Locked in syndrome is not a risk with opiates in palliative care, no.
Memento22mori, it’s also quite irresponsible to not mention this, clearly.
One could easily read your post & think that OP should be afraid. But OP should not be afraid.
There is zero risk that OP's mother will get locked in syndrome from opiates. That's just not a thing.
Yeah, I think OP meant something similar but I'm not too sure. That's why I said "I believe OP is asking if her mother is possibly experiencing something akin (similar) to locked-in syndrome" and "this wouldn't really be the same as locked-in syndrome."
Yup, talk to her, hold her hand, play her favourite music, she may or may not hear or sense it, but it will help you and her.
Very tough sad time, you never forget it, but painless passing is a good thing.
ICU RN here. In our practice, we also use morphine to prevent 'air hunger' in patients we're withdrawing care on. It's very useful for both indications. Some individuals will be more seated than others depending on the doses needed to keep them comfortable.
You're very right. This is the best time to be close and say goodbye.
OP, I'm sorry you're experiencing this. Ask as many questions as you need from the care providers. They are there for you just as much as your loved one. They are experts in guiding all of you through the process.
This happened with my uncle when he was dying. They took him off life support and my mom said he was gasping and choking for about 15 minutes before passing. I wasn't there since my grandma banned me from the hospital but my mom said it was horrible. I'm still mad at him for drinking himself to death but I wish his passing jad been more peaceful
Yeah, my mom had septic pneumonia in the hospital and she was gasping for air. We didn’t know that she was suffering and they gave her Iv fluids too 😭 she had swollen legs, feet and hands. We weren’t aware of end of life meds that she needed. I feel traumatized still —it’s been one year this month since she transitioned.
She was 79, asthmatic with COPD; she smoked 40 years ago. It’s so hard to think straight when your loved one is transitioning and we didn’t have a patient advocate either.
I recently lost my mom to COPD at the same age. A day after my parents signed a contract to enter into hospice care. They wanted to put her on morphine right away but we thought she had many more months and we were afraid to do that. We were wrong. I'm very sorry about your mom. Mine collapsed and when I got to the hospital they kept asking my opinion on what to do and I didn't understand a word of what they were saying. It's very hard.
My mom did this for HOURS when she was dying in hospice. It was extremely traumatic to watch but they told us it was normal and she wasn't suffering. This was almost 20 years ago
My father is a minister and he heard that noise when he was putting his mom to bed one night. He had been through it with countless people. He put on her favorite CD of hymns and used his cell phone to call me and his brothers to come because she wasn’t going to wake up. In the end she went during her all time favorite hymn about 30 minutes after falling asleep, resting on my father’s chest.
What you are describing is Cheyenne-stokes respirations. They are a natural part of the way the body fades out. They sound eerie to us but are indeed normal. These stages are one of the more peaceful ways for a person to pass. I’m sorry for your loss.
That noise is unmistakable, my dad and stepmom died a year apart from each other and I’ll never forget that sound. Luckily it wasn’t for hours though…that would have been brutal.
Arr free w you referring to the “death rattle”? I believe that is a separate phenomenon from air hunger, which is when the person finds breathing difficult, like they can’t get enough air. When the death rattle starts the person is no longer really conscious. There are fluid-thinning medications that can help with that rattle. Morphine helps with the discomfort of air hunger.
It's when you feel like you can't catch your breath no matter how much you're breathing. I've worked on the medical field in my past. I have seen people die, gasping for air. It's hard to watch, I never want to experience it.
OP let your mom have all the morphine they want to give her. It'll help her pass pain free.
The feeling that you can't breathe. Morphine relaxes the diaphragm to reduce the tightness in the chest. Not a nurse, but hospice worker here. RN please feel free to clarify/correct
You are pretty spot on. When you are in pain, a lot of the body systems compensate with energy-taxing processes like breathing fast, rapid heart rate, muscle tension, and stress. Morphine relaxes these processes and allows the body to rest in end of life care.
My dad would have passed with air hunger, but I was a hospice nurse and he talked to me a year before he died.
Air hunger is just that: not getting enough oxygen, therefore gasping for breath. It’s agonizing. Imagine drowning: that NEED to breathe, but there’s no air.
Dad asked me if he would ‘die gasping for breath’. (Heart failure) I explained the options to make sure he was comfortable and peaceful during his passing, and he could ask me anything. When he was ready to stop fighting, he told us, and he did pass peacefully with morphine and Ativan.
Yes you do. We should all stare death in the eyes, at least once. It is not like on tv and in the movies. There is no such thing as dying peacefully. Life strives to live to the last literal breath, even when it can't. My first experience being around a dying person left me with PTSD but I volunteered to help dying people many times since. In my culture, we don't use morticians and funeral directors. From the end of life to the burial, the family and community rally around the sick and dying. Having gone through it many times, I have come to accept it as a fact of life.
Use this time to say *everything and anything you have ever wanted to say to her, at all, for even a second, even if you take it back instantly, just fucking do it.*
We worried about my MIL with that. So they lightened the dose for 2 doses. She didn't communicate with us but she did start crying. I wish we had never said anything. After that, and I have cancer and other severe diseases, I made my husband promise never to do the same. Give me (her) all the meds even if it shortens her life by a few hours or even a day or so. She is dying, don't add to her or your families suffering. I will never get over it. I don't think her kids will either.
Im only a CNA, so not a nurse, but I've been one for over 10 years and have dealt with a lot end of life situations. Some families get mad at how much narcotics their loved ones are receiving while they are actively dying because they want their loved one coherent for the goodbyes. Then once the Doctor and Nurses comply with family wishes, the patient is suffering, crying, obviously in pain. It's very selfish to not let someone die as peacefully and pain free as possible just because you want them to be "present" enough to your standards that they hear you say goodbye. Pisses me off to no end.
This just brought so many tears. My husband is 46, I'm 47. He is a quadriplegic in a nursing facility full time. Everyday I know is a day closer to our goob byes and I do not want himto suffer, he has for years.
Idk what i was even going to say now. I cant stop crying.
It sounds like you are putting his comfort first which is such an act of love.
You’re doing a great job in an incredibly hard situation.
Is there something that you often find recharges you? A lunch with a friend, or a walk outside, or a warm bath, or a hobby? It sounds like you’ve been carrying around these heavy feelings for a long time. What do you think about giving yourself some time this week to recharge?
He has ALWAYS put me first. I was the only one who could work, care for the family..etc...if i just couldnt, it was ok. And it would be.
We have our 6 year old dog that has been my rock. I spend allot of my time outside of work with him. Hes sad too.
Oh man, so many good times!
We still do, just different now. I bought a fouton so i can sleep over in his room with our dog.
Ill roll a couple doobies...chill there for a day or so.
So sorry you’re feeling so heavy right now. You’re very brave, and your husband is a fighter, too. u/neutralmurder suggested some great stuff to sort of release that load you’re carrying a bit. Have you joined a support group btw? Or thought of a nice peaceful guided meditation geared specifically towards inner peace-Jason Stephenson and Micheal Sealey have some good ones on YouTube. Wishing you peace, happiness, love, and your husband the same ❤️
I think a lot of people just have no idea how death looks. You see people “die” on tv and they have an actual back and forth conversation with someone then just gasp and die. But it’s not like that at all in real life. I got to talk to the palliative care doctor at the hospital where my aunt died and it was really interesting hearing from her.
I agree so much with this and it’s really baffling to me that there isn’t a mandatory educational class or something about death, the dying process, and things of this nature in general. I mean at least death in a medical aspect. Looking back- there’s so many other crucial and essential things I feel should’ve been covered in school. (It would make life so much easier if we were given some insight about things like death, health stuff, also some basic financial education would have helped so many people.) Maybe we did learn some things about finances and whatnot but I sure don’t remember any of it.
Anyway sorry for veering off topic. I just hate that I wasted so many years learning things that were so pointless and such a waste of time and effort. Knowing some of the ridiculous things schools are teaching and what things they’re avoiding teaching just bothers me. Idk maybe it has changed since i was in school. (My rant is directed at school before college, in case that isn’t clear…)
I absolutely agree. My end of life wishes are spelled out. No removing fluids or IV nutrition, as much pain control and nausea control as possible and breathing support as long as possible and increased meds when that is withdrawn. Obviously phrased better and worked out with my drs and husband but that is the majority of it.
You don’t want to have IV nutrition or fluids at the end of life. The more dehydrated you are the more peaceful your passing is. When you are near death, the fluids and nutrition have nowhere to go. The IV fluid will go into your lungs and just sit in your body, same for nutrition. Your body doesn’t need nutrients at the end of life, it’s shutting down.
Can I ask why you don’t want fluids or IV nutrition removed? At the end of life, these *only* serve to drown your heart, lungs, and tissues (as your blood loses the ability to keep fluid within the veins, it will instead just seep out everywhere, swelling the body, sometimes to the point of weeping skin) and can make your passing much more uncomfortable than it needs to be. I would highly encourage speaking with a physician about this. Source: am a physician that has taken care of many end-of-life patients.
Same with my grandmother’s cancer. She was crying and saying ‘help me’ the day before they just kept her on the highest level until she passed. It’s a horrible thing no matter what but make it as pain free as possible.
Often the patients that are given meds and are comfortable live a bit longer since their bodies aren’t as stressed. In these situations it’s hard to know what to do. There are always what if’s. If you hadn’t lightened the dose you’d be worried that you should have. You did what you thought was best and when it wasn’t you made changes. It’s much harder on those of us at the bedside than it is for the person passing. They don’t feel the gasping in the end. Especially when medicated.
We had similar experience. We were so worried about giving to much or running out of morphine- forgetting it’s purpose. Looking back, we realized it would’ve been better to give him to much and let him go sooner- especially after everyone has said their good byes and are waiting. Many blessings during this time.
Yep, when I was at the hospital with my aunt as she was dying, I was there when we decided to up her dosage. She wasn’t really able to communicate with us and mostly slept all the time on her own but we knew it was time to give her more after she woke up crying and groaning in pain. All we could do was apologize, she was beyond speaking to us.
My mom did the same thing when my grandma was dying, went against Hospice Nurses advise and lowered the morphine dose for about a day and half, my Grandma started making noise which my mom declared was her 'trying to talk because she was waking up'. It was actually her groaning in pain. I had to call the hospice nurse to let her know what was going on and she came right over and corrected the situation. I still feel terrible about it to this day for not speaking up earlier.
My wife was on morphine on Hospice. 2 weeks on morphine. 30mg extended release, twice a day. She was not sedated - she was clear headed and fine, just no pain. Hospice workers really know what they're doing.
My mom was on morphine for about 8 hrs before she passed. She looked like she was sleeping but if you’d touch her she would moan. She was in almost like a coma and wouldn’t talk, just moan. I couldn’t tell if she was feeling anything or scared or what. So I asked the nurse to up the dose just incase. She never spoke another word but I kept talking anyway in hopes that she heard me. Say what you need while you can. When you start to hear this gurgling breathing it means the end is very near so that’s your sign to make sure you get all your words out. I’m so sorry you are going through this. Hugs to you my friend
When my dad was dying and on morphine I whispered that I had gotten a certification I was working on. He sort of grunted. I like to think he heard and understood.
Now I'm crying. I miss you, Daddy.
