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My mom is on hospice in memory care... Seroquel for hallucinations. Last week Thursday the hospice CNA found her in extreme pain.


Thursday, The hospice nurse put her on morphine, discontinued her pain med.


Friday I had a normal phone conversation with her.


Saturday she didn’t answer the phone, I figured she was sleeping because of new morphine.


Sunday late afternoon I go visit and find her incoherent, unable to wake or comprehend. I called hospice and they did come out and hold the morphine. Which she is back on. Yesterday, Monday, I visited late afternoon, she did wake, but was unable to carry a conversation, tried to answer the phone via TV remote. Took her 45 minutes to eat a piece of cake. Hospice states the morphine is equivalent to Tylenol 3 , my mom has had opiates for pain for years.



Hospice wants to keep her on the morphine because it is quickly metabolized... that her change is probably due to her stepping into the next phase of end of life.



I’m not sure if my mom has had a minor stroke, I believe she had one a couple years ago when I had to fly out for an incident during the previous night. My mom refused to go to the hospital. But watching my mom eat that cake yesterday was very reminiscent of watching my mom eat lunch on that trip. but she was able to communicate.



Anyone know if I leave her on morphine and wait to see if she acclimates to the morphine, that if she continues to be snowed, can we go back to her original pain med with morphine as needed? Morphine had been available if needed prior to Thursday?



I hate to see this huge change… not even close to baseline when she started morphine.

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Lealonnie1: You are right. Morphine, these, days is given under the tongue in individual doses. The plastic dispenser looks like a needle, and that's why I made the mistake of saying "injection". Technically though, it isn't an injection.
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Morphine is a powerful narcotic, good for intense pain, but also slows down the breathing reflex. In some cases, it helps the dying patients to die sooner from respiratory arrest, but without pain.
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It reminds me of what happened to my dad at the end. He was released from the hopsital to my mom's and my care at his home, with the (2hrs per day) help of visiting hospice nurses. Every day the nurses injected Dad with morphine, and right from the beginning of the injections, Mom and I noticed a severe decline in his functioning. His speech which had been soft and halting became unintelligibly slurred, he was always drowsy and unsure of his surroundings, and he waffled back and forth between helplessness (unable to lift an arm or leg) and agitation (jumping out of bed). None of this happened before the morphine.

We'll never know for sure, however, whether it was the meds or advanced cancer or a series of strokes that did this to my dad: He only lasted for 5 days on this regimen. I guess we were lucky that his suffering was brief.

Best of luck to you and your mom!
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lealonnie1 Apr 2022
Funny but morphine is given in the mouth as a liquid, not by injection, at least in all the experiences I've had and seen with hospice over the years. I've never witnessed them inject a patient with anything
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Visited with my mom today… she was much better, not the same. Have decided to leave the morphine in place and trust the experts…hospice has ordered a hospital bed in anticipation of more decline, so it’s there when needed.

I must say she is no longer talking of her hallucinations, maybe it’s calmed her down. That’s a good thing…

thank you for your advise !
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Shortly after mom started on hospice, her Sundowning started to get VERY bad. They had to up her Ativan from .25 mgs to .5 in short order to alleviate her symptoms, which I agreed with 100%. All of a sudden, mom became like a vegetable. Which I, of course, insisted was the increased Ativan! The hospice nurse said No, that's not what's going on.........your mom is declining; it's just a coincidence that the Ativan was increased recently, and not the cause of her decline. I insisted otherwise, b/c I'm a micro-manager at heart, and had her taken down to .25 mgs of Ativan once again. Which did nothing to change her vegetable like state at ALL. She was declining due to her advanced dementia and CHF, just like I was told to begin with. But I had to find out MYSELF what was going on, have her meds decreased, and be 100% certain she wasn't being over medicated.

You have to do the same thing with the morphine, imo.

So then when I realized mom was really dying, I authorized a very low dose of morphine to be added to her Ativan dose b/c she was showing discomfort when being moved/changed/repositioned in bed. It immediately calmed her down w/o making her any more 'out of it' than she already was. She no longer winced when being moved, so I was happy.

The way it was explained to me, the lowest dose of morphine mom was getting was comparable to the 2 Tramadol she had been taking all along, just easier to metabolize and not in pill form. A different med, yes, and one that worked better ultimately and obviously. I have no thought in my mind whatsoever that either of those meds 'killed' mom. What killed her was heart failure and dementia combined.


I also feel certain that mom was having TIAs or strokes during the last 6 months of her life; she was leaning WAY over to the left in her wheelchair, more and more so as the days went by. Before she became bedbound at the end, she was SO leaned over in her w/c that she was in danger of tipping it over, the caregivers said, so they moved her out of her w/c and into her recliner for safety purposes. That's a stroke if ever there was one! Plus, her speech was slurred and getting worse, and her ability to understand language was becoming more compromised with time, which to me, was indicative of stroke(s).

Wishing you the best of luck with a difficult situation.
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Hospice should be able to tell you what they think is going on with your mom. It sounds like she may actually be transitioning from this world to the next, but they should be able to let you know that for sure.
When a person is transitioning, they will stop eating and drinking, as their digestive system starts to shut down and it can be very painful to try and force food on them, so please be careful with that. If your mom doesn't want to eat or drink don't force her. Let her be your guide.
And morphine is meant to keep someone comfortable when they are dying as when the body starts to shut down it is quite painful, and I know that you want your mother to be as comfortable as possible when she leaves this world, so trust what hospice is telling you.
It's hard I know, but just be there for your mom and make sure that you leave nothing left unsaid. God bless you.
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I'm very sorry that you and mom have to go through this.

I think when we have loved ones in hospice, one of the biggest concerns is pain management - specifically the administration of morphine. How much, how often, how long? The desire to keep our loved ones free of pain vs. the concerns of drugging them into oblivion.

Does mom live with you, and therefore you are the one responsible for administering the morphine the majority of the time? Unfortunately, it might not be the medication that is making her unresponsive.

I think your best bet is to put these questions and concerns to the hospice nurses. Believe me, you will not be the first person to bring these concerns to them - they are well versed on the conflict between enough medication and too much medication. My mom's hospice nurse told me the dosages were so small the effects would last about 2 hours on average. For the 4 days my mom transitioned, she was getting about 4 hours out of each dose, until her last 24 hours where, although unconscious, she was becoming visibly agitated very quickly after administration of morphine and I increased the dosage to every 2 hours. By that time, she was clearly at the end, and I was more worried about her comfort than anything else, especially given the fact she was totally unresponsive by that point.

As hard as it was, I was very glad that the power to relieve any discomfort she was having rested in my hands rather than having to wait for a medical person to come and administer pain relief.

I know how hard this time is, and you have my utmost sympathy. (((hugs)))
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babsjvd Apr 2022
Thank you, my mom is in memory care. Mostly my concern is how she could not communicate after the morphine was put in place . And prior to could talked talked talked…

this morning after posting this , I was a able to have a phone conversation! Yay…

but yes, it’s hard to tell if she is just transitioning…
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