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.