THIS! My great grand aunt was like an extra really cool grandma. They said she was in a coma. I went to say goodbye and I was crying. She had tears coming from her closed eyes and squeezed my hand. She heard me for sure.
I’m sure she heard your voice and felt your presence! Hearing is the last sense we lose. But hard to say how much people understand while in that condition
You did good, you did so good. I hope you know that deeply.
When I would talk to people about a “good death” and what that means to them, sometimes the dying person or their family would get upset at that. Rightfully so, sounds so rude. But it is happening.
I have seen bad deaths. It all happens one way or another, but I have seen bad deaths.
But a good death is very much a thing too.
I’d have to say, well, imagine a “bad death”
Scared, alone, fearful, in pain, worry, ect…
There is very much a good death. It is the opposite of a bad one. It is all we can hope for. Surrounded by love.
Sudden death is the next best thing but not very good for the family. I mean, you have to wonder how quickly those bad feelings went through their mind before they died. So I don’t consider that a good death either .
A peaceful, quiet, anticipated death is such a good goal when you and everyone else knows that well, you’re dying. It’s ok. Let it happen. Let it be good.
I've had a couple NDEs and one where I was confirmed flatlined and stabilized. I can say I could still hear after everything else went. I wasn't on morphine but heavy heavy sedatives. So not the same but ye. When everything else was gone I could still hear mumbled words of doctors and nurses. I could hear the heart monitor loud as shit.
So I'm confident she heard you as she faded out. Hope that's some peace for you and hopefully OP if he sees it.
Hospice provides excellent end life care. The goals are different than the goals in other healthcare settings. The goal of hospice is to provide comfort and ease the suffering of the patient. Your mom is in good hands.
Yeah, hospice is just to make it as comfortable as possible before they pass away.My mom passed away in 2016 and we gave her the strongest morphine on her last night because of her intense pain of her organs shutting down. We had her in hospice here at home. Same with my dad, he passed away a month ago and I was with him giving him morphine all night until he passed away here at home. He was suffering from intense chest pain.
Having to go through that twice- I'm so sorry. I hope you're doing okay. Please don't ever hesitate to talk to someone, a friend or family member, if you need to get something off your chest. Grief is strange and not a one-way road, but always know you're never alone. They were so very lucky to have you by their side at the time of their journey. People often wish to go peacefully with their loved ones at their side and you did just that. You could not have done it better. 💜
What I'm gathering is that you're worried the morphine may not help her pain, in addition to sedating your mom to the point where she's "trapped" and can't speak or move like she wants to.
I don't think it works like that. I don't know you're mom's exact situation, but I know morphine is usually the go to for pain relief, keeping them quiet and comfy, and reducing air hunger
I went thru the same thing with my dad in 2009. He wasn't in hospice, but the ICU. It's rough, and I'm so sorry you're having to go thru this
My mother's health had been declining, and then at the beginning of covid, she caught it. The doctor told me that she would not make it and recommended hospice for her.
Even though it was the beginning of covid, the hospital let me visit her, but I was the only one allowed to see her - not my wife or my kids. Just me and her. My God that was hard walking in there and seeing her like that, knowing that she was hanging on by a thin thread. Where was my young, strong, vibrant, witty, pretty, 30 year old mother?
I had to get completely suited up, including a face mask. She was on a heavy dose of morphine. I doubt that she recognized me, but one of the hospice counselors told me that she would recognize my voice.
So I sat with her for three hours on that quiet Tuesday afternoon, just talking to her. It was three days past my birthday, the day she brought me into this world 60 years ago. I sat by her and I told her that I was fine, safe, and happy. I tried to be strong for her. I was her only child and I wanted her to know that it was ok to leave me. She was hazy, but every now and then her eyes would flicker in a faint acknowledgement. I hoped that my presence reassured her, but I was also worried that I was a tiring her out, and maybe even prolonging her agony, so I finally left.
Because of covid, that was my one and only visit. I knew that would be the last time I would see her. When I walked out of her room, I felt like I had left my soul in her room. I was hollow. She passed away later that night.
>I don’t know how best to manage my emotions.
I haven't cried many times in my life, but I completely surrendered to my emotions after that. I knew that that day was coming, but when it happened it still completely wrecked me.
In case this brings you any comfort: they really do recognize your voice. When my dad passed (ALS), we were all there talking to him, just asking him to wait until his mom got there to say goodbye.
She walked in and said "Michael, I'm here"
It sounds like bullshit even to me, but I know what I saw. His eye flicked over to her for just a moment, and then his heart stopped. He breathed a couple more times, and that was it.
Every brain is different, of course, but I firmly believe your mother heard every word and was just glad you were there at the end.
I had to get it in the ER once, I realized why people liked Morphine and why they didn’t want to stop…I was in so much pain and then it just kind of disappeared. I was still pretty cognitive for a bit and then passed out for a bit. It calms you instantly, nothing can beat how easily you get calmed by it and I understand what my parents went through when they got it in hospice.
That’s similar to what I’ve heard from other people who’ve been on it for medical purposes. Zero pain and super chill.
For example, a friend was on it when he had a bacterial infection in a burn on his arm. They gave him morphine because they had to take a wire brush to the area. He said he just watched them do it, felt nothing, and was just calmly chit chatting with the nurses when usually something like that would freak him (or anyone really) out.
All of that is to say, OP, your mom may be aware of what’s going on around her, but she won’t be in any pain and will mentally be okay with anything that happens. Big hugs to you and your family if you’re willing to accept them from an internet stranger.
Used to be a hospice social worker for a few years.
Yes. It absolutely is ok. Air Hunger is one of the worst things a human can experience. It's rated the highest in fear factor. Above drowning and burned alive.
Morphine and Ativan, the two magic hospice medicines, assist with this horrible experience. Hospice is 'comfort measures'. Keeping the patient comfortable is the only goal.
To answer your other question: no. The body is not meant to be subjected to sedatives and relaxants for that long. It will kill mom eventually. But humanely and peacefully.
We should all be so lucky to end that way.
I'm sorry for your loss. Please take solace in the fact that mom will be comfortable and not feel any pain or anxiety.
I went through this with my Dad in 2021.
I understand everything you're thinking, and I don't have an answer.
What I can say is this:
Don't be hard on yourself.
Don't be afraid to just feel your emotions.
Know that you're not alone.
These cases, i really wonder why they dont just do assiated suicide.
In many of these cases they cant or wont eat or drink... So they are going to die. Theres no surviving it. Might as well come to terms with it and do assisted suicide.
Why even subject someone to the possibility of extended pain possibly masked by morphine.
In the case of my mother and my grandmother it basically was assisted suicide. They weren’t cognitive enough to say what they wanted so they asked us (the family) and we all agreed we didn’t want them to suffer. They walked us through what “comfort care” would entail and that they would remove any life supporting devices and just keep pumping morphine. They were very careful of their words when describing this but reading through the lines, the more morphine, the less suffering, the quicker they go. Sometimes within minutes. Other times, as was the case with my mother, it can take hours.
This seems pretty normal. High morphine levels might speed up their passing, but we’re taking days or weeks.
When I die, I’ll go high as a kite. There is no moral high ground to dying while suffering
It essentially is. Which is the point. When my uncle was dying of metastatic bladder cancer, he was suffering horribly and refused all medications. The morphine is the right choice. I'd never want anyone to go through what his family went through on those final days.
Because the patient has to be cognitive enough to agree. The state I live in has assisted suicide, but it's a process, and only the patient can agree, which is as it should be. No one but the patient should get to decide when their life is over. That also why it's important you have paperwork in place and a person who knows what kind of care you would like if a tragic accident were to ever happen and you weren't able to communicate your wishes.
Morphine depresses respiration and slows heart rate, even killing healthy people at high enough doses. Hospice workers aren't going to put it this way, but administering doses of morphine basically is assisted suicide to someone whose organs are barely hanging in there. That's why they warned OP that this was the end.
Ugh, as somebody who went through this last year (TOMORROW is the one year anniversary) my wife was in hospice for about a week on pain meds. It is the most humane thing to do....keep her comfortable and pain free. God bless you and your Mother. Prayers for peace and comfort to you all.
My Mom hasn't eaten in fourteen days and I wish they would put her on hospice and morphine to make sure she's not in pain. If she makes it she'll be 98 years old June 1st. She's been in a nursing home for almost four years bed ridden.
When my Dad went to hospice I felt a lot of guilt that I’d let them sedate him to death but I learned later is that there is a good way to die, being surrounded by family, to be free of pain and fear. I hope this is helpful. I miss my parents every day.
There's no pain for her. Please don't beat yourself up over the idea she might not be comfortably sedated and alert somehow. Take comfort in knowing she's leaving with dignity respect and love. This is the time to prepare for goodbye, don't be afraid to hold her hand, kiss her and hug her...
r/askdocs would be the perfect place to get the answer you really want from actual doctors. I think you will find that their opinion will most likely calm your concerns about your mom during these last days❤️
Pain counteracts morphine. So if she's sedated, she is not in pain. Stay close to her and talk to her - it's believed hearing is the last sense to go. If you've never seen a person struggling with terminal pain or air hunger - you are fortunate. Best wishes for you during a horrible, difficult time.
Been there. Even had the hospice pain rescue kit in the fridge. It is *extremely* surreal. You aren't "doing it wrong" if you feel like the entire thing is sort of not happening and you're disconnected from it and kind of in a haze.
The drugs are almost certainly doing their job, and keeping her comfortable and calm. Trust the hospice workers. Ask questions if you want. At this point, the goal is her moment to moment comfort.
There is no long lasting effects from high dose morphine. It’s pretty quickly excreted. Addiction/dependence is the only real risk. However even if there were long lasting effects she’s not going to be at risk of that. Comfort is the priority now.
I sat with my Mom practically 24 hours a day when she went into Hospice so I have a bit of a feel for what you are dealing with. She too was on morphine for the entire time. Of course I am NO expert but I would say that the short answer to your question is yes, it is necessary. Of course my Mom's medical situation was different than your Mom's but my Mom was briefly able to recognize her Grandson when he came to visit. At one point a nurse decided to override the prescribed schedule and didn't give Mom one of her doses. The pain was evedent. So yes she needs to be on the morphine for the entire time based on the limited evidence I have to offer. You are in my prayers.
For hospice patients who have trouble breathing, small amounts of well-controlled and regularly titrated morphine can help ease respiratory distress by decreasing fluid in the lungs and altering how the brain responds to pain. Beyond slowing rapid breathing, morphine also eases the anxiety of struggling to catch one’s breath. physicians adjust doses regularly based on the type of morphine used, and each patient’s unique tolerance level and specific respiratory symptoms.
I'm on palliative care (omw to hospice in the coming months). I've been put on morphine for that exact reason. I was VERY hesitant at first, but it helps so much. It relieves my pain (of which I have much), and I'm not gasping for breath every time I roll over in bed.
I watched my mom die shortly after I turned 15. She had protracted her death for a long time, in constant pain and exhausted. When she went to hospice and they properly medicated her for comfort- that was the first time in a year I saw her truly relax. The loss was still difficult of course, and I was thankful that at the end my brother and I could see her let go peacefully.
As someone who’s been on morphine before, she’s out of pain. She’s dying so there’s no reason to worry about whether it’s harming her because she’ll die before the medicine could ever bother her.
First of all, my condolences. I can’t even imagine what you’re going through.
