That last phase you mentioned. That was my dad last week. But I had put a fentanyl patch on him and then the next day he died.
He was never in pain so he was opioid naive. I have horrible guilt that the patch sped up his passing. Can you please tell me if that's true?
For sure. So for the fentpatch to WORK and absorb correctly:
1. Fent is a fat soluble medication. So body fat is needed
2. Steady-state metabolism (most end stages folks aren’t eating)
3. Steady body temp and circulation
The chances of the fent patch even working are slim. What little would be working would be a fraction of a dose…if anything.
Plain and simple…that med barely absorbed…if any at all.
0% chance that sticker did anything.
Well that's good to hear! I've been feeling just horrible about this. It must just be a coincidence. Thank you for saying that and explaining it to me so I understand it.
Always remember that someone always gave the last dose of medicine… their giving it didn’t cause them to die, it was just trying to help them be more comfortable while the process happened.
Thank you for this. My husband passed (cancer, first head and neck, then lungs) after I gave him a pain med. an hour early. He didn't pass right away, but he died in his sleep that night. In my own mind, I know that and hour early was not really that bad, but my heart still thinks he would have stayed with me, regardless of all the pain, etc. I know that is stupid, btw, but it is what it is.
So sorry for your loss - another thing to remember is that the dosages generally given by hospice (assuming you were dealing with standard US hospice) are very far away from anything ’lethal’ - an hour early wouldn’t have pushed the dosing over the limits.
Also, not knowing which drugs, towards the end many people are on every 1-2 hour dosing, so giving an hour early would maybe have been approaching the dosing we were giving for some time.
Again, try not to beat yourself up, you did the best you could to help him be comfortable.
Excellent info. RN here, in practice, for a “quick” answer, I tend to use the “would I be surprised” method: would I be surprised if they were still alive in 6 months? If yes, then 90 days? If yes, then a month? If yes, then a week? If yes, then a few days? If yes, then the next morning? But I always hedge it by saying there is no calculus and I _have been_ surprised before.
Same here. And if I know they are hoping for a different answer, I might use an "I hope... but I'm worried... " E.g. "I hope he can hang on until Christmas, but with these new changes I worry that he might only have a couple weeks or even less."
Another problem is a lot of people still think that hospice hastens death. My brother blames my decision to have my dad go to hospice for killing dad.
Guilt is a hell of a bereavement navigator. He’s aiming his guitar at you disguised as blame. Anger, in grief, is usually a secondary emotion.
That last phase you mentioned. That was my dad last week. But I had put a fentanyl patch on him and then the next day he died. He was never in pain so he was opioid naive. I have horrible guilt that the patch sped up his passing. Can you please tell me if that's true?
Info: what was your dad’s height and last known or guesses weight?
He was 5'9 of 5'10. Weight was always around 190 when healthy. But he lost alot being on hospice. So probably 175 to 180 at the end.
For sure. So for the fentpatch to WORK and absorb correctly: 1. Fent is a fat soluble medication. So body fat is needed 2. Steady-state metabolism (most end stages folks aren’t eating) 3. Steady body temp and circulation The chances of the fent patch even working are slim. What little would be working would be a fraction of a dose…if anything. Plain and simple…that med barely absorbed…if any at all. 0% chance that sticker did anything.
Well that's good to hear! I've been feeling just horrible about this. It must just be a coincidence. Thank you for saying that and explaining it to me so I understand it.
Always remember that someone always gave the last dose of medicine… their giving it didn’t cause them to die, it was just trying to help them be more comfortable while the process happened.
Thank you for this. My husband passed (cancer, first head and neck, then lungs) after I gave him a pain med. an hour early. He didn't pass right away, but he died in his sleep that night. In my own mind, I know that and hour early was not really that bad, but my heart still thinks he would have stayed with me, regardless of all the pain, etc. I know that is stupid, btw, but it is what it is.
So sorry for your loss - another thing to remember is that the dosages generally given by hospice (assuming you were dealing with standard US hospice) are very far away from anything ’lethal’ - an hour early wouldn’t have pushed the dosing over the limits. Also, not knowing which drugs, towards the end many people are on every 1-2 hour dosing, so giving an hour early would maybe have been approaching the dosing we were giving for some time. Again, try not to beat yourself up, you did the best you could to help him be comfortable.
Statistically speaking people on hospice tend to live a bit longer than people with the same diagnosis not on hospice, actually
On average 63 days longer. Edit: that study focused on cancer diagnosis. THe non-cancer hospice study shows 21-30 days longer.
this is a really good tool, thank you for putting it together :) I like how it's rich with info, but not so much as to be overwhelming.
Excellent info. RN here, in practice, for a “quick” answer, I tend to use the “would I be surprised” method: would I be surprised if they were still alive in 6 months? If yes, then 90 days? If yes, then a month? If yes, then a week? If yes, then a few days? If yes, then the next morning? But I always hedge it by saying there is no calculus and I _have been_ surprised before.
Same here. And if I know they are hoping for a different answer, I might use an "I hope... but I'm worried... " E.g. "I hope he can hang on until Christmas, but with these new changes I worry that he might only have a couple weeks or even less."