End of Life:: Morphine starting as needed.... is this step called "actively dying"?

I have a concern about my mom, last week she was still walking and eating, this week started Tuesday 7/6/2017 the in home nurse that visits the home once a week said she thought it would be a good idea to give her morphine to help with her being combative which she suggested to give it twice a day with her other medication for anxiety and restlessness. Since she has been taking this she is sleeping all day and don't want to eat as I said before she was eating and not sleeping all day. Looks like the Hospice Nurse is trying to kill her sooner. Thoughts from someone would be nice. Thank you Anita

Last week my father died. 91 yrs young :) He did not want to go. About a week before the Health Center along with hospice would give Dad a bit of morphine via mouth for his pain. Tuesday got a call from the HC to come because they thought he might pass that night. He lasted till Thursday night around 9 pm surrounded by his family Mom and my siblings. He was given a dose of morphine I think every hr on the hr from Wed to early Friday evening when they increased to every 1/2 hr. He fought to stay alive even though Mom prayed for him to pass. It was an ugly death scene. Not peaceful. I held him in my arms as the aids tried to change his bed sheets...don't know if he died in my arms or just before but he was gone. Now my brother blames my sister for having the HC start the morphine treatments. I've been reading online and I think the morphine was for the best. I just wanted to tell you death does not always come peacefully even for 91 yr old's especially when they don't want to go.

I am going through the same thing with my husband. A social worker at the hospital told me to read "The Final Stages of Life after googling "Kokua Mau". It is an Hawaian hospice and is simple caring and VERY supportive of the carers...
I found I was doing some things wrong for my husband.... You might too.
Be kind to yourself.

When there is terrible pain, it needs relieved.
And sometimes, getting that pain relieved, means the person can relax and let go.
I feel so sad that you experienced this; it is so hard to sit watching someone die, wanting to be with them for each possible moment, to help and comfort them....then not be there when they do go.
Morphine can be seen as 'expediting death' in some circumstances.
But it is primarily used, and authorized to be used for, stopping pain...though, for many, it fails to stop pain...instead, stupefying them into inability to speak to say they are still 'in there', and hurting. When doses of morphine seem to be failing to control pain, there need to be other remedies to help that, be it other drugs, or sometimes alternative measures.

I am so sorry to all of you for losing your loved ones. I do just want to say that although I believe that morphine seems to be a good way to help people comfortably die, I think it's time that we stop pretending that this is not what is happening. My mom (and I) never knew that the morphine would end her life. More open communication is needed. This is basically assisted suicide, which I am in favor of. I just think that we need to discuss it as a country and be honest about what we are doing. If we could do that, more patients could be informed and less anxious about what will happen when they near end of life, and family members could be better prepared. It's not widely known, but this is common practice. Again, I am not against it, because I believe that people should pass painlessly, but I wish that both my mom and I had known that this was what the nurses and hospice workers planned. They practice this all of the time, but rarely (if ever) communicate that it is what happens.

I have read all of these comments and I understand now that Ativan and Morphine are what is given to basically hasten death, when it is imminent. The problem I have is that NO ONE, not the Skilled nursing facility workers, or the Hospice worker who came in and changed my mom's meds, TOLD ME that she was so close to death. We increased her morphine to 10mg every hour, to keep her comfortable, but then I left (I had been with her all day and was physically and emotionally exhausted, and I just wanted her to sleep). Had I known she was so close, I would have stayed with her. I am angry and sad and can not forgive myself for leaving her during her last night. I wanted to be with her to make sure she didn't vomit, or choke. I know now that she was close to passing, but at the time I thought she had at least a few more days.

I am curious why you say your are not a Christian but you love Jesus??? I do believe that ALL we do should be done to the glory of God! just my thoughts...

Matthew 25:31-46. And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.

I'm not a "Christian" but I love Jesus. You are doing this for Jesus, and how can that not be a joy? Sorrow and joy together.

I am so thankful for everyone's kind, helpful, and thoughtful responses...we are all in this process together, aren't we, and such is why we meet together and share our stories, seeking comfort, consolation and help... Bless each of you and your loved ones.