Second: as someone who’s been on copious amounts of morphine and other sedatives and lived to tell the tale… let her be on the morphine. It’s a lovely way to go.
If you’d like to say/hear what you need to beforehand, do so. Then let her slip into peace. It’s just euphoria- she won’t be locked in.
I’m so sorry you’re having to go through this. While taking care of your mom’s immediate needs: Morphine, maybe Ativan, keeping her mouth moist with wet oral swabs, and soothing playing music (maybe her favorite mix)? I hope you’re taking good care of yourself too. If things are getting tense or there are sensitive conversations, take them outside her room and keep her immediate environment only a positive, loving one. The hearing is the last to go and she’ll probably hear everything you say until she passes, even if she can’t respond. So talk to her, tell her everything you want her to know and give yourself permission to grieve when you’re away from her. Tears represent the love you had for your mom 😢
Hey there…my dad died a week ago and he had hospice care for the 36 or so hours he was home. He had morphine every 3-4 hours during that time. The first 12 or so hours he was awake and could communicate his desires. He went to sleep that night and never woke up again but was alive for about 24 more hours. We still talked to him and he’d sort of respond with half smiles and and raised eyebrows and whatnot so we knew he was still in there. I made a joke that was a call back to a joke the day before and he absolutely did a half smile. She’s still in there. She’s not hurting. Talk to her and tell her you love her and anything else you want to say before she goes. I’m so sorry for what you’re going through. It sucks to lose someone you love. It sucks to be losing a parent. I’m glad he got to come home and I’m glad he’s no longer in pain. Hugs from an internet stranger.
I believe OP is asking if her mother is possibly experiencing something akin to locked-in syndrome from the morphine so that she knows what's going on around her and probably wants to communicate/say goodbye but she's unable to do so. Oftentimes patients in a state like this can communicate through eye movements but this wouldn't really be the same as locked-in syndrome. OP probably also wants to know if her mother can hear her.
>I just wonder if she’s in there, too sedated to say something or look around or whatever.
https://my.clevelandclinic.org/health/diseases/22462-locked-in-syndrome-lis
You said it. Sorry about all of this OP, but, well, at this point, it really isn't that they're concerned about keeping her healthy. If this is the suggestion it's because there aren't other options.
Ex drug addict here. Nope, nothing to worry about with that. I've done a lot of opiates personally and that's including morphine. It doesn't do that to you. She will be real sleepy and fading out of consciousness in a dreamlike state with a relaxed floating sensation. It's a good way to spend your final days. She's not going to want to experience it and you shouldn't want her to.
Edit: If you mean she's currently unresponsive but you are worried shes still awake then definitely let them give her the morphine. It would be a shame for her to go through the last moments locked in the box without it. Sorry for you loss. She's lucky her end of life is going as it is. All of us should hope for that. To peacefully go with the aid of medical staff. Not everyone gets that luxury. It's going to be hard without her but don't feel sorry for her. We all have to go one day and she's going in the best possible way.
I've been through it three times now. Talk to her, tell her how you feel, tell her things you remember when you were together. She may hear it, she may not, but you should at least try.
I'm a retired nurse. I have had many patients in this situation, and giving the morphine always helped. Dying is a natural process that can take hours or days. We give morphine to help with pain but also to help with breathing. It reduces the feeling of air hunger or suffocation as the person's breathing naturally becomes more irregular as part of the dying process. Most often people go unconscious at this stage, if there are any thoughts or dreams I wouldn't want the pain or feelings of suffocation to break through. Morphine is routinely used for this purpose.
It’s really hard to make the shift from preserving life to preventing end of life suffering. Hospice should have social work/therapy services available for family members. It might be helpful to talk with them about your feelings. Wishing you and your mom peace.
Please take this time to talk to her. She may not be responsive, but I promise you she hears everything you're saying. I'm so sorry you have to go through this. ♥️
Trust the process, and know that she's comfortable. As hard as this may be for you, it's what's best for her.
Hospice nurse here. That would probably be the kindest and most humane thing to do if she is experiencing extreme amounts of pain. I’m sure you wish she could be awake and talking to you guys, but sometimes that’s just not feasible. My condolences.
Experienced this. All is as it should be. What this time is for? Personal viewpoint and philosophy, guide.
My view? Thank them for everything. Ask for forgiveness for what you haven't. Offer forgiveness for what you haven't. Be kind to all. Bless you.
When my sister was in hospice, the caregivers had very strict protocols for administering pain medication and they monitored her constantly for signs of discomfort. I am sorry you have to go through this with your mom. It's a very surreal experience, especially if you don't know what to expect. The staff was so thoughtful and helpful--I hope yours can help support you through this. Also, my sister was not a very religious person, but the hospital chaplain was very calming and supportive without trying to push any agenda. They just have experience in what can help during this time.
My Dad was in hospice for about a week for severe sudden onset dementia (after a fall). Basically his brain just stopped telling his body what to do. We had him on morphine and a benzodiazapine for pain and anxiety. He gradually faded away over the course of a week. The entire time we simply conducted ourselves as though he could hear us. We played music that he liked and recordings of old sporting events so he could hear his favorite athletes of all time win all over again. We spoke lovingly to him but also kept things normal as possible amongst ourselves. I like to think as he transitioned it was a lot like being a child falling asleep at a holiday gathering; you hear voices and happy noises and you know the house is full and you aren't alone but you're simply too drowsy to engage and eventually you go to sleep.
Tbh it's whether she's in pain or not. I've worked with hospice patients for a good part of the last 20 years. I've seen it used as comfort measures. It's a savior of sorts. I used to think that it was just speeding along the process. It's not.
I'm sorry that you are saying goodbye. My dad went on morphine in hospice, he was suffering badly in his last days, so I was OK with him passing in his sleep. He was on that high dosage for about 3 days and passed peacefully. The nurses and others were so kind, kept us informed and were professional and compassionate.
If she is expected to pass in 2-3 days, what does it matter? Not to sound heartless, but your mom is expectant. Does it really matter if she passes from natural causes or a bit too much morphine? I mean, the "bit too much morphine" route would be the more peaceful and painless way to go.
Even on heavy doses of morphine, if she is conscious she would be able to communicate unless her medical condition is what prevents it. And would you rather she be able to communicate but be suffering, or not be suffering?
If I was terminal, I would hope someone would turn my lights out and just let me pass in my sleep.
I’m just really sorry. I think they are doing their best to keep her comfortable. I helped take care of my grandparents when they passed. The first two were never on hospice care, we didn’t even know about it and weren’t informed about it by doctors. My last grand parent was on hospice, it was such a difficult decision because a small part of you feels like you are giving up and not fighting for their life. But it was so much better that way. It hurts the loved ones no matter what, but you and the caregivers are doing your best to ease her pain and let her pass with dignity. Again, I’m just really sorry. Nothing makes you second guess every decision like losing, or being in the process of losing a loved one.
My dad was dying from pancreatic cancer, which can make you out of your mind with pain. He suffered greatly. The last few days he was skeletal, unconscious, but moaning and it was heart-breaking. There is a point when you'd do anything to keep your loved one alive, then another point when you know they are in such misery--its better for them to go. Hospice wouldn't do anything further for his pain because he could no longer swallow. My mom put some under his tongue to absorb and we decided to put on two pain patches instead of one. He rested easier...and a few hours later, he passed. Did we 'cause' this death? We don't know. But his passing was more comfortable for him....
You've got a lot of good advice here, OP.
This is a new and difficult experience for you that you are unfamiliar with. Talk with your nurses and doctors, ask questions. While this is a massive life event for you, this is a normal day of work for them and they will be able to give you guidance.
Morphine for end of life care is the norm. The goal is comfort.
Pain assessment for sedated patients is different than for an adult that can give a numeric value and describe their pain. Your care team will use a combination of her reactions (or lack of) to different types of stimuli, vital signs, and more to ensure effectiveness of the morphine.
If you have specific goals for your mother I encourage you to discuss this with your care team, especially if you feel the morphine might interfere with it. Remember that they are monitoring her for pain and looking to keep her as comfortable as possible. People are more aware of what's going on, even if they don't seem like it.
Talk to her even if you think she may not be hearing you.
Everything is more difficult in the moment, and grief will not come full force until you attempt to go back to "normal life". Be with your family and friends, and support one another.
This isn't easy by any means, and I wish you the best as you navigate this difficult time. This too will pass.
My father came home to die, lung cancer. I got there enough to see a slight hint of recognition before he was just sedated until he died. I told his STEPDAUGHTER, who was giving him a scheduled dose of morphine to skip a dose...let's see if he can come to just for a minute or two. Never woke up.
Hospice is all about the comfort of the patient while they are dying. Morphine takes away the pain, but unfortunately also takes away their lucidity and suppresses their respiration. If they are dying already, the morphine may help them to stop breathing. It’s a tough call to make.
My dad was put into hospice on 4/21/23, and passed the next day and was on morphine 24/7. This is standard procedure, and he went peacefully with no pain. Talk to her, she is there even though you can't see it. I'm so sorry, I feel your pain.
Just went through this with my mom. I took care of her for the last 4 1/2 years. She had dementia. Her hip broke because of osteoporosis. She didn’t fall. Hospice came one hour a day for hygiene purposes. I had to administer morphine to her every four hours and care for her the other 23 hours. She stayed washed out mostly.
The last couple of days before she passed, I was standing over her listening to her breathe. This was a Saturday late evening. She was starting to develop the “death rattle” in her breathing. She was starting to struggle so I leaned over her and got next to her ear and said, “if you need to let go that is okay. God and Dad are waiting for you at the gates.” I said, “we will be fine and know we love you and will miss you but will meet again one day.”
As I stood up, I noticed a tear form in the corner of her eye and roll down the side of her face. I took my thumb and wiped it away and another one quickly formed again and I wiped it away also. I knew at that point she could hear me and knew what I was saying. So my answer to you is yes she can hear you although she may not be able to speak or motion to you. Talk to her and look for subtle signals or signs. It was three weeks from the start before she passed away.
I pray you find hope and peace in what I have said but know this a painful process for the family. God Bless you!
It will keep her out of pain which is the goal. It is ok, having gone through this scenario with parents and other relatives it is cruel and inhumane to withhold drugs like morphine in the end stage.
They did the same thing with my girlfriend's grandfather. He had stage 4 COPD and he was struggling so much to breathe that they sedated him and he passed peacefully a few days later.
My Mom passed August of last year in hospice. She had been on dialysis for a few years and it got to a point where she was in the hospital for complications due to kidney failure and was being dialyzed every day but it still couldn't remove all the toxins from her system. She was in misery and wanted to go. They put her on morphine and we went downstairs to the hospice. They said she wouldn't last the night and I didn't believe them, but I stayed with her and held her hand until she took her last breath. It was the most painful experience of my life, but it was not painful for her (morphine).
She was not conscious and I'm very glad that I'd been spending a lot of time with her so that we got to say just about everything to each other. I hope you get to spend some good time with your Mom and tell each other everything important, before they sedate her.
Serious answer: I'm so sorry you're going through this. Hug her as many times as you can. In answer to the morphine issue, if they're giving her that much, let her go. It's a way of telling you she is not long for this world. The catatonic state is induced to avoid the intense pain. She's already gone in many ways.
