MORPHINE and Dying Patients - page 15
Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.... Read More
4Oct 6, '08 by MAISY, RN-ERQuote from Iam46yearsoldI am with you 100%!Give me morphine, dilaudid, marijuana, anything that eases my suffering in my final days.
Currently in a bio ethics class in a Catholic university, we just had a case study about end of life, the Ethicist who wrote the book and scenarios was perpetuating the myth of addiction. I went crazy and sent a letter to the head of the department, publisher and the author.
Suggested they spent time with a hospice nurse to understand how Morphine is used for palliative care and addiction is the last thing that should be included for young undergrads. If I see one more "kid" tell me that their parent needs to be awake, or wouldn't want addicting drugs as they die I will scream!!!!!!
Sometimes I just want to pinch them sooooooo hard and give them a little pain! What the hell are schools thinking? If I wasn't almost done with this degree I'd bail!
9Jul 15, '10 by Julieann79To all the wonderful nurses in the world,
I am NOT a nurse so I really have no business even being on this forum, but nursing really interests me. Especially end of life care. It's very dynamic. I recently watched my grandmother die of pnemonia (sp?) back in November of 2009. I'll never forget that night. My Nana was probably given the lowest dosage of morphine, but she wasn't used to pain meds and she was 101 yrs of age. I am glad that the nurses were keeping her comfortable. Even a low dosage of morphine seemed to keep her breathing less labored. She was basically unconscious. She wasn't talking or anything. She cried out "Owww" a few moments before her "last syringe" was administered. I know that the nurse, Rebecca did it to keep her comfortable and I respected that as did my Mother. Rebecca was extremely compassionate not only to my Nana, but also to us. My Mom and I were fortunate enough to not have to see my Nana struggle to breathe or hear her gasp her last breath. That's what we were fully expecting for whatever reason.
My Nana's oxygen levels dropped, the antibiotics didn't work for her (The Dr. had said even a person who was 40 yrs old may not have been able to fight off the pnemonia she had). Eventually her kidneys were slowing down, less and less urine in the cath bag..her legs and hands were clammy. I remember her eyelids were purple, the color in her face just wasn't looking good. Lack of oxygen will do that I guess. The only thing that concerned me about the morphine was that my Nana wasn't conscious so I thought in my mind that my Nana may have not known my Mom and I were there with her and I was haunted by the thought that she maybe thought she "died alone". I don't know enough about morphine to know weather or not your mind is there or not...and I don't know enough about the dying process to know all the stages. Do people generally have a "death smell"? My Nana had a certain smell about her that night, but I couldn't tell if it was her "dying smell" or if they had just recently cleaned the floors or whatever. Eventually my Nana's breathing came to almost a complete halt. I went out to the desk and got Rebecca. I knew the time was near. Rebecca looked at my Nana's eyes and said "She's still fighting-just a few more minutes". It was very peaceful. My Nana actually died with her tongue out. I thought that was weird, but she had an oxygen mask on her throughout the night so that could have been why or maybe it's normal as your tongue is a muscle? It was a sad experience yet peaceful at the same time. Even the nurse was a bit emotional herself that night as my Nana passed away because the nurse had just lost a family member of her own not too long before this. She was extremely nice and compassionate.
I am trying to find a CNA program to get into. I hope to take the class this fall. This may sound weird, but I love hospitals...not to be a patient (unless it's the maternity ward), but a visitor. I take in everything. I want to make a difference in someones life/death.. even if I did hospice I think I could be OK with that. I just want to offer comfort and compassion to not only the dying, but also to their family members. I want to give back to a family what I received the night my grandmother passed away.
I don't think I've ever met a nurse who wasn't compassionate. They have hard jobs and hard decisions to make. I'm sure every day and every situation is different and they have to go on instinct and what they feel is "right". I don't know if I could ever be an LPN or any other type of nurse that administered meds. I think I'd just stick to the basic CNA stuff. I would want to make sure the dying patient or patients in general are comfortable and have what they need. Basically "putting yourself in their shoes" as was mentioned on this forum previously. I just want to service the sick and dying. I feel strongly about it. Now I just have to make it happen.
To all the nurses out there- you all do a wonderful job! Without all of you-hospitals would not be as organized and as efficient as they are. Doctors have hard jobs too, but it's mostly the nurses you see running around with their heads cut off trying to answer family questions, calm families, calm patients, and so on. God Bless you all for making a huge difference in someone's life and death.
