My Mom passed away. Did I do the right thing?

  1. Hi everyone. Please excuse this long post – but I am in desperate need of very honest advice and opinions, as I am uncertain as to whether I did the right thing for my beautiful Mom, who passed away recently. I need to tell the whole story, as I feel I may have caused my mother to pass – and the guilt I feel is overwhelming and I honestly don't think I cannot continue with my own life, having contributed to my Mother’s demise.

    My 70 yo Mom (who lived with me – and I nursed FT for 7 years) had a series of significant medical issues, including but not limited to systemic lupus, non-cystic fibrosis bronchiectasis (24/7 02), RV heart failure, significant weight loss (88 pounds), advanced steroid induced osteoporosis, multi pathological Fx. She was a very unwell lady – but always had a positive outlook. In the days prior to her passing, she felt extremely nauseated, very breathless, would go 16-17 hours before urinating, did not eat and was unable to walk due to feeling so weak. She also suffered from debilitating pain (despite using heavy meds). She had recently been referred to a palliative care service (in the home) – but we were still waiting to hear from them. In any case, we had regular visits from her GP, dietitians, physiotherapists and we also had access to CN and RNs if/when required. In any case – I looked after Mom full time and happily quit work in order to do so. I promised her I would not put her into a nursing home. We were doing OK – and we got by each day just being together. We were best friends.

    On the day prior to my Mom’s passing, she had not been to the toilet for 17 hours. I took her to the ED to have a in & out catheter to drain her urine – but a bladder scan showed she only had 6 oz of fluid in her bladder - so they didn't do it and said that she would "go" when she was ready. She complained of nausea to the Dr, who gave her Ondanzetron (antiemetic). Mom immediately fell asleep and I felt (at the time) it was because she was completely exhausted from feeling nauseated all of the time and also because she hadn’t been sleeping very well (sometimes not at all). I thought it was simply her body feeling relieved. She was also taking Fentanyl for chronic pain, but I was assured that one Ondanzetron would not cause any Seratonin issues / poor interactions with her pain medications. We never really got to the bottom of WHY Mom was nauseated all the time. Her kidney function bloods were good – no UTI, etc. Actually – her bloodwork was quite good (for her).

    We were taken home. Mom was still very drowsy and disorientated. But once I had her sitting up on her couch and had well positioned AND she had a cup of tea – she perked up really well. She later went to the toilet (huge wee – yay) and then she asked for some dinner (wow!! Yay). I really thought that we had solved the problem with this great medication – Ondanzetron. After dinner, Mom became drowsy again and confused. I again thought it was because she had had such a big day at the hospital.

    I took her to bed that night very early. She was very unsteady on her feet during the stand transfer (more than usual) – and this was the reason I put her to bed early. It was a difficult process, but we got there. She was in a right lateral position, with her head slightly elevated and her legs slightly elevated with pillows to protect her heals from pressure. She was on a pressure relieving mattress.

    Ordinarily, I would turn Mom every 3 hours (from right lateral - to supine - and then back into right lateral again later). This worked well. She had very poor skin integrity, already had a stage 4 pressure ulcer (courtesy of a hospital stay), and due to her poor nutritional status and heavy requirement for steroids, I felt regular turning was important. She would usually rouse a little to help me with the re-positioning – and after about 1-2 minutes, we’d be finished and she go back to sleep. Ordinarily, she wouldn’t even remember being turned.

    But on THAT night it was different. After I put Mom to bed, she was staring off into the distance. I asked her if she could see something or someone – she said no. I asked her if something was wrong – she said no. I asked her if she was angry with me – she said no. I asked her if she was in pain – she said no. All just single words. I told her to close her eyes and that I would be sleeping right beside her if she wanted anything. I put a mattress on the floor beside her bed, so I could be close.

    I checked on her an hour later – she was fine. I then checked on her 3 hours later – she looked fine. I was going to turn her then – but she looked so peaceful – and it had only been 4 hours, so I made an executive decision to leave her a little bit longer and that her sleep was more important. I got up 2 hours later to check on her. At this point, she had been in the same position for 6 hours. I really felt it was important to re-position her a little. I took the pillows out from under her legs. Turned them over, so they were nice and cool and moved her legs a little. Instead of a big roll into a supine position – I decided to just give her a small lateral nudge, to move the pressure point slightly. I didn’t want to wake her. When I nudged her, she flopped almost into a prone position and seemed unconscious. This surprised me. I had never experienced that before. At that point, I felt I had no other choice but to place her into a supine position. But when I did that, she was too far down the bed, so I had to turn her laterally again, place a slide sheet underneath her, turn her supine again and shift her up the bed. When removing the slide sheet, Mom flopped over into a right lateral position. Again this had never happened before. She was clearly unconscious – and I would have thought that after 6 hours of sleep, she would rouse a little bit. As I turned her back, she became very pale and it was obvious she had passed away.

    So, my question is – have any of you experienced something like this before? And to what extent do you think my actions contributed to my Mom’s passing? Please be honest with me. If it was my fault - then I really need to know. Mom and I were best friends and I did everything I possibly could to do all the right things.