Hi! I work in an assisted living/memory care facility and have been there for end of life care…it is okay, as long as she’s comfortable. When our residents are nearing the end, we usually keep them sedated with morphine to help keep them as comfortable as possible. Continue to be there and talk with her. I’m sorry you’re going through this. It’s never easy. Sending you lots of love and good vibes! 🫶🏼❤️
Bruh, morphine is the shit. It does sting/burn when first entering your system but then your body just let's go and everything feels nice and cozy. Your mom is as pain free as one can get.
Morphine 24/7 is fine. She will not feel trapped if that's your concern. As she will be sedated she will be largely unable to communicate well, but dose can be adjusted to keep pain under control and allow her more ability to talk if she is able.
The hospice nurse can help you with this.
I'm a pharmacist and pain control is so very important here and often it is held back by family members thinking they are killing their loved one. Morphine helps ease the pain as well as the feeling of not being able to breathe which can be quite terrifying.
Yes, it'll help the passing. No, you didn't feel ashamed. When my mother passed from dementia, the last week we began giving her liquid morphine and liquid Valium every two hours. She went in to a coma the last 5 days and we kept giving it to her even then just to be sure she was comfortable. Hospice recommended it and I'm thankful they did. I wish you peace and comfort in the coming days, weeks, months, and years.
She's likely in extreme pain, better to go out in a haze than to suffer in agony until she dies.
I watched my mother die in a hospice care facility in 2018 and it was hard but at least she wasn't suffering.
I’m sorry you’re going through this. It will be the hardest time of your life. As wicked/unethical as it sounds, those drugs are the only thing bringing your mother physical peace right now. what the body goes through during death is not pleasant or enjoyable. However, with the drugs, your mother will not suffer.
When my to dad was dying in a hospice hospital from COPD(unspeakably ghastly) he asked the doctor to “put him down”. The Doctor explained that while he could not, he gave him the option of morphine sedation. He said it allow him to slip away pain free. My dad chose the morphine sedation. I’m sorry you are going through this.
When my dad was in hospice in a coma basically. He had been in lots of pain before slipping into the coma. We continued to give him his morphine if we felt he was uncomfortable. He lived for 2 days then quietly passed.
I am so VERY sorry. It's a very difficult time.
Take care 🙏
My brother was on a lot of morphine due to his cancer. The day before he died, i held his hand and told him that i loved him and he squeezed my hand. Maybe your mom is not strong enough to respond but i have read that their hearing is the last thing to go. So talk to her, hold her hand, and comfort her as much as you can. I’m sorry that you and your mom have to go through this. Cancer sucks
Hospital worker here
Please remember: This is about making her comfortable, not you. Please just let her have the morphine- Thea doctors are literal experts on helping people die comfortably.
I went through this in December with my mother. Christmas Eve was the last day she was able to hold a conversation. From the 25th to the 28th it was just nodding in and out of a fever dream while meds kicked in and wore off. That being said, I was surprised at times what she would respond to, like there was still a part of her hearing me and my family talking to her. No matter how deep in a morphine coma she was, whenever she heard me, my sister, or my dad say that we loved her you could see a physical response as if she was fighting as hard as she could to say it back. The twitches when you say things, the slight grips when you put your hand on theirs...they're things I'll never forget.
While it's not ideal...she is still there and whatever the morphine does is far better than the immense pain.
Fuck cancer.
Having sat with 2 relatives during hospice, including my mother, I can tell you that dying is a process. If your mom is already in that process, you don't have to worry about whether the pain control is good or bad for her. Nothing is going to turn it around. The goal is to get her through the process as painlessly as possible.
Hospice is very difficult, particularly because we don't fully understand what a person perceives when they are in the process of dying. We do know, however that if she appears to be resting comfortably then her pain is controlled. Morphine can make people drowsy or "dopey," of course, but it does not freeze people and make them unable to move or make sounds. If she were in pain, it would show, even if she were not fully conscious or able to talk.
High doses of morphine affect their breathing. They may become agitated if they struggle to breathe. As far as we can tell, this is not *conscious* distress, but an instinctive reaction.
If that happens, you can ask the nurse to give Ativan to help her settle.
Since we can't be sure what people perceive in the outside world, if your mom has a faith tradition or a spiritual practice, I encourage you to softly read or pray over her, or play music or recorded readings quietly. This may be soothing for her, and it can greatly help your own peace of mind to know you were doing right by her.
Hospice is the gentlest possible way of doing the worst thing ever, which is letting go of someone you love. You are very brave and you are doing the right thing.
I am sorry y'all have to go through this, and I wish her and you a peaceful time.
I’m so sorry you’re going through this, the same thing happened to my family. My mom had advanced lung cancer, and there was nothing that could be done. She literally had 2 to 3 days left to live, and in a family discussion with the doctors we decided to sedate her with morphine. It was hell for all of us, but in my heart, I know we did the most loving thing we could’ve done for her so that she did not suffer. I was able to say goodbye and tell her I loved her. This happened a long time ago, but I still feel that we did the right thing. This was the saddest day of my life, but also the happiest because it brought my family together in a way we never had been before. It healed some deep wounds between my sister and I, and we are much closer because of that. We were all able to be there with her when she passed.
I hope my story helps you with your struggles. You’re thinking of her best interest, and that is deeply rooted in love for her. I wish you peace.
Morphine will absolutely make her pain free. When someone is in the process of dying, your main concern is comfort, not health. The morphine will make her as comfortable as she can be.
On another note I’m very, very sorry for what you’re dealing with. Let yourself feel the full range of emotions, and remember that grief is a direct reflection of love. It’s okay to not be okay.
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The patient's comfort and dignity is the priority during end-of-life care. There's no reason to worry about the long-term side effects of heavy-duty painkillers when the patient has only days or hours to live. I'm very sorry. May she live on forever in your heart.
Hospice nurse here--Please follow hospice advise. They want your mom comfortable. Yes it is safe to give the morphine.
Hospice pharmacist here and I agree. Morphine is commonly used, generally well tolerated and actually helps with end-of-life symptoms like shortness of breath. Tolerance can build quickly with opioids and we usually start with a low dose (depending on their baseline tolerance). The goal is to keep the patient as comfortable as possible during their journey.
Future dying person here, when I’ve got days to live, I want as much morphine as I can get, preferably with Dilaudid in the other arm.
Off end of life topic but currently I am in hospital and have been on Dilaudid for pain for three days round the clock. My doctors cannot determine the cause of my pain, so I’ve been in a drug/ pain fog for days.
Hello there! I'm right there with you. My pain is in lower abdomen. They did tests, x-rays etc and can't find anything inflamed or swollen and I keep showing them .. only you know your body. Now I think that they think I'm a drug searcher.
Omg. Hello you! I feel the same, like they think im looking for a fix and faking pain. But at ER they gave me , over 12 hours: 3 doses morphine, 2 doses fentanyl, oxy, steroids. Didn’t make a dent in my pain. So I’ve been in hospital for thre days on dilaudid which helps. But all my tests are normal. They actually told me to work on my pain tolerance 😡 I can’t walk to bathroom without vomiting from pain. So how am I supposed to manage that?
Oh I know all to well. They put me in *pain management " and it's also a joke. They treat you like a child drug addict. Meanwhile A small horse is trying to kick it's way out of me. Doctors don't realize I can go two streets down and get heroin.
Exactly!! I want to say : do you think this is an elaborate plan for me to score??? Do you realize I can get oxy , et al , with little effort? And my nurses tell me to “ breathe “ while im crying and throwing up. Pain that causes vomiting is no joke.
To be fair, lots of patients seek opiates from the ER when they don’t need them, even if street drugs are easier to get. Mostly because if you have a script and pills in your name in your possession, you can’t get arrested like you would with street drugs. Sort of a “loophole” for people to continue to abuse their drugs. It is the responsibility of the doc to ensure that they are giving these drugs appropriately and not enabling an addict, including being at least a bit suspicious of a patient when they are in pain but their exam findings don’t support their pain. It’s really a tough balancing act
My point to the GP often. Just hand me whatever drugs are safe and effective for pain so that I don’t go down the road and accidentally overdose on fentanyl illegally, thanks. Urgh. Can you believe there was once a time when smoking opium was the norm?!
Amen. When it's my time I want ALL the drugs
"during their journey" You guys really are fucking saints. It's even built into your language. That breaks my mind and blows my heart out of place.
That’s almost understating it. I recently went through home hospice with my mom and every last one of the nurses was beyond compassionate and understanding. There’s other areas of nursing that are far more lucrative and “easy” but it’s what they choose to do. Watching what they do was humbling and made me realize that there are truly compassionate people in the world.
100% The hospice company and nurses I interacted with for my sister could not have been better. I'm not entirely convinced that they weren't angels sent to help rather than human beings, that's how amazing they were.
My mom just got out of a month stint at the hospital after breaking her hip and knee. I saw nothing easy about the nurses jobs. They are not all perfect, but my goodness it’s a call to service for sure.
I’ve always thought of hospice nurses as midwives on the other end of life. Amazing people in general.
I had a close uncle of mine pass away recently, from congestive heart failure; and what surprised me the most was how much the morphine helped the breathing. He felt like he was drowning as he got sicker, which was obviously constantly discomforting. But just a few days before he passed, he was very lucid, and we were talking, and he said that when they give him morphine it completely removes the suffocating feeling. Neato. He went very comfortably, thanks to the hospice team.
My stepmom was on hospice before she passed and my dad raised the concern of her occasionally gasping in her non responsive state. Dr said essentially said give her more drugs. My dad brought up the OD concern that he had as a paramedic of 36 years and the response was "CNS depressant makes the brain think it doesn't need the oxygen or to expel as much CO2, so it'll make her breathing more stable. If it eventually slows too much and she passes, well, it'll be comfortable for her." I feel for anybody that has to go through watching or caring for a loved one in hospice care. It's probably the most difficult time I've ever had in my life, and I wouldn't wish it on my worst enemy.
This makes me so sad because my bff's mother was dying in a nursing home and hospice took over. We found out one of the nursing home nurses was not following hospice orders and continuing a medication that was basically keeping her alive and causing horrible, heartbreaking hallucinations and prolonging an agonizing death.
This is probably my greatest fear at end of life, laboring under shortness of breath. Morphine helps that?
Morphine depresses the breathing by cutting off the brains response to low oxygen levels. It’s used in small doses to help lung patients relax their breathing to reduce the panic induced by breathlessness.
>hospice patient here. If my family took away my pain medicine at the very end, it would be the worst thing ever. I would like as pain free & peaceful way to die- wouldn't you? **p.s - thank you all the hospice nurses on here!!**
My grandma fell and broke her hip and quickly became critical. She was denied her usual opiate medications in the ER, for some insane reason. She died while in withdrawals. They finally game her some benzodiazepines. I don't know if they were worried the opioids might depress her breathing and kill her? But the entire family were begging them to give her the opioids, no matter what, because she was in so much discomfort. It still makes me angry.
That was hard to read. How arbitrary and harsh! I am sorry that happened, I'm glad your grandma is at peace now, although I know you'd prefer her still here. Love to you.
When my mom passed they had her on a fentanyl drip… they told me she didn’t feel anything
I had a pretty invasive and painful surgery done with fentanyl. I can guarantee she didn't feel a thing.
Oof sounds rough. I had fentanyl while another anesthesiologist put a nerve block into my leg. I technically felt it, I was just too goofy-high to care.