Mom is still eating her pureed foods and drinking when she wants to... but the other night she vomited for the first time... I've been with her each time she's been on morphine after asking Mom if she is in pain and she indicates so (usually an hour or more after she's given her usual tylenol and it is not working). I am beginning to see that if I don't advocate for her, the NH home medtechs, as sweet as they can be, are not really probing her for her level of pain...

Mom is so endearing in this stage of her life. I am so blessed to be a part of this process. My only concern is for her comfort and that Mom knows she is deeply loved. I hold her hands, pray over her, often prepare her for bedtime when I am there (taking out dentures, washing face, putting facial cream on, massing her hands, and changing her clothes) because I choose to... and she appreciates this. The caregivers are wonderful towards her... but I find I enjoy caring for her when she is so needy and dependent.

I do grieve that my siblings and her grandchildren are not more attentive towards her. Some hold grudges. Mom made some mistakes... she didn't know the LORD most her life (only coming to faith less than a year ago) and she could be rather self-absorbed and cutting... But she is so different now... and I wish they could see this.. and make peace with her... sometimes I wonder if this is why she is holding on...

Nonetheless, I celebrate my time with her and rejoice for each of my precious experiences with her. I love my Mom. I always will.

I'll continue to share updates with you. Thank you for reading, asking and praying for me and for all of us here. We all need strength and courage for this passage of our life and those of our loves ones. Hugs to each of you.

Perseverance ((((((((hugs)))))) This is a hard time for you. From my experience, morphine really eases the transition. The antianxiety meds will help the body to relax as well. I am wondering how she is now, 10 days later. Can you update us? It is a very special time, difficult of course, but also very meaningful.

My mom passed away yesterday at around 3 p.m. She was in pain by around 6 a.m. & when I called Hospice and described her symptoms (and her decision to stop taking all of her CHF/PH meds), they suggested giving her the max dose of morphine hourly. Which is what I did. I know that my mom was not in pain at her death and she died holding the hand of me and her best friend, in her house, surrounded by her things, her husband, her cats & her memories. It was just the way she wanted it.

Hospice was incredible & I was lucky enough to have my Case Manager arrive literally moments before she passed. She did EVERYTHING (called the funeral home, called Mom's doctors, informed the hospital, etc.). Plus, she was the most kind and amazing person and was right there with strong hugs and soothing words. I could not have held up at all without Hospice.

And, I was very grateful to the morphine for easing my mom's transition.

R.I.P. Mom (1938-2013)

spicygrr! my heart goes out to you... I know this is hard. Take care and may the Lord give you strength and peace...

Chimonger, this is the best article I have ever read on death in Hospice. Thank you. I experienced it with my Dad. Didn't realize some of the things you spoke of. The wet rattle, I thought he was drowning from fluids. I didn't realize what it was. I kept giving him morphine, but he was not communicating long before that. You article is so informative and compassionate! Thank you so much. I copied it for future reference when I need it. My dad only lasted three days and it was a blessing from God. Hospice was wonderful. They came right away when I called them and took care of everything. We were exhausted from being up around the clock and we really appreciated Hospice.

I am in this position now. My mom was diagnosed with congestive heart failure back in January. He was hospitalized for a few days & then put on Lasix. In early May, she was back in the hospital because she couldn't breathe. And then again at the end of May where she was also diagnosed with pulmonary hypertension. When she was released, I did everything I could to help her & she actually started getting stronger again. She could walk unassisted to the bathroom and was helping to make dinner at the table (while sitting). Then, last week, she took a horrible turn for the worse and ended up back in the hospital with atrial fibrillation. They finally got her heart rate under control, but by the she needed 9 units of oxygen just to breathe & she wasn't eating much in the hospital. She was sent home last Saturday with Hospice.