2Jul 15, '10 by talaxandraThank you, Julie.
Some people who are dying, particularly if they're ill for a while and dying over a period of days to weeks, do have an unusual, sweetish, almost chemical smell.
My experience with caring for people who are dying is that they often have n awareness of those around them even when they're profoundly unconscious - the wait for a certain important date (like an anniversary), or until a family member's arrived or baby born, or (like my grandmother) wait until they're alone or not with family before they die. I think it's very possible your grandmother knew you and your mother were with her.
Pneumonia was once known as 'the old man's friend' because it's a relatively quick and comfortable way to die, particularly with a little morphine to ease the respiratory symptoms of the condition.
I wish you all the best
1Jul 16, '10 by elizabeth8503RNI lost my gpa M to a heart attack post LLL amputation last October. Immediately following his MI, he was lucid, able to talk, and manageable. As the night wore on, and his heart began to further fail, he became aggitated, combative, and un grandpa like. Had it not been for the morphine and ativan that the nurses gave him, he would have been yelling, screaming, pulling at his IV tubes, and foley catheter until the second he passed away.
In Decmber of last year I lost my grandma F to chronic renal failure along with numerous other co-morbities (previous MI, and pneumonia being a few). Her last days were very peaceful, she did not require alot of morphine, but it was given to her when it even looked like she was in pain.
The last 5 hours of her life I was with her. As she took her last breaths, she became slightly aggitated, her hands started to move around, and it seemed to me that she was having a difficult time breathing. The nurse who was in the room asked if we (my mother and I) would like my gma to have some morphine. We both said yes. She took her last breath as the nurse was drawing up the morphine.
I have worked hospice numerous times over the last 2 1/2 years. Never have I doubted the effects of morphine, and how well it helps the dying. When I die (hoepfully it won't be for a loooooong time) I hope that the nurse taking care of me has the decency to give morphine if/when I need it.
4Jul 16, '10 by nursel56 GuideQUOTE=Julieann79;4417653]To all the wonderful nurses in the world,
I am NOT a nurse so I really have no business even being on this forum, but nursing really interests me. Especially end of life care. It's very dynamic. I recently watched my grandmother die of pnemonia (sp?) back in November of 2009. I'll never forget that night.
I reacted to it as a loving daughter would, not as a nurse, but I had already decided I would fight tooth and nail to make sure she had an adequate amount of morphine, drops to dry her secretions and oxygen as needed. I would not want my mother to feel any sensation of drowning or aware of her dropping oxygen levels and try to gasp for air. She was semi-conscious and grimacing and pulling at her gown, I asked her if she wanted some more pain medication and she nodded. She was conscious enough to say, "I love you" back to us before she slipped into a state that seemed unresponsive, but I had the feeling she heard the Priest who annointed her and gave her the Sacrament of the Sick. The expression on her face changed. After that she stopped talking, but we still talked to her and I held the phone up for my children to say their "I love yous" to her.
For the next 18 hours she appeared comfortable on her Morphine drip and Ativan, though the color of her skin, it's temperature and clammy feeling were as your Nana's were. Her oxygen levels were in the 80s, her breathing became slower and slower, urine output stopped and it was sort of like a clock ticking slower and slower and then stopping.
I was actually relieved in a way that this happened, because she had been at a nursing home for a week with her oxygen levels in the 90s but her respirations were very fast and she struggled and struggled to get to that level. It exhausted her. I never want to see a person suffer that way when we have compassionate people and pharmaceuticals that don't cause death in any way unless you deliberately overdose the patient. I have no regrets at all about the way things went.
You sound like you would be a great nurse. You are compassionate and a keen observer. Thanks for sharing your story.:redpinkhe
0Jul 16, '10 by Julieann79thank you for sharing your story. i'm very very sorry for the loss of your mother. i cannot begin to imagine how hard that is. i dread the day i lose my mother. she has been in the beginning stages of copd for about 2 yrs now (and she still smokes and i yell at her everyday). she also has diabetes. so between the two i am well aware that she may die sooner rather than later (heart failure most likely).