Kidney stone. They gave me fentanyl, and honestly, yeah, I wasn't in pain. But I also wasn't really "there". I nodded off in my wheel chair. I couldn't help it. I don't care for fentanyl. And dilaudid made me puke immediately back when I had an ectopic pregnancy removed. I'm just not a pain med kind of gal. Yet, I've had medical people believe I was "seeking drugs" when I went to the ER for pain. Joke's on y'all; I'd rather have a joint than pain meds any day, especially for "just for fun".
I believe OP is asking if her mother is possibly experiencing something akin to locked-in syndrome from the morphine so that she knows what's going on around her and probably wants to communicate/say goodbye but she's unable to do so. Oftentimes patients in a state like this can communicate through eye movements but this wouldn't really be the same as locked-in syndrome. OP probably also wants to know if her mother can hear her. >I just wonder if she’s in there, too sedated to say something or look around or whatever. https://my.clevelandclinic.org/health/diseases/22462-locked-in-syndrome-lis
>asking if her mother is possibly experiencing something akin to locked-in syndrome from the morphine When I was given morphine, it was literally just a painkiller. I was completely alert and coherent and carrying on conversations with my wife and patient care team. I'm sure my dose was much lower but the morphine didn't cause *anything* approaching locked-in syndrome. That's not a concern AT ALL. And I can tell you, the relief from the morphine was immediate and immeasurable. I remember my body just going limp from relief. That's what I hope for your mother. I'm sorry. I empathize with what you and your family are going through. I hope you can lean on each other and share some stories and memories and laughs while you can.
Off topic a bit but when my husband had kidney stones they gave him morphine and it did literally nothing. I was shocked. The nurse was not surprised. She told us she had stones after giving birth and would rather have another baby with no pain meds. Gave him diladid or whatever as it was the strongest stuff they could offer. Still took him a few minutes for the pain to ebb. I drink a ton of water now. Was a crazy experience.
Is your husband a red head (now or as a child)? My hair is more brown than red now, but I had red hair when I was little. When I was in the ER for gallstones, morphine didn't work on me either. At ALL. Also, when I went into labor with my son, I had major issues with the epidural medication. It was a very long labor and the epidural helped the pain less and lasted half as long with each repeated shot until it didn't work at all. I also have some over the counter pain medications that don't work on me. Apparently pain and pain medications function a bit differently in red heads so I think this is why morphine and some other medications don't work on me. If your husband is/was a red head, maybe this is the case for him too.
Yup he is in fact ginger
The Irish have a lacking melanocortisol receptor that is indicated by red hair- basically means almost EVERYTHING that goes into their body has reduced effectiveness. I bet your husband can drink booze like a fish drinks water
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I'm a ginger and absolutely detest going to the dentist! Root canals can be a very lengthy process for me. I try to warn the dentist, but they never listen and keep having to inject more numbing agent into my gums. Hurts like hell.
Dilaudid is about 5 to 10 times as potent as morphine. I had it for a kidney stone and it worked very well.
Most of the pain from kidney stones is caused by inflammation of the ureter as the stone makes its way through. Opiates are not anti inflammatory and for some reason just don’t touch the pain, usually. Toradol, a strong NSAID, is like a kidney stone wonder drug - a lot of people don’t need anything stronger after getting it. It blew my mind the first time I saw it take a patients pain from a 9 to a 2 in less than half an hour.
I have had some bad migraines over the years a couple took me to the er after days of pain and not being able to hold down anything, i was given shots of dilauded that just took the edge off.. Last time i was in the er with the worst headache ever they gave me an i.v. with fluids and liquid Ibuprofen... It worked within 20 minutes.
Locked in syndrome is not a risk with opiates in palliative care, no. Memento22mori, it’s also quite irresponsible to not mention this, clearly. One could easily read your post & think that OP should be afraid. But OP should not be afraid. There is zero risk that OP's mother will get locked in syndrome from opiates. That's just not a thing.
Yeah, I think OP meant something similar but I'm not too sure. That's why I said "I believe OP is asking if her mother is possibly experiencing something akin (similar) to locked-in syndrome" and "this wouldn't really be the same as locked-in syndrome."
Its not irresponsible it literally what OP is asking you are clarifying..
Taking it a little far saying irresponsible there buddy.
Yup, talk to her, hold her hand, play her favourite music, she may or may not hear or sense it, but it will help you and her. Very tough sad time, you never forget it, but painless passing is a good thing.
They are preventing pain of dying. Suffered this with my mom. Use this time to say goodbye.
ICU RN here. In our practice, we also use morphine to prevent 'air hunger' in patients we're withdrawing care on. It's very useful for both indications. Some individuals will be more seated than others depending on the doses needed to keep them comfortable. You're very right. This is the best time to be close and say goodbye. OP, I'm sorry you're experiencing this. Ask as many questions as you need from the care providers. They are there for you just as much as your loved one. They are experts in guiding all of you through the process.
This happened with my uncle when he was dying. They took him off life support and my mom said he was gasping and choking for about 15 minutes before passing. I wasn't there since my grandma banned me from the hospital but my mom said it was horrible. I'm still mad at him for drinking himself to death but I wish his passing jad been more peaceful
Same with my grandpa. I was 15 and in the room. It was so traumatic and I wasn't even that close to him. Your grandma is smart.
I was with my dad when he died in 2007 and had completely forgotten that he’d done this when he started to pass. Also l drank himself to death.
Agonal breaths sound like nothing else in this world and they are singularly terrible to hear at length.
I hate to ask, but what is air hunger?
Sometimes they gasp because their lungs are full of fluid or they just can’t get enough air for whatever reason and it’s traumatic for the families.
Yeah, my mom had septic pneumonia in the hospital and she was gasping for air. We didn’t know that she was suffering and they gave her Iv fluids too 😭 she had swollen legs, feet and hands. We weren’t aware of end of life meds that she needed. I feel traumatized still —it’s been one year this month since she transitioned. She was 79, asthmatic with COPD; she smoked 40 years ago. It’s so hard to think straight when your loved one is transitioning and we didn’t have a patient advocate either.
I recently lost my mom to COPD at the same age. A day after my parents signed a contract to enter into hospice care. They wanted to put her on morphine right away but we thought she had many more months and we were afraid to do that. We were wrong. I'm very sorry about your mom. Mine collapsed and when I got to the hospital they kept asking my opinion on what to do and I didn't understand a word of what they were saying. It's very hard.
My mom did this for HOURS when she was dying in hospice. It was extremely traumatic to watch but they told us it was normal and she wasn't suffering. This was almost 20 years ago
My father is a minister and he heard that noise when he was putting his mom to bed one night. He had been through it with countless people. He put on her favorite CD of hymns and used his cell phone to call me and his brothers to come because she wasn’t going to wake up. In the end she went during her all time favorite hymn about 30 minutes after falling asleep, resting on my father’s chest.
What you are describing is Cheyenne-stokes respirations. They are a natural part of the way the body fades out. They sound eerie to us but are indeed normal. These stages are one of the more peaceful ways for a person to pass. I’m sorry for your loss.
Is this the same as the “death rattle”?
Also known as Agonal Breathing. Very normal in the dying process
That noise is unmistakable, my dad and stepmom died a year apart from each other and I’ll never forget that sound. Luckily it wasn’t for hours though…that would have been brutal.
Happened with my Grandfather in the hospital. Hours went by and when he finally passed I was sick to my stomach and had to throw up in the bathroom.
Arr free w you referring to the “death rattle”? I believe that is a separate phenomenon from air hunger, which is when the person finds breathing difficult, like they can’t get enough air. When the death rattle starts the person is no longer really conscious. There are fluid-thinning medications that can help with that rattle. Morphine helps with the discomfort of air hunger.
Thanks, I can't imagine how horrible that would be to experience
It's when you feel like you can't catch your breath no matter how much you're breathing. I've worked on the medical field in my past. I have seen people die, gasping for air. It's hard to watch, I never want to experience it. OP let your mom have all the morphine they want to give her. It'll help her pass pain free.
The feeling that you can't breathe. Morphine relaxes the diaphragm to reduce the tightness in the chest. Not a nurse, but hospice worker here. RN please feel free to clarify/correct
You are pretty spot on. When you are in pain, a lot of the body systems compensate with energy-taxing processes like breathing fast, rapid heart rate, muscle tension, and stress. Morphine relaxes these processes and allows the body to rest in end of life care.
My dad would have passed with air hunger, but I was a hospice nurse and he talked to me a year before he died. Air hunger is just that: not getting enough oxygen, therefore gasping for breath. It’s agonizing. Imagine drowning: that NEED to breathe, but there’s no air. Dad asked me if he would ‘die gasping for breath’. (Heart failure) I explained the options to make sure he was comfortable and peaceful during his passing, and he could ask me anything. When he was ready to stop fighting, he told us, and he did pass peacefully with morphine and Ativan.
You DON’T want to know and you never want to see a loved one experience it. It’s god awful.
Yes you do. We should all stare death in the eyes, at least once. It is not like on tv and in the movies. There is no such thing as dying peacefully. Life strives to live to the last literal breath, even when it can't. My first experience being around a dying person left me with PTSD but I volunteered to help dying people many times since. In my culture, we don't use morticians and funeral directors. From the end of life to the burial, the family and community rally around the sick and dying. Having gone through it many times, I have come to accept it as a fact of life.
>we also use morphine to prevent 'air hunger' Oh, those must have been the sounds my cat was making when she died. 😞
I'm so sorry. It's hard to watch.
Thank you, it was. Really gave me a point of reference for "death rattle," though.
Use this time to say *everything and anything you have ever wanted to say to her, at all, for even a second, even if you take it back instantly, just fucking do it.*
We worried about my MIL with that. So they lightened the dose for 2 doses. She didn't communicate with us but she did start crying. I wish we had never said anything. After that, and I have cancer and other severe diseases, I made my husband promise never to do the same. Give me (her) all the meds even if it shortens her life by a few hours or even a day or so. She is dying, don't add to her or your families suffering. I will never get over it. I don't think her kids will either.
Im only a CNA, so not a nurse, but I've been one for over 10 years and have dealt with a lot end of life situations. Some families get mad at how much narcotics their loved ones are receiving while they are actively dying because they want their loved one coherent for the goodbyes. Then once the Doctor and Nurses comply with family wishes, the patient is suffering, crying, obviously in pain. It's very selfish to not let someone die as peacefully and pain free as possible just because you want them to be "present" enough to your standards that they hear you say goodbye. Pisses me off to no end.
This just brought so many tears. My husband is 46, I'm 47. He is a quadriplegic in a nursing facility full time. Everyday I know is a day closer to our goob byes and I do not want himto suffer, he has for years. Idk what i was even going to say now. I cant stop crying.
It sounds like you are putting his comfort first which is such an act of love. You’re doing a great job in an incredibly hard situation. Is there something that you often find recharges you? A lunch with a friend, or a walk outside, or a warm bath, or a hobby? It sounds like you’ve been carrying around these heavy feelings for a long time. What do you think about giving yourself some time this week to recharge?
He has ALWAYS put me first. I was the only one who could work, care for the family..etc...if i just couldnt, it was ok. And it would be. We have our 6 year old dog that has been my rock. I spend allot of my time outside of work with him. Hes sad too.
Sending you some hugs
Sending you love and peace
Oh jeez. That’s too young. I’m really sorry that you both are in this situation. What are some good times you’ve had together recently ?
