Family member in Hospice care

[amortentia62442]

Hi everybody!

I have been working in oncology/BMT for the better part of four years...and I love it! Palliative care has become my passion while working in this field. I think it is an honor and very special to be able to help someone in their last days or be able to help their family through such a difficult time.

Since May my husband's grandfather has been ill. He has had CML for 10 years, and was told over two years ago there was nothing else that could be done for him. He Has a multitude of other co-morbidities that are not helping his condition. My husband and I are the closest family members and such have ended up being the main caregivers along with his wife, my husbands grandmother.

Throughout my career in this field I have cared for many dying patients, and have a hard time when they have families that do not come see them or refuse to attempt to understand what is happening.

I completely understand that denial is a big part of the dying process, but I hate to see people suffer, I want to make sure that is their last moments they are not moaning in pain or gasping for air.

And lately I have been living my worst nightmare. My husband's grandparents have 8 children ...only two of which would come to visit, before I called and spoke to the rest explaining the end was coming. The rest came reluctantly.

This past Thursday we enrolled him in hospice care and brought him home...over the past day or so he has gotten to the point of moaning, grimacing, and rarely being awake, and if he is he does not make much sense.

This morning he was moaning much more than I had ever heard him before. I spoke with grandma who let me give him a dose of morphine. The hospice nurse came about an hour later and gave him another dose, after which he seemed comfortable. Later in the day it started back up again and grandma is refusing to allow us to give him anymore morphine.

My husband tried to talk to her, her two children that are here tried to talk to her, but she would say it is too early in the night to give him something.

I guess I just needed to vent to people that would understand. I plan to talk to her in the morning when I get out of work to see why she doesn't want him to have anything and if I can calm her any, and probably call the hospice nurse as well.

Thanks for listening!

[Racer15, BSN, RN]

Could you sneak it to him? My grandfather was on hospice for about a week before he passed away. My aunt and I are both nurses and the rest of my family pretty much deferred his care to us, thankfully, so he was given his morphine and Ativan round the clock. We took shifts so that someone was always at bedside. Sorry you are going through this, I hope your husband's grandpa can remain comfortable.

[amortentia62442]

My husband is ready to just sneak it to him. One of his uncles in spending the night tonight and said if he appear uncomfortable when he checked on him he would give it. For the most part the family has deferred most of his care to me or at least asked my opinion. My gut is telling me he only has a few days left and I just want him comfortable. My grandmother was in hospice and we had a wonderful experience, but my family seemed more willing to accept what was happening.

[jadelpn, LPN, EMT-B]

Denial is one of the stages of grief.

There may be some sort of dynamic there that you are unaware of.

There may have been some communication between the couple (who have probably been married for 152 years) that you are unaware of.

There may be a thought process that the morphine will "kill" him.

Have the hospice nurse have a go at it. Explain that ________ is the appropriate number of doses that will make the patient comfortable at this point. And the goal of hospice is peaceful and comfortable.

If all else fails, you may have to put grandpa into a hospice facility who would be able to manage his pain with a morphine pump, and more of a consistency.

This way, it takes it off of you. If grandpa can still speak, is coherent, ask him what he wants.

It is tough to be a nurse, and to be a nurse involved in a family dynamic and care of a loved one. Especially when they have 8 children. It is just a tough spot.

[Been there,done that, ASN, RN]

You don't need to be working right now. It's too late for FMLA, hopefully you have an understanding NM, and can take the time.

Call a stat family care conference with the hospice nurse. Then do WHATEVER it takes to get him comfortable. If you are at his bedside, it will be easier to manage him. Sneaking doses is not an option, the morphine is counted.SL ativan should also be administered. Tell grandma ... it's Vitamin A.

Whatever it takes, my motto.

Best of luck with this mess. I hope grandpa passes quickly and peacefully.

[toomuchbaloney]

It is not clear to me that Grandma is making this choice because of "denial", I suspect that there are healthy doses of ignorance and fear mixed into her decisions and comments.