I drove up from LA on Wednesday a.m. & she was pretty bad. I made her a smoothie with protein yesterday and she drank it, but that's all. Today, she had a few bites of food, but nothing else. Earlier tonite, she told me she no longer wants to take any of her meds. She also has been taking morphine since coming home which, allegedly, also helps her breathe. Tonite, she & I talked about what she wanted done after her death. And I told her how amazing she is. That I couldn't have accomplished any of the things I had done in my life without her. And I saw her smile for the first time in weeks. She is giving up...I know that. But, that is her choice, I laid a cold compress on her head, massaged her arms and neck & told her how much I love her. I've been crying all night. I'm surrounded by my mother's life (this is the house I grew up in & she's lived here for 40 years), while waiting for her death. This is truly the hardest thing I've ever done. My heart goes out to everyone on this board.

Morphine is a blessing in disguise. I was not there when my Mom passed, and I wondered if the morphine prevented her from consciously leaving us, but I was assured by those there, that it was the best thing. My Mom also had breathing problems all her life, and I think that contributed a lot to her passing. She will stay as long as she can, make sure she has no pain or regrets. God bless.

ive read many times that labored breathing can be assisted with a small fan pushing air into the patients face. this does amount to slightly pressurized air and is said to be at times a better solution than oxygen.

Perseverence,

I just hold you in my heart! {{{hugs!}}}
It is hard to go through hospicing or caregiving a loved one, helping them birth into a new existence.

Yes, it sounds from your post like the end is near.
How near, none can predict--none of us have expiration dates on the bottoms of our feet! But there are signs and symptoms to watch for.

I am amazed you had to fight so hard to get her into a Hospice program, given her condition. They should have gladly come in, evaluated her, & immediately set things up.

Breathing tends to get wet when the end is near--the person has trouble breathing effectively, & fluids in the body are migrating to the wrong compartments, as systems start to fail more.
When breathing gets "wet" [rattly, bubbly], it is common to stick on a little Scopalamine patch [often used for motion sickness], behind one ear--these get changed periodically, & swap sides.
This helps dry up the fluids in the lungs, to help ease breathing a bit.
It's also a bit of a sedative.

Anti-anxiety meds help keep a person laboring to breath, feel a bit calmer... hopefully.
Morphine is formally used to reduce pain--however, it fails to do that for some folks.
It's also a very good relaxant, even in those it fails to relieve pain for.
Good hospice staff know, that using anti-inflammatory meds are a better 1st use against pain, since pain stems from inflammation; then if the anti-inflammatory cannot do the whole job, it might be time to adjust the morphine dose--but using the anti-inflammatory meds first, means less morphine is needed--lowering side effects, and helping keep breathing comfort levels.
The usual rules that apply for narcotics use: it's important to watch that breathing rate stays at 6 breaths per minute -or more-. That may not be appropriate in Hospice at times like these...breathing rates are declining, usually, anyway. There's a fine line between giving the drugs that help relax them despite slowed breathing, or withholding them because of the slowed breathing, and having them be more agitated. You will have to decide.

Stopping eating is an indicator--they're bodies are slowing, things just don't digest; putting food in a system that cannot handle it, is unpleasant--it can trigger nausea, vomiting or diarrhea, etc. .

Getting fluids into the person may, or not, be a comfort measure.
It's very uncomfortable to have a dry mouth & body.
But, if fluids don't sit well in the digestive system before they get absorbed, that can be uncomfortable.
Sometimes, hospice staff may OK an IV just for fluids, & then it's a matter of keeping the mouth moistened--though most believe doing IV fluids prolongs the inevitable--as do feeding tubes.
It's comforting, usually, to use a moist wash cloth to put on their forehead, etc., maybe massage their feet & hands gently, perhaps with a nice lotion or creme that helps sooth dry skin, but avoid perfumed ones.
--Though, some folks do well with real essential oils; some of those can be very soothing--sandalwood, frankincense, etc. depending on the person.
If there are bad odors in the room, it helps to use peppermint oil--maybe on a light-bulb to diffuse it.

When breathing is not effective, circulation is also less effective.
Caregivers may start noticing changes in color--particularly pale/bluish/purple at toes, feet, fingers. Lips may become pale to bluish. So might ears.
Hands & feet can become quite chilled; as the body starts shutting down, it withdraws circulation from the extremities, to feed the core organs as long as possible--it's kinda like birthing backwards.
Usually once a person has gotten to that point, it may be a matter of hours , but it could as well last days.