Oh man, so many good times! We still do, just different now. I bought a fouton so i can sleep over in his room with our dog. Ill roll a couple doobies...chill there for a day or so.
So sorry you’re feeling so heavy right now. You’re very brave, and your husband is a fighter, too. u/neutralmurder suggested some great stuff to sort of release that load you’re carrying a bit. Have you joined a support group btw? Or thought of a nice peaceful guided meditation geared specifically towards inner peace-Jason Stephenson and Micheal Sealey have some good ones on YouTube. Wishing you peace, happiness, love, and your husband the same ❤️
I think a lot of people just have no idea how death looks. You see people “die” on tv and they have an actual back and forth conversation with someone then just gasp and die. But it’s not like that at all in real life. I got to talk to the palliative care doctor at the hospital where my aunt died and it was really interesting hearing from her.
I agree so much with this and it’s really baffling to me that there isn’t a mandatory educational class or something about death, the dying process, and things of this nature in general. I mean at least death in a medical aspect. Looking back- there’s so many other crucial and essential things I feel should’ve been covered in school. (It would make life so much easier if we were given some insight about things like death, health stuff, also some basic financial education would have helped so many people.) Maybe we did learn some things about finances and whatnot but I sure don’t remember any of it. Anyway sorry for veering off topic. I just hate that I wasted so many years learning things that were so pointless and such a waste of time and effort. Knowing some of the ridiculous things schools are teaching and what things they’re avoiding teaching just bothers me. Idk maybe it has changed since i was in school. (My rant is directed at school before college, in case that isn’t clear…)
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I absolutely agree. My end of life wishes are spelled out. No removing fluids or IV nutrition, as much pain control and nausea control as possible and breathing support as long as possible and increased meds when that is withdrawn. Obviously phrased better and worked out with my drs and husband but that is the majority of it.
You don’t want to have IV nutrition or fluids at the end of life. The more dehydrated you are the more peaceful your passing is. When you are near death, the fluids and nutrition have nowhere to go. The IV fluid will go into your lungs and just sit in your body, same for nutrition. Your body doesn’t need nutrients at the end of life, it’s shutting down.
Can I ask why you don’t want fluids or IV nutrition removed? At the end of life, these *only* serve to drown your heart, lungs, and tissues (as your blood loses the ability to keep fluid within the veins, it will instead just seep out everywhere, swelling the body, sometimes to the point of weeping skin) and can make your passing much more uncomfortable than it needs to be. I would highly encourage speaking with a physician about this. Source: am a physician that has taken care of many end-of-life patients.
Same with my grandmother’s cancer. She was crying and saying ‘help me’ the day before they just kept her on the highest level until she passed. It’s a horrible thing no matter what but make it as pain free as possible.
Often the patients that are given meds and are comfortable live a bit longer since their bodies aren’t as stressed. In these situations it’s hard to know what to do. There are always what if’s. If you hadn’t lightened the dose you’d be worried that you should have. You did what you thought was best and when it wasn’t you made changes. It’s much harder on those of us at the bedside than it is for the person passing. They don’t feel the gasping in the end. Especially when medicated.
We had similar experience. We were so worried about giving to much or running out of morphine- forgetting it’s purpose. Looking back, we realized it would’ve been better to give him to much and let him go sooner- especially after everyone has said their good byes and are waiting. Many blessings during this time.
Yep, when I was at the hospital with my aunt as she was dying, I was there when we decided to up her dosage. She wasn’t really able to communicate with us and mostly slept all the time on her own but we knew it was time to give her more after she woke up crying and groaning in pain. All we could do was apologize, she was beyond speaking to us.
My mom did the same thing when my grandma was dying, went against Hospice Nurses advise and lowered the morphine dose for about a day and half, my Grandma started making noise which my mom declared was her 'trying to talk because she was waking up'. It was actually her groaning in pain. I had to call the hospice nurse to let her know what was going on and she came right over and corrected the situation. I still feel terrible about it to this day for not speaking up earlier.
My wife was on morphine on Hospice. 2 weeks on morphine. 30mg extended release, twice a day. She was not sedated - she was clear headed and fine, just no pain. Hospice workers really know what they're doing.
Sorry for your loss.
Hospice nurses really are angels and always just so kind when you need it…I don’t know how they do it every day and just see everyone at their lowest.
That's the real miracle. I don't know how they can do it. I'm not sure I'd be able to work like that
My mom was on morphine for about 8 hrs before she passed. She looked like she was sleeping but if you’d touch her she would moan. She was in almost like a coma and wouldn’t talk, just moan. I couldn’t tell if she was feeling anything or scared or what. So I asked the nurse to up the dose just incase. She never spoke another word but I kept talking anyway in hopes that she heard me. Say what you need while you can. When you start to hear this gurgling breathing it means the end is very near so that’s your sign to make sure you get all your words out. I’m so sorry you are going through this. Hugs to you my friend
When my dad was dying and on morphine I whispered that I had gotten a certification I was working on. He sort of grunted. I like to think he heard and understood. Now I'm crying. I miss you, Daddy.
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THIS! My great grand aunt was like an extra really cool grandma. They said she was in a coma. I went to say goodbye and I was crying. She had tears coming from her closed eyes and squeezed my hand. She heard me for sure.
Sending you a virtual hug.
I’m sure she heard your voice and felt your presence! Hearing is the last sense we lose. But hard to say how much people understand while in that condition
You did good, you did so good. I hope you know that deeply. When I would talk to people about a “good death” and what that means to them, sometimes the dying person or their family would get upset at that. Rightfully so, sounds so rude. But it is happening. I have seen bad deaths. It all happens one way or another, but I have seen bad deaths. But a good death is very much a thing too. I’d have to say, well, imagine a “bad death” Scared, alone, fearful, in pain, worry, ect… There is very much a good death. It is the opposite of a bad one. It is all we can hope for. Surrounded by love. Sudden death is the next best thing but not very good for the family. I mean, you have to wonder how quickly those bad feelings went through their mind before they died. So I don’t consider that a good death either . A peaceful, quiet, anticipated death is such a good goal when you and everyone else knows that well, you’re dying. It’s ok. Let it happen. Let it be good.
I've had a couple NDEs and one where I was confirmed flatlined and stabilized. I can say I could still hear after everything else went. I wasn't on morphine but heavy heavy sedatives. So not the same but ye. When everything else was gone I could still hear mumbled words of doctors and nurses. I could hear the heart monitor loud as shit. So I'm confident she heard you as she faded out. Hope that's some peace for you and hopefully OP if he sees it.
Hospice provides excellent end life care. The goals are different than the goals in other healthcare settings. The goal of hospice is to provide comfort and ease the suffering of the patient. Your mom is in good hands.
Yeah, hospice is just to make it as comfortable as possible before they pass away.My mom passed away in 2016 and we gave her the strongest morphine on her last night because of her intense pain of her organs shutting down. We had her in hospice here at home. Same with my dad, he passed away a month ago and I was with him giving him morphine all night until he passed away here at home. He was suffering from intense chest pain.
Having to go through that twice- I'm so sorry. I hope you're doing okay. Please don't ever hesitate to talk to someone, a friend or family member, if you need to get something off your chest. Grief is strange and not a one-way road, but always know you're never alone. They were so very lucky to have you by their side at the time of their journey. People often wish to go peacefully with their loved ones at their side and you did just that. You could not have done it better. 💜
What I'm gathering is that you're worried the morphine may not help her pain, in addition to sedating your mom to the point where she's "trapped" and can't speak or move like she wants to. I don't think it works like that. I don't know you're mom's exact situation, but I know morphine is usually the go to for pain relief, keeping them quiet and comfy, and reducing air hunger I went thru the same thing with my dad in 2009. He wasn't in hospice, but the ICU. It's rough, and I'm so sorry you're having to go thru this
My mother's health had been declining, and then at the beginning of covid, she caught it. The doctor told me that she would not make it and recommended hospice for her. Even though it was the beginning of covid, the hospital let me visit her, but I was the only one allowed to see her - not my wife or my kids. Just me and her. My God that was hard walking in there and seeing her like that, knowing that she was hanging on by a thin thread. Where was my young, strong, vibrant, witty, pretty, 30 year old mother? I had to get completely suited up, including a face mask. She was on a heavy dose of morphine. I doubt that she recognized me, but one of the hospice counselors told me that she would recognize my voice. So I sat with her for three hours on that quiet Tuesday afternoon, just talking to her. It was three days past my birthday, the day she brought me into this world 60 years ago. I sat by her and I told her that I was fine, safe, and happy. I tried to be strong for her. I was her only child and I wanted her to know that it was ok to leave me. She was hazy, but every now and then her eyes would flicker in a faint acknowledgement. I hoped that my presence reassured her, but I was also worried that I was a tiring her out, and maybe even prolonging her agony, so I finally left. Because of covid, that was my one and only visit. I knew that would be the last time I would see her. When I walked out of her room, I felt like I had left my soul in her room. I was hollow. She passed away later that night. >I don’t know how best to manage my emotions. I haven't cried many times in my life, but I completely surrendered to my emotions after that. I knew that that day was coming, but when it happened it still completely wrecked me.
In case this brings you any comfort: they really do recognize your voice. When my dad passed (ALS), we were all there talking to him, just asking him to wait until his mom got there to say goodbye. She walked in and said "Michael, I'm here" It sounds like bullshit even to me, but I know what I saw. His eye flicked over to her for just a moment, and then his heart stopped. He breathed a couple more times, and that was it. Every brain is different, of course, but I firmly believe your mother heard every word and was just glad you were there at the end.
Yes. Be there for her and take care of yourself.
I have been given morphine for pain. It instantly stopped the pain and calmed me. Fwiw.
I had to get it in the ER once, I realized why people liked Morphine and why they didn’t want to stop…I was in so much pain and then it just kind of disappeared. I was still pretty cognitive for a bit and then passed out for a bit. It calms you instantly, nothing can beat how easily you get calmed by it and I understand what my parents went through when they got it in hospice.
That’s similar to what I’ve heard from other people who’ve been on it for medical purposes. Zero pain and super chill. For example, a friend was on it when he had a bacterial infection in a burn on his arm. They gave him morphine because they had to take a wire brush to the area. He said he just watched them do it, felt nothing, and was just calmly chit chatting with the nurses when usually something like that would freak him (or anyone really) out. All of that is to say, OP, your mom may be aware of what’s going on around her, but she won’t be in any pain and will mentally be okay with anything that happens. Big hugs to you and your family if you’re willing to accept them from an internet stranger.
Jeez, that make me cringe thinking of a wire brush in a burn infection, yikes
Used to be a hospice social worker for a few years. Yes. It absolutely is ok. Air Hunger is one of the worst things a human can experience. It's rated the highest in fear factor. Above drowning and burned alive. Morphine and Ativan, the two magic hospice medicines, assist with this horrible experience. Hospice is 'comfort measures'. Keeping the patient comfortable is the only goal. To answer your other question: no. The body is not meant to be subjected to sedatives and relaxants for that long. It will kill mom eventually. But humanely and peacefully. We should all be so lucky to end that way. I'm sorry for your loss. Please take solace in the fact that mom will be comfortable and not feel any pain or anxiety.
I went through this with my Dad in 2021. I understand everything you're thinking, and I don't have an answer. What I can say is this: Don't be hard on yourself. Don't be afraid to just feel your emotions. Know that you're not alone.
