MORPHINE and Dying Patients - page 20

by constantlylearning 122,350 Views | 221 Comments

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.... Read More


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    QUOTE=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.
    Hi Julie-- your story caught my eye because my mother just recently passed away, and even though she was younger than your Nana the course of her last day of life was very similar.

    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
    leslie :-D, Julieann79, Hoozdo, and 1 other like this.
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    thank 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.
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    Thanks, Julie.

    I saved your post. Best wishes to you. (back to work today)
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    I 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!
    Julieann79 likes this.
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    I'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.
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    Vancouver Son - in my experience, low-dose morphine can, sometimes, shorten the dying period, but only by a period of hours, and only for a person who's already close to dying. Its primary use in these cases is to reduce anxiety, improve cardiac function, and ease respiratory distress.

    While large doses can supress the brain's respiratory drive (which is what kills people who overdose), in small doses this is only true if there's serious kidney or liver function, or advanced respiratory disease.

    I agree the doctor should have discussed things with you and your family, but if it were me I'd have explained what it was about your mother's condition caused me to conclude that she was "probably nearing the end" and how this time was different to the previous admissions where she'd bounced back.

    You didn't say how long your mother was in hospital on the occasion, nor what kinds of investigations she had; and in any case the ToS prevent diagnosis. There are certainly elements that flag a significant change, particularly the shallow breathing and difficulty swallowing. And, at least where I work, subcutaneous (rather than IV) hydration is used almost exclusively in end-of-life care.

    The langage health care practitioners use sometimes has different meanings to us than to lay people - if I tell a colleague that a patient doesn't look very well, for example, it means that I have serious concerns about their wellbeing or potential to deteriorate without warning. It's often difficult, especially for less experienced staff, to realise that these code words aren't heard the same way by all audiences. I have many times had the experience of a doctor telling me s/he'd explained a patient's condition to family, only for me to realise when speaking to them that there had been two, very different discussions - what s/he said and what they heard. I wonder if that might be the case here.
    Last edit by talaxandra on Aug 21, '10
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    Quote from Julieann79
    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.
    when folks are in need of strong narcotics, there is always that balance betw alleviating pain and maintaining coherency.
    from your description of your grandma, it sounds like she definitely needed the morphine.
    otherwise, her death would have been miserable...
    nothing worse than the feeling of drowining in your own fluids.

    had you observed her struggling like that, i highly doubt that conversation would have been on your mind.
    however, of course i sympathize w/you wanting that 'one last time' with her.
    but from a professional point of view, i am very relieved to hear she got that morphine, and that she died peacefully.

    please accept my condolences.
    she lived a wonderfully long life.

    leslie
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    vancouver son~
    i am sorry you lost your mother.

    you do not have to be terminally ill, such as a dx of cancer, to be "nearing the end". people die from natural causes all of the time. their bodies become weak, they begin to have difficulty breathing, fevers, etc. these patients deserve comfort.

    all of my experience is in ltc, with the elderly. i have seen many patients pass away without having a 'terminal illness', they begin the steady decline downwards. we ensure their comfort is a priority.

    your mother did not have to have a terminal illness, like cancer, to be 'near the end'. her body was wearing out. she was 86, chronic diahrreah, which is no small matter, and she may have had other undiagnosed issues.. she began the breathing patterns that were hallmarks of impending death, and they desired to make her comfortable.
    Last edit by VioletKaliLPN on Aug 21, '10
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    Quote from Vancouver Son
    I 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!
    So sorry for your loss, but your mother DID NOT, DID NOT, DID NOT die from morphine!!!!! She WAS terminally ill if she was unable to breathe and could no longer swallow: that's the body's way of telling us we are ready to die. Why should she have to fight to stay alive at 86? We do not live forever. 86 is elderly and a perfectly normal age to pass away, even if we are not ready for our loved one to go. Truly, I'm sorry you think the morphine killed your mother, but PLEASE don't perpetuate the 'myth' that morphine will kill people. The health care professionals should have explained to you about death and dying and how morphine allows those who cannot breathe comfort in their last hours rather than having to struggle for breath.
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    Quote from Vancouver Son
    I 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!
    i don't how i missed your post, vancouver.

    i agree with what the others are telling you, about morphine NOT causing your mom's death.
    she may not have had any diagnosed illness, but she was indeed, terminally old.
    even if your mom died of natural causes, she displayed the applicable symptomology before she got the morphine.
    with my yrs of experience as a hospice nurse, i can say that she would have likely died within hrs anyway...
    and not "bounce back".

    all that said, i truly am sorry for your loss.
    it sounds like you miss her tremendously.

    btw, did you read the study where folks who are on palliative care, with their pain being properly managed (with morphine and other opioids), that they actually live longer?
    if anything, evidence is showing us that the opposite is true:
    that when folks get relief from pain and/or other distressing symptoms, it shows they are living longer.

    what i'm telling you, is morphine did not hasten your mom's death.
    it just sounds like it was her time to go.

    heartfelt prayers for peace and healing.

    leslie


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