It's common for someone going through the dying process, to also have a period of rebound, or "rally"--can be hours, days or a few weeks ahead of their dying---when their health & demeanor perk up, as if they are fine, sometimes....this "rally" can fool most family into thinking they are on the road to recovery.
It varies widely, how this manifests; sometimes there can be multiple rallies, but usual is one.
But it's not a recovery. I don't think anyone knows exactly why there is this feature to the process, so often. It seems like a great time to have wonderful memory conversations, & say final lucid goodby's, more lucid conversation, hugs.

Please also understand, unless the person is profoundly deaf,
hearing is the first sense to develop in the womb, & the last sense to quit when one dies.
Speak your sweetest, encouraging words for them to walk to the light, assure them their loved ones are waiting to help them along, that you will meet them when it's your turn later. Time in that place does not exist--time is only something we have here.

It is common for people who have believed firmly in their spiritual truths--regardless of what those are--to suddenly become afraid, suddenly unsure if their lifetime beliefs have been all wrong--please reassure them of the love, continuity, peace!

Sometimes, a person fears letting go, or they're stuck in pain.
These need permission to let go.
Sometimes they cannot hear it from a loved one
--sometimes another person needs to simply tell them it's OK to go to the light, to see their loved ones who've already gone there.
Bend to their ear that might still hear you, & simply, lovingly tell them: it's OK--they are OK, & those left behind are OK--you will miss them, but will be fine, & will remember them dearly.
No doubt, your mom held you when you were scared, as a child--
--this is doing that for her, now--hug, pat on back, reassuring words.
Everything will be OK. I love you; I will see you later when it's time!

It IS emotional!
Allow it, be gentle with yourself, make no apologies for your emotions!
It's part of life.
{{hugs!}}

Perseverence,
My heart goes out to you! Last week, my family and I were in the same exact situation. Dad had many,many health problems and was in the hospital again. Congestive heart failure had taken over..Pnemonia with kidney failure. The hospital moved him to the Pallative care unit "to make him comfortable". He was taken off of his feeding tube and oxygen Tuesday A.M and he was kept comfortable by morphine. He passed Tuesday evening. He was very tired and was ready to be with mom again. :,(

My father died about 7 years ago of emphysema and pneumonia. He had been ill for about a year a coughed very hard and nothing stopped it. He finally just gave up and wanted to pass away. He was in the hospital about 3 times his last year and then contracted the pneumonia.

He told us he was tired and ready to go and that he wanted to talk to the doctor. I think he thought the doctor could just give him a shot, he was put on morphine to keep him comfortable. I believe I was told that the morphine also slows down the breathing allowing them to pass peacefully. Once he was given it, he did pretty much just go to sleep and never spoke to us again, so please say everything you want or need to say now, do not wait.

God Bless you and your mother, my prayers are with you.

May our Lord continue to bless your caring heart & may your dear mother be given a peaceful, pain free passing when the time arrives. Remember, she is still with you , so do continue to treat her as a vital woman & don't forget to smile every chance you get - she feels it. I know this because I too am experiencing similar things with my 89 year old mother. I know neither of us want to lose our loved ones, but we never really will if we continue to love them now and after they pass. Bless you again for your love and kindness - my prayers are with you and yours as we continue to give all we can. Keep the Faith.

my mom also stopped eating awhile ago, only wanted lemonade and ice cream, so that's what she got! Hospice care began early in May then started on morphine and anti-anxiety a few weeks later. She passed away June 29th peacefully in her sleep with family by her side .The books from hospice are quite accurate about how long she had in those last weeks and hours.When they have trouble getting pulse,blood pressure etc. no not leave if you want to be there when it happens .I was there every day and most of night, but be sure to tell the nurse to call when any changes occur if you do leave. I absolutely had to be there. My brother passed away 5 days earlier from a massive heart attack so I know he was up there waiting to greet her . Stay strong, you know she will be in a better place, with no pain.

thank you amyrup... take care and God Bless! Hospice is a medicare benefit and they are VERY helpful....

Jave I am so thankful you said that! I spent last Tuesday night in Prayer for an hour! I was praying to take my mom and put her out of her pain. Then apologizing for praying for that, then thanking GOD for giving me compassion and sympathy towards my mom while cleaning up yet another accident! She cant make it to the bathroom and she is in so much pain! My mom is not in a nursing home or with hospice yet but I feel like it is only a matter of time.

Pain management without the goal of 'getting better/well' is called palliative care. Palliative care can be given in Hospice situations but it is not always in Hospice. What you describe is to make your mother comfortable for as long as she has. Which even in Hospice can be longer than some of us might expect! Either way, you fought the good fight to get her this care and that is wonderful.
My MIL has been in a nursing home for five years, where she went with constant UTI's and two hip fractures to name a few of her issues. She also has had a very slow growing lung cancer which is not uncommon in 93 year olds, and which the doctor has seen for several years and says will probably not be what causes her to go. When she entered Hospice care almost a year ago she sort of fought the concept, saying that she wasn't ready to go yet and she thought a) it would be expensive (! - so 'her' to worry about the money part of it first!) and b) that somehow it would hasten her demise. Well, she is on morphine as needed and has been for six or more months. At first there was an adjustment and she slept a lot more but now, yes, she still sleeps a lot but her system has adjusted to her dose and she still has good, cognitive times every day. She wears oxygen almost constantly so the increased oxygen makes her more alert and less mentally foggy. And the Cymbalta helps her depression and aches and pains. Our understanding is that this could go on for a long time. Or could end tomorrow. My husband just made the trip to see her, took her to church, out to lunch, and they talked a lot. He has had about four 'last visits' with her and who knows! There may be more. You may find these medications give her a better ability to converse and 'be' with you and you will have more quality times with her because of it. God bless you.

Of course you're emotional. It's a very difficult time.

My experience is much like everyone else's. My dad was prescribed morphine by hospice on an 'as needed' basis. The staff at his NH didn't think he needed it so they didn't give it. However, when I was with my dad he'd admit to me (and me only) that he was in pain. Long story short, with the help of the hospice my dad was given morphine and Ativan every few hours around the clock. This began on a Tues. He died on Sat. It was very quick and while we knew he was dying we thought it might take a little longer.

His fingertips became bluish from a lack of oxygen. He had the rattle in his throat, called Cheyne-Stokes breathing but otherwise known as 'the death rattle'. Of course he wasn't eating or drinking. I put cool compresses on his forehead, held his hand, talked to him (he wasn't really conscious). I would put a wet washcloth in his mouth to keep his mouth moist and I thought that maybe somewhere inside of him he could taste the cool water and I used the washcloth then to wipe his lips off. Then I would apply lip balm. That Saturday night the nurse went to give him his meds and realized that he had died. It was very quiet and peaceful. For that I was grateful.

That was my experience.

Yes I truly believe you will see her again and she will be strong and healthy and beautiful as you know you want her to be. God Bless you in this tough week or two ahead of you! Pray without ceasing!

Bill is in very good physical shape right now after having had AZ for at least 7 years. I figure he will live at least another 7, maybe 10 more years. Right now it is still OK. I haven't had to face a lot of what I know is coming down the road. I just pray that I am strong enough physically and mentally to stay active in his care. But I fear the future.

I know it is hard to watch someone you love declining... I personally do not feel it is wrong to pray for their death to come peacefully and soon! take care may you find strength and comfort in keeping your promise!

all of us going through or having gone through these things. We have a lot to share and can support each other. But for the AZ patients it feel like the end will never come! It seems to go on forever. I just wish there was a way for it to end before the patient has to succumb back to being a baby again. It is humiliating for me to watch this process and even though he doesn't know it now he would not like being a baby again either. I have promised I will never leave him until it is time.

to finish my thoughts... morphine. He knew we were there and we kept him clean and comfortable. We played George Beverly Shea CD's for him... He enjoyed that! I will miss him always but I am grateful he is not suffering and thankful for the time I had him with me. I believe I will see him again in heaven.