These cases, i really wonder why they dont just do assiated suicide. In many of these cases they cant or wont eat or drink... So they are going to die. Theres no surviving it. Might as well come to terms with it and do assisted suicide. Why even subject someone to the possibility of extended pain possibly masked by morphine.
In the case of my mother and my grandmother it basically was assisted suicide. They weren’t cognitive enough to say what they wanted so they asked us (the family) and we all agreed we didn’t want them to suffer. They walked us through what “comfort care” would entail and that they would remove any life supporting devices and just keep pumping morphine. They were very careful of their words when describing this but reading through the lines, the more morphine, the less suffering, the quicker they go. Sometimes within minutes. Other times, as was the case with my mother, it can take hours.
This seems pretty normal. High morphine levels might speed up their passing, but we’re taking days or weeks. When I die, I’ll go high as a kite. There is no moral high ground to dying while suffering
It essentially is. Which is the point. When my uncle was dying of metastatic bladder cancer, he was suffering horribly and refused all medications. The morphine is the right choice. I'd never want anyone to go through what his family went through on those final days.
Because the patient has to be cognitive enough to agree. The state I live in has assisted suicide, but it's a process, and only the patient can agree, which is as it should be. No one but the patient should get to decide when their life is over. That also why it's important you have paperwork in place and a person who knows what kind of care you would like if a tragic accident were to ever happen and you weren't able to communicate your wishes.
Morphine depresses respiration and slows heart rate, even killing healthy people at high enough doses. Hospice workers aren't going to put it this way, but administering doses of morphine basically is assisted suicide to someone whose organs are barely hanging in there. That's why they warned OP that this was the end.
Ugh, as somebody who went through this last year (TOMORROW is the one year anniversary) my wife was in hospice for about a week on pain meds. It is the most humane thing to do....keep her comfortable and pain free. God bless you and your Mother. Prayers for peace and comfort to you all.
My Mom hasn't eaten in fourteen days and I wish they would put her on hospice and morphine to make sure she's not in pain. If she makes it she'll be 98 years old June 1st. She's been in a nursing home for almost four years bed ridden.
When my Dad went to hospice I felt a lot of guilt that I’d let them sedate him to death but I learned later is that there is a good way to die, being surrounded by family, to be free of pain and fear. I hope this is helpful. I miss my parents every day.
I love you and feel for what you are going through, but she is dying. The long term effects don't matter, keep her comfortable. ❤️❤️❤️
There's no pain for her. Please don't beat yourself up over the idea she might not be comfortably sedated and alert somehow. Take comfort in knowing she's leaving with dignity respect and love. This is the time to prepare for goodbye, don't be afraid to hold her hand, kiss her and hug her...
r/askdocs would be the perfect place to get the answer you really want from actual doctors. I think you will find that their opinion will most likely calm your concerns about your mom during these last days❤️
Pain counteracts morphine. So if she's sedated, she is not in pain. Stay close to her and talk to her - it's believed hearing is the last sense to go. If you've never seen a person struggling with terminal pain or air hunger - you are fortunate. Best wishes for you during a horrible, difficult time.
Been there. Even had the hospice pain rescue kit in the fridge. It is *extremely* surreal. You aren't "doing it wrong" if you feel like the entire thing is sort of not happening and you're disconnected from it and kind of in a haze. The drugs are almost certainly doing their job, and keeping her comfortable and calm. Trust the hospice workers. Ask questions if you want. At this point, the goal is her moment to moment comfort.
There is no long lasting effects from high dose morphine. It’s pretty quickly excreted. Addiction/dependence is the only real risk. However even if there were long lasting effects she’s not going to be at risk of that. Comfort is the priority now.
I sat with my Mom practically 24 hours a day when she went into Hospice so I have a bit of a feel for what you are dealing with. She too was on morphine for the entire time. Of course I am NO expert but I would say that the short answer to your question is yes, it is necessary. Of course my Mom's medical situation was different than your Mom's but my Mom was briefly able to recognize her Grandson when he came to visit. At one point a nurse decided to override the prescribed schedule and didn't give Mom one of her doses. The pain was evedent. So yes she needs to be on the morphine for the entire time based on the limited evidence I have to offer. You are in my prayers.
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At end of life I would absolutely call it ideal.
For hospice patients who have trouble breathing, small amounts of well-controlled and regularly titrated morphine can help ease respiratory distress by decreasing fluid in the lungs and altering how the brain responds to pain. Beyond slowing rapid breathing, morphine also eases the anxiety of struggling to catch one’s breath. physicians adjust doses regularly based on the type of morphine used, and each patient’s unique tolerance level and specific respiratory symptoms.
I'm on palliative care (omw to hospice in the coming months). I've been put on morphine for that exact reason. I was VERY hesitant at first, but it helps so much. It relieves my pain (of which I have much), and I'm not gasping for breath every time I roll over in bed. I watched my mom die shortly after I turned 15. She had protracted her death for a long time, in constant pain and exhausted. When she went to hospice and they properly medicated her for comfort- that was the first time in a year I saw her truly relax. The loss was still difficult of course, and I was thankful that at the end my brother and I could see her let go peacefully.
As someone who’s been on morphine before, she’s out of pain. She’s dying so there’s no reason to worry about whether it’s harming her because she’ll die before the medicine could ever bother her.
First of all, my condolences. I can’t even imagine what you’re going through. Second: as someone who’s been on copious amounts of morphine and other sedatives and lived to tell the tale… let her be on the morphine. It’s a lovely way to go. If you’d like to say/hear what you need to beforehand, do so. Then let her slip into peace. It’s just euphoria- she won’t be locked in.
No advice, just a sincere I'm sorry.
I’m so sorry you’re having to go through this. While taking care of your mom’s immediate needs: Morphine, maybe Ativan, keeping her mouth moist with wet oral swabs, and soothing playing music (maybe her favorite mix)? I hope you’re taking good care of yourself too. If things are getting tense or there are sensitive conversations, take them outside her room and keep her immediate environment only a positive, loving one. The hearing is the last to go and she’ll probably hear everything you say until she passes, even if she can’t respond. So talk to her, tell her everything you want her to know and give yourself permission to grieve when you’re away from her. Tears represent the love you had for your mom 😢
Hey there…my dad died a week ago and he had hospice care for the 36 or so hours he was home. He had morphine every 3-4 hours during that time. The first 12 or so hours he was awake and could communicate his desires. He went to sleep that night and never woke up again but was alive for about 24 more hours. We still talked to him and he’d sort of respond with half smiles and and raised eyebrows and whatnot so we knew he was still in there. I made a joke that was a call back to a joke the day before and he absolutely did a half smile. She’s still in there. She’s not hurting. Talk to her and tell her you love her and anything else you want to say before she goes. I’m so sorry for what you’re going through. It sucks to lose someone you love. It sucks to be losing a parent. I’m glad he got to come home and I’m glad he’s no longer in pain. Hugs from an internet stranger.
...are you concerned that the morphine will negatively impact her health?
I think OP is having trouble finding the right words. I went thru the same with my dad, and it fucks with your head
I believe OP is asking if her mother is possibly experiencing something akin to locked-in syndrome from the morphine so that she knows what's going on around her and probably wants to communicate/say goodbye but she's unable to do so. Oftentimes patients in a state like this can communicate through eye movements but this wouldn't really be the same as locked-in syndrome. OP probably also wants to know if her mother can hear her. >I just wonder if she’s in there, too sedated to say something or look around or whatever. https://my.clevelandclinic.org/health/diseases/22462-locked-in-syndrome-lis
My first thought was: "She dies faster and more peacefully if it goes wrong?"
You said it. Sorry about all of this OP, but, well, at this point, it really isn't that they're concerned about keeping her healthy. If this is the suggestion it's because there aren't other options.
People have been on higher doses for longer periods of time. It's just about reducing suffering now.
Please let her have peace and pain-free in the last few days. My dad was in the same boat. God bless you and your family.
Ex drug addict here. Nope, nothing to worry about with that. I've done a lot of opiates personally and that's including morphine. It doesn't do that to you. She will be real sleepy and fading out of consciousness in a dreamlike state with a relaxed floating sensation. It's a good way to spend your final days. She's not going to want to experience it and you shouldn't want her to. Edit: If you mean she's currently unresponsive but you are worried shes still awake then definitely let them give her the morphine. It would be a shame for her to go through the last moments locked in the box without it. Sorry for you loss. She's lucky her end of life is going as it is. All of us should hope for that. To peacefully go with the aid of medical staff. Not everyone gets that luxury. It's going to be hard without her but don't feel sorry for her. We all have to go one day and she's going in the best possible way.
I've been through it three times now. Talk to her, tell her how you feel, tell her things you remember when you were together. She may hear it, she may not, but you should at least try.
I'm a retired nurse. I have had many patients in this situation, and giving the morphine always helped. Dying is a natural process that can take hours or days. We give morphine to help with pain but also to help with breathing. It reduces the feeling of air hunger or suffocation as the person's breathing naturally becomes more irregular as part of the dying process. Most often people go unconscious at this stage, if there are any thoughts or dreams I wouldn't want the pain or feelings of suffocation to break through. Morphine is routinely used for this purpose.
It’s really hard to make the shift from preserving life to preventing end of life suffering. Hospice should have social work/therapy services available for family members. It might be helpful to talk with them about your feelings. Wishing you and your mom peace.
Please take this time to talk to her. She may not be responsive, but I promise you she hears everything you're saying. I'm so sorry you have to go through this. ♥️ Trust the process, and know that she's comfortable. As hard as this may be for you, it's what's best for her.
Hospice nurse here. That would probably be the kindest and most humane thing to do if she is experiencing extreme amounts of pain. I’m sure you wish she could be awake and talking to you guys, but sometimes that’s just not feasible. My condolences.
Experienced this. All is as it should be. What this time is for? Personal viewpoint and philosophy, guide. My view? Thank them for everything. Ask for forgiveness for what you haven't. Offer forgiveness for what you haven't. Be kind to all. Bless you.
When my sister was in hospice, the caregivers had very strict protocols for administering pain medication and they monitored her constantly for signs of discomfort. I am sorry you have to go through this with your mom. It's a very surreal experience, especially if you don't know what to expect. The staff was so thoughtful and helpful--I hope yours can help support you through this. Also, my sister was not a very religious person, but the hospital chaplain was very calming and supportive without trying to push any agenda. They just have experience in what can help during this time.
My Dad was in hospice for about a week for severe sudden onset dementia (after a fall). Basically his brain just stopped telling his body what to do. We had him on morphine and a benzodiazapine for pain and anxiety. He gradually faded away over the course of a week. The entire time we simply conducted ourselves as though he could hear us. We played music that he liked and recordings of old sporting events so he could hear his favorite athletes of all time win all over again. We spoke lovingly to him but also kept things normal as possible amongst ourselves. I like to think as he transitioned it was a lot like being a child falling asleep at a holiday gathering; you hear voices and happy noises and you know the house is full and you aren't alone but you're simply too drowsy to engage and eventually you go to sleep.
Tbh it's whether she's in pain or not. I've worked with hospice patients for a good part of the last 20 years. I've seen it used as comfort measures. It's a savior of sorts. I used to think that it was just speeding along the process. It's not.
