Why no medication? Only oxygen was given for my father with sudden breathlessness, blood clotting, fibrosis of lung and infection. He died fighting for breath.
If the patient has a DNR (do not resuscitate), then only minimal measures are put in place. It sounds like that to me (being a retired nurse). Everyone dies "breathless" however, know your father probably died with the blood clot reaching his heart which would "cause" his death. (Without an autopsy, one will never know for sure). Know your father is in a much better place, and I extend my condolences to you and your family.
It's not unusual for someone who is dying to feel hot & push & scrabble at their blankets in an effort to cool off. Again, this is a normal physiologic response to the dying process...and what is most everyone's immediate reaction - cover them up. This can be an especially difficult situation for nurses that have to tread that fine line of caring for the patient AND caring for the family. Doing right by the patient would mean allowing the patient to kick off their covers & just leave them off. Trouble is, families often see an uncovered patient as "not being cared for", "cold" or "not having their dignity maintained". So now it's the nurses job to walk that tightwire of pleasing the family's perceptions or doing what the patient needs.
I would suspect from what you've said, FedUpNow, about your father receiving code drugs & CPR that your father did not have end of life documents like a DNR and/or they were not on file at the time. Again, it's a legal & emotional tightrope that medical staff is walking. If they don't have a DNR & they don't do anything, they can be liable for neglect, malpractice, murder, etc. By giving 2 doses of Epi before stopping when you asked them to, they have legal grounds to stand on that they did *something* & it didn't work. As for being ushered out of the room before they started coding him...not only will a code room fill incredibly quickly with all of the personnel required to be at a code, but it's also done with the lived ones in mind. Do you really want your last memories of your loved one to be someone shoving a tube down their throat with a fountain of vomit splashing across Dad's face (happens often w/intubation) & the sound of breaking ribs as someone starts jumping up & down on his chest? Codes aren't pretty & we do our best to protect families from the ugliest stuff all while trying to save a life.
Am I saying all nurses & doctors are wonderful & blameless? Heck, no. In 28 yrs of nursing I've encountered some awesome nurses & doctors & some awful nurses & doctors. After all, we are human, too. BUT, I am saying that medicine is a difficult profession that often doesn't have clear cut, pretty, wrapped up in a bow answers or outcomes & we deal with that on a daily basis.
Yes, that does not seem right. My Mom is on palliative care (not even hospice) for COPD,and we have morphine on hand. I am sorