foudini

Thank you all so much for your kind words. I think nurses have a different perspective on this situation, because we deal with life and death, depending on our chosen area of nursing, which is why i'm reaching out to you all. I have always worked in skilled nursing with an emphasis on hospice care. I've also worked in Home Health/Hospice as well, so I've been with families so many times during the dying process…given the Roxanol, Ativan and Atropine…know all the protocols. I always had a vision of what his death would be like…in a comfy bed, listening to his favorite music, no pain, morphine as needed, all done by me. I was shocked at his aspiration…at that point, I was no longer a nurse. I was a scared daughter, watching her dad choke. After that I just wanted to make sure he died without any pain, and yes, a part of me wanted it to come sooner rather than later. I am grateful that he was with me, and therefore wasn't scared. He could have died or aspirated at home alone. Looking back on it, he was coughing some when he would eat. I didn't even pick up on the fact that he was having difficulty swallowing. Thanks again…it really has helped me.

My dad was diagnosed with advanced primary liver cancer in June of 2012. He was 80. He had survived end stage liver disease secondary to hep c and cirrhosis about 9 years prior. I live in Utah, he in Southern Ca. He was my best friend and only support. My sister has Alzheimer's at the age of 49. My dad and I spoke a minimum of twice a day, and I listened to him struggle with all of the aspects of liver cancer. A doctor had told him that, without a liver biopsy, they couldn't say it was cancer for sure, even though his AFP was over 10,000 and he had multiple large nodules in his liver, so he never believed he was dying. I was expecting it to look like ESLD, with ascites, jaundice and confusion, but he never developed ascites. He lost some of his bowel control, had multiple visits to the E.D. because he couldn't urinate and his bladder would become so distended that he was suffering severely, but he was confused enough that he didn't recognize that his inability to urinate was causing it. He had a TURP which helped some. He also had bilat 4+ pitting edema to feet and legs, severe jaundice, facial edema, severe confusion and weakness, lack of appetite, atrial flutter and his liver could be palpated in his LLQ. Anyway, he wanted to be with me more than anything in the world. Wanted to see the mountains, wanted out of Long Beach. I had promised him, 9 years ago, that I would never let him suffer. I went thru months of worry because he was confused and getting lost and couldn't figure out how to use his phone anymore. I packed up my 2 kids, dog and cats and moved to So Cal to take care of him. I planned on staying, but ended up moving back home. I'm a single mom, so this was no easy task. Okay, now to the part that has me consumed with guilt. He came to live with me so I could care for him. He would be up in the night confused, fell once and I found him on the floor by the bathroom. His urine was rust colored. He was confused but seemed content. I took him to the mountains and helped him walk down to the lake. He didn't have the physical or mental strength to really enjoy it, but we did it. On the 3rd night that he was with me, he woke me up complaining of severe epigastric pain. He was on hospice care at that point, but wanted a shot of vodka, first time he'd asked for that in almost 10 years. I gave him one but it didn't relieve the pain. I started him on the prescribed dose of 2.5 mg's Roxanol q4 hours. I gave him the first dose with no relief. Side note...he had stopped eating or drinking coffee the day before and got in bed and didn't get out. Anyway, I gave him more. That didn't help. My dad never, ever complained of pain, so I was scared. I knew he had esophageal varicies, so I was scared that he was going to bleed out or his liver capsule would burst-I was told that a lot of patients with this form of cancer die from catastrophic bleeding events and I didn't want him to die afraid. He fell into a deep sleep, then woke up asking for water. I gave him some, got him up on his elbow, had him turn his head and tilted the straw down towards his tongue. He took a big sip, but when he went to swallow, it all went in his lungs. He turned blue and coughed so hard that he went completely unresponsive. I have never been so scared in my life. I had no one with me...no family or friends. Just me and my dad. I knew at that point, he either coughed so hard he had a stroke or something terrible had happened. I sat by his bedside for the next 20 hours and listened to him moan a soft moan on exhalation, he sounded very wet, I suctioned him when it he needed it, then positioned him on his side. He looked very comfortable but was having trouble breathing. I knew there was no going back at this point, so I gave him lots of Roxanol. I probably gave him 20 mg q4 because I was terrified he'd wake up in pain or worse due to his aspiration. To be honest, i'm not sure what I was doing anymore. He did die peacefully, meaning he never regained any consciousness. He did however, roll onto his back with his eyes wide open and reach out in front of him as if to grasp something, then back to unresponsive for a few hours before he passed away in my arms. His last breaths were small gasps...no air movement. I watched his pulse in his wrist go into a fast arrhythmia, then stop. I'm coming up on the one year anniversary of his death, and I am struggling with my decision to be his hospice nurse. I wanted his death to be peaceful, with his favorite music playing, and it was, but he aspirated in my care, and I gave him morphine, knowing I was brining the end sooner because it was coming anyway. I'm looking for support because I can't continue to feel like I killed him. I know he was going to die anyway, but I feel like I brought death sooner. Maybe that was a good thing, idk. Was it my decision to make? It is affecting me deeply and profoundly. Please don't say anything cruel. But I want to know anyone's thoughts on this. thank you.