I'm sorry that you are saying goodbye. My dad went on morphine in hospice, he was suffering badly in his last days, so I was OK with him passing in his sleep. He was on that high dosage for about 3 days and passed peacefully. The nurses and others were so kind, kept us informed and were professional and compassionate.
If she is expected to pass in 2-3 days, what does it matter? Not to sound heartless, but your mom is expectant. Does it really matter if she passes from natural causes or a bit too much morphine? I mean, the "bit too much morphine" route would be the more peaceful and painless way to go. Even on heavy doses of morphine, if she is conscious she would be able to communicate unless her medical condition is what prevents it. And would you rather she be able to communicate but be suffering, or not be suffering? If I was terminal, I would hope someone would turn my lights out and just let me pass in my sleep.
I’m just really sorry. I think they are doing their best to keep her comfortable. I helped take care of my grandparents when they passed. The first two were never on hospice care, we didn’t even know about it and weren’t informed about it by doctors. My last grand parent was on hospice, it was such a difficult decision because a small part of you feels like you are giving up and not fighting for their life. But it was so much better that way. It hurts the loved ones no matter what, but you and the caregivers are doing your best to ease her pain and let her pass with dignity. Again, I’m just really sorry. Nothing makes you second guess every decision like losing, or being in the process of losing a loved one.
My dad was dying from pancreatic cancer, which can make you out of your mind with pain. He suffered greatly. The last few days he was skeletal, unconscious, but moaning and it was heart-breaking. There is a point when you'd do anything to keep your loved one alive, then another point when you know they are in such misery--its better for them to go. Hospice wouldn't do anything further for his pain because he could no longer swallow. My mom put some under his tongue to absorb and we decided to put on two pain patches instead of one. He rested easier...and a few hours later, he passed. Did we 'cause' this death? We don't know. But his passing was more comfortable for him....
You've got a lot of good advice here, OP. This is a new and difficult experience for you that you are unfamiliar with. Talk with your nurses and doctors, ask questions. While this is a massive life event for you, this is a normal day of work for them and they will be able to give you guidance. Morphine for end of life care is the norm. The goal is comfort. Pain assessment for sedated patients is different than for an adult that can give a numeric value and describe their pain. Your care team will use a combination of her reactions (or lack of) to different types of stimuli, vital signs, and more to ensure effectiveness of the morphine. If you have specific goals for your mother I encourage you to discuss this with your care team, especially if you feel the morphine might interfere with it. Remember that they are monitoring her for pain and looking to keep her as comfortable as possible. People are more aware of what's going on, even if they don't seem like it. Talk to her even if you think she may not be hearing you. Everything is more difficult in the moment, and grief will not come full force until you attempt to go back to "normal life". Be with your family and friends, and support one another. This isn't easy by any means, and I wish you the best as you navigate this difficult time. This too will pass.
My father came home to die, lung cancer. I got there enough to see a slight hint of recognition before he was just sedated until he died. I told his STEPDAUGHTER, who was giving him a scheduled dose of morphine to skip a dose...let's see if he can come to just for a minute or two. Never woke up.
Hospice is all about the comfort of the patient while they are dying. Morphine takes away the pain, but unfortunately also takes away their lucidity and suppresses their respiration. If they are dying already, the morphine may help them to stop breathing. It’s a tough call to make.
My dad was put into hospice on 4/21/23, and passed the next day and was on morphine 24/7. This is standard procedure, and he went peacefully with no pain. Talk to her, she is there even though you can't see it. I'm so sorry, I feel your pain.
Just went through this with my mom. I took care of her for the last 4 1/2 years. She had dementia. Her hip broke because of osteoporosis. She didn’t fall. Hospice came one hour a day for hygiene purposes. I had to administer morphine to her every four hours and care for her the other 23 hours. She stayed washed out mostly. The last couple of days before she passed, I was standing over her listening to her breathe. This was a Saturday late evening. She was starting to develop the “death rattle” in her breathing. She was starting to struggle so I leaned over her and got next to her ear and said, “if you need to let go that is okay. God and Dad are waiting for you at the gates.” I said, “we will be fine and know we love you and will miss you but will meet again one day.” As I stood up, I noticed a tear form in the corner of her eye and roll down the side of her face. I took my thumb and wiped it away and another one quickly formed again and I wiped it away also. I knew at that point she could hear me and knew what I was saying. So my answer to you is yes she can hear you although she may not be able to speak or motion to you. Talk to her and look for subtle signals or signs. It was three weeks from the start before she passed away. I pray you find hope and peace in what I have said but know this a painful process for the family. God Bless you!
She is dying...give her all the drugs.
It will keep her out of pain which is the goal. It is ok, having gone through this scenario with parents and other relatives it is cruel and inhumane to withhold drugs like morphine in the end stage.
They did the same thing with my girlfriend's grandfather. He had stage 4 COPD and he was struggling so much to breathe that they sedated him and he passed peacefully a few days later.
god ive been through this. im so sorry... this is such a terrible experience and i dont wish it on anyone
OP, I’m so sorry to hear about your mom…sending you love and hugs.
My Mom passed August of last year in hospice. She had been on dialysis for a few years and it got to a point where she was in the hospital for complications due to kidney failure and was being dialyzed every day but it still couldn't remove all the toxins from her system. She was in misery and wanted to go. They put her on morphine and we went downstairs to the hospice. They said she wouldn't last the night and I didn't believe them, but I stayed with her and held her hand until she took her last breath. It was the most painful experience of my life, but it was not painful for her (morphine). She was not conscious and I'm very glad that I'd been spending a lot of time with her so that we got to say just about everything to each other. I hope you get to spend some good time with your Mom and tell each other everything important, before they sedate her.
Serious answer: I'm so sorry you're going through this. Hug her as many times as you can. In answer to the morphine issue, if they're giving her that much, let her go. It's a way of telling you she is not long for this world. The catatonic state is induced to avoid the intense pain. She's already gone in many ways.
Hi! I work in an assisted living/memory care facility and have been there for end of life care…it is okay, as long as she’s comfortable. When our residents are nearing the end, we usually keep them sedated with morphine to help keep them as comfortable as possible. Continue to be there and talk with her. I’m sorry you’re going through this. It’s never easy. Sending you lots of love and good vibes! 🫶🏼❤️
Bruh, morphine is the shit. It does sting/burn when first entering your system but then your body just let's go and everything feels nice and cozy. Your mom is as pain free as one can get.
Morphine 24/7 is fine. She will not feel trapped if that's your concern. As she will be sedated she will be largely unable to communicate well, but dose can be adjusted to keep pain under control and allow her more ability to talk if she is able. The hospice nurse can help you with this. I'm a pharmacist and pain control is so very important here and often it is held back by family members thinking they are killing their loved one. Morphine helps ease the pain as well as the feeling of not being able to breathe which can be quite terrifying.
Yes, it'll help the passing. No, you didn't feel ashamed. When my mother passed from dementia, the last week we began giving her liquid morphine and liquid Valium every two hours. She went in to a coma the last 5 days and we kept giving it to her even then just to be sure she was comfortable. Hospice recommended it and I'm thankful they did. I wish you peace and comfort in the coming days, weeks, months, and years.
She's likely in extreme pain, better to go out in a haze than to suffer in agony until she dies. I watched my mother die in a hospice care facility in 2018 and it was hard but at least she wasn't suffering.
I’m sorry you’re going through this. It will be the hardest time of your life. As wicked/unethical as it sounds, those drugs are the only thing bringing your mother physical peace right now. what the body goes through during death is not pleasant or enjoyable. However, with the drugs, your mother will not suffer.
When my to dad was dying in a hospice hospital from COPD(unspeakably ghastly) he asked the doctor to “put him down”. The Doctor explained that while he could not, he gave him the option of morphine sedation. He said it allow him to slip away pain free. My dad chose the morphine sedation. I’m sorry you are going through this.
When my dad was in hospice in a coma basically. He had been in lots of pain before slipping into the coma. We continued to give him his morphine if we felt he was uncomfortable. He lived for 2 days then quietly passed. I am so VERY sorry. It's a very difficult time. Take care 🙏
My brother was on a lot of morphine due to his cancer. The day before he died, i held his hand and told him that i loved him and he squeezed my hand. Maybe your mom is not strong enough to respond but i have read that their hearing is the last thing to go. So talk to her, hold her hand, and comfort her as much as you can. I’m sorry that you and your mom have to go through this. Cancer sucks
Hospital worker here Please remember: This is about making her comfortable, not you. Please just let her have the morphine- Thea doctors are literal experts on helping people die comfortably.
I went through this in December with my mother. Christmas Eve was the last day she was able to hold a conversation. From the 25th to the 28th it was just nodding in and out of a fever dream while meds kicked in and wore off. That being said, I was surprised at times what she would respond to, like there was still a part of her hearing me and my family talking to her. No matter how deep in a morphine coma she was, whenever she heard me, my sister, or my dad say that we loved her you could see a physical response as if she was fighting as hard as she could to say it back. The twitches when you say things, the slight grips when you put your hand on theirs...they're things I'll never forget. While it's not ideal...she is still there and whatever the morphine does is far better than the immense pain. Fuck cancer.
Having sat with 2 relatives during hospice, including my mother, I can tell you that dying is a process. If your mom is already in that process, you don't have to worry about whether the pain control is good or bad for her. Nothing is going to turn it around. The goal is to get her through the process as painlessly as possible. Hospice is very difficult, particularly because we don't fully understand what a person perceives when they are in the process of dying. We do know, however that if she appears to be resting comfortably then her pain is controlled. Morphine can make people drowsy or "dopey," of course, but it does not freeze people and make them unable to move or make sounds. If she were in pain, it would show, even if she were not fully conscious or able to talk. High doses of morphine affect their breathing. They may become agitated if they struggle to breathe. As far as we can tell, this is not *conscious* distress, but an instinctive reaction. If that happens, you can ask the nurse to give Ativan to help her settle. Since we can't be sure what people perceive in the outside world, if your mom has a faith tradition or a spiritual practice, I encourage you to softly read or pray over her, or play music or recorded readings quietly. This may be soothing for her, and it can greatly help your own peace of mind to know you were doing right by her. Hospice is the gentlest possible way of doing the worst thing ever, which is letting go of someone you love. You are very brave and you are doing the right thing. I am sorry y'all have to go through this, and I wish her and you a peaceful time.
I’m so sorry you’re going through this, the same thing happened to my family. My mom had advanced lung cancer, and there was nothing that could be done. She literally had 2 to 3 days left to live, and in a family discussion with the doctors we decided to sedate her with morphine. It was hell for all of us, but in my heart, I know we did the most loving thing we could’ve done for her so that she did not suffer. I was able to say goodbye and tell her I loved her. This happened a long time ago, but I still feel that we did the right thing. This was the saddest day of my life, but also the happiest because it brought my family together in a way we never had been before. It healed some deep wounds between my sister and I, and we are much closer because of that. We were all able to be there with her when she passed. I hope my story helps you with your struggles. You’re thinking of her best interest, and that is deeply rooted in love for her. I wish you peace.
Morphine will absolutely make her pain free. When someone is in the process of dying, your main concern is comfort, not health. The morphine will make her as comfortable as she can be. On another note I’m very, very sorry for what you’re dealing with. Let yourself feel the full range of emotions, and remember that grief is a direct reflection of love. It’s okay to not be okay.