it's definitely not easy sitting there watching a loved one die. you have a million emotions going on all at once. were you able to administer medication to your mom on your own? did she pass away at home with hospice in the end or in a hospital? i would imagine being a nurse you would most likely want to be the only one caring for her throughout the entire process, but having a nursing job yourself and a family of your own probably didn't allow you a lot of time to do so. not that you wouldn't trust another nurse to care for your mom, but you maybe felt as though nobody could care for her as well as you could. it's a mother/daughter thing. maybe just a family thing in general. i think it's different when it's your own family member. at least if it's a patient you don't know very well you maybe able to detach yourself just enough so it doesn't make you lose sleep. don't get me wrong i'm sure losing a patient is not an easy thing, but i've heard some of my friends who are nurses say "you get used to it-and the last nice thing you can do for them is to clean them and prepare them before they are taken to the morgue." i wished i could have done post-mortem care for my nana the night she died. i almost asked the nurse on duty if i could, but she probably would have thought i was a nutcase who was not dealing with death very well and she may have locked me up in 200 west somewhere. lol!
fortunately, my grandmother was never in a nursing home or a rehabilitation center or anything. her pneumonia took her quickly. she was doing very well according to the doctor on saturday and sunday, but come that monday afternoon she just got worse and worse. in fact, when we got there to visit we didn't even know how compromised she was. the nurse had said "we just paged a priest". that was hard to swallow it was like walking into a brick wall as she was doing better the 2 days prior. i wasn't too shocked given her age. it still hurt like hell to lose her though. they just stopped all antibiotics at that point.
my mom is retired so she was able to keep my nana home and care for her. my grandmother suffered from dementia for about 8 yrs before she passed. it was trying for all of us, but we were able to manage. it's just hard to watch someone you love who was once strong and sharp as a tack deteriorate in front of your eyes. they revert back to being a baby is the only way to describe it. i would sometimes change my grandmother's diapers and give her a shower and dress her when i was visiting just to give my mom a break.
i think the hardest part about leaving the hospital the night my nana passed away was knowing she wouldn't be coming home with us again. she was now in the care of others...nurse, morgue employees, and then funeral home director/undertaker. the nurse had asked us to leave the room so the m.d. could examine her. after he jotted down time of death and confirmed her clinically dead we were able to go back in the room. i cried and hugged my nana one last time. i was crying hysterically at parts during the night (it wasn't until later i read that the dying don't like noise, lights, or family crying-it doesn't allow for them to slip out as easily). i felt like a jerk after reading that. my nana was probably saying to herself in her unconscious state "julie, shut the hell up so i can die in peace".
death and dying is not a fun experience to go through, but wasn't it comforting and peaceful at the same time knowing you were there for your mom and that she didn't die alone. you were there for her last breath. you said your goodbyes and had the grandchildren do the same. it still sucks to lose someone no matter what, but think of all the elderly people in nursing homes who don't have any family and they die alone. that breaks my heart. i couldn't even imagine.
thank you for your kind response.
1Aug 21, '10 by Vancouver SonI think you know Morphine speeds up dying. But I didn't.
Our mother was declining - no doubt - at 86, in and out of hospital on various stomach ailments (primarily chronic diarrhea), but always bounced back. Then she came down with low fever and was put to bed. Breathing shallow, unable to swallow, subcutaneous IV, etc, and the Dr said 'Well, she's probably nearing the end" and ordered morphine as required. Now you need to know my mother was not "terminally" ill - no cancers, etc, just old and beaten down by vague, undiagnosed ailments. From the time they administered the first low dose of morphine (two in total) to the time of her passing, it couldn't have been more than 4 or 5 hours. So in my humble opinion, as a professional, but not a 'medical' pro, the morphine relaxed her to such a degree that she could no longer fight for life - let alone breath. Remember - this was someone who was NOT terminally ill with any life-threatening condition - other than old age. Cynical? You bet. Should Doctors explain this to families in advance? Absolutely!
0Aug 21, '10 by Julieann79I'm sorry to hear about your mother. That's a shame. My grandmother had 2 shots of morphine within 6 hrs and she was gone. But, she was 101 and had pnemonia in both lungs. The Dr. said "I don't even think a 40 yr old could fight this". I'm glad that they gave her morphine in the sense that it helped relieve pressure from her chest and back. On the other hand I was sad because she wasn't coherent. I would have loved to have had one last conversation with her. I guess morphine is good in some ways, but not others. But, yes I think Doctors should explain the pros and cons of morphine to the families of the patients so at least they know and can prepare for what they are in for. Mixed emotions on this subject I guess. I hope to take a CNA class in the fall. I want to care for people. I don't have a strong stomach, but I'll work on it.