    I appreciate any and all advice you can offer.
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  2. 43 Comments

  3. by   Emergent
    Your mother had multiple health problems and was 70 years old. It sounds like you did everything you could to care for her but her time had come.


    I think you should find someone to talk to face-to-face. A counselor or or minister might be able to help you work through this. I'm so sorry for your loss.
  4. by   scott.tyshawna
    I'm so sorry for your lost I wouldn't know what to do in your position right now but no I don't think it was your fault.
  5. by   NurseCard
    I agree with Emergent; please please seek counseling. I am happy that you
    were able to get that off of your chest. You did nothing wrong.

    If you are truly thinking of hurting yourself... 1-800-273-8255. Now.
    Please.
  6. by   LovingMom1
    Thanks for your responses so far. I am already talking it through with counselors, but they don't have medical training - and all they can give me are the usual platitudes (and that's fine) - but nothing more technical in nature. Am not thinking of hurting myself.

    My issue is with the pressure area care. Was I right to turn her?
    Last edit by LovingMom1 on Apr 20 : Reason: more context.
  7. by   blondy2061h
    Your mom did not have serotonin syndrome. You are correct in thinking that one zofran would not be enough to cause this. Working in oncology, I routinely have patients on 8mg of zofran q6h and PCAs of hefty narcotics who do fine.

    Your mother passed because she was quite ill for some time and it was her time. For anyone, losing a parent is hard and we have a natural tendency to blame ourselves. For those of use working in healthcare, this tendency quadruples. I can say with certainty that it was NOT your fault.

    It sounds like taking care of your mother was your whole life. Please find ways to occupy yourself everyday as you are ready.
  8. by   LovingMom1
    Have you ever had pt's pass away during pressure area care / re-positioning? It was during this process that she passed away. If she passed away while I was doing this, I can only imagine that she would probably have passed very soon?

    It was only 4mg Zofran. She was on 200mcg transdermal Fent, but had been for 15+ years, so was very tolerant.

    Now that I think of it - her recent weight loss combined with heavy transdermal Fent may have caused the nausea - but I guess I'll never know.
  9. by   notanumber
    You were doing the right thing per pressure sore care. In our facility, we only stop turning when we know death is imminent and repositioning may cause more discomfort/distress than not turning. I have not personally had a resident/patient pass during repositioning, but I know nurses who have - again, when the patient is already very fragile, non-responsive, receiving end of life care, and death was expected.
    You gave your mom great care. She was dying and you were there for her and with her. If you had not been there to be caring for her at that moment, it seems likely that you would have missed her passing entirely since she had already significantly deteriorated. I hope that looking at that night from that perspective will give you some comfort.
  10. by   VivaLasViejas
    I've had patients who passed away during or shortly after a turn. Not sure what kind of phenomenon is at play here, but it's more common than you'd think.

    It was simply your mom's time. Nothing you did or didn't do caused her to pass on. Please don't feel guilty about anything---you gave her the very best care possible.

    I'm sorry for your loss.
  11. by   MunoRN
    Your mom was going through some very natural and normal steps in the dying process, these weren't caused by you or any decisions made about her care.

    From your description, you took exquisite care of your mother and there's nothing apparent that you should have done differently, I'm sure she appreciated your devoted care.
  12. by   Amy01
    I am really sorry for your loss, it a very difficult situation to be in but you did best you could do for her....things will change
  13. by   nurseletDZ
    Quote from LovingMom1
    Thanks for your responses so far. I am already talking it through with counselors, but they don't have medical training - and all they can give me are the usual platitudes (and that's fine) - but nothing more technical in nature. Am not thinking of hurting myself.

    My issue is with the pressure area care. Was I right to turn her?
    Yes, you were absolutely right to turn her! Good on you for looking after your mom's skin (and all her other needs so carefully). You did exactly as you should have done, and to me it doesn't sound like the movement in any way could have contributed to her passing.

    From what you've told us, it sounds like she was "on her way out" so to speak for the several days before she passed. Not eating or peeing are subtle signs that the body is closing up shop, as is withdrawal from interpersonal interactions. She was a very sick lady, and she had been for years. I'm sorry for your loss, and I'm sorry that you didn't get a little more "warning" or time to acclimate to her final decline. Just know you did all you could for her, and if she could tell you know, I'm sure she'd be so grateful for the loving attention you gave her up until her last moments.

    Be well.
  14. by   amoLucia
    Quote from VivaLasViejas
    I've had patients who passed away during or shortly after a turn. Not sure what kind of phenomenon is at play here, but it's more common than you'd think.

    It was simply your mom's time. Nothing you did or didn't do caused her to pass on. Please don't feel guilty about anything---you gave her the very best care possible.

    I'm sorry for your loss.
    I, too, had just repositioned a pt and had put her arm above her top sheet so her arm would be nice & straight and IV accessible/visible. She took one deep breath and just passed away. The CNA and I had just finished turning & repositioning her with incont care.

    She was very ill and just passed. I don't think she was in any great discomfort by our care and she did not die alone, but within our presence trying to make things as comfortable as poss.

    I would like to think that was a gentle way to pass.

    Sorry for your loss. Please take are of yourself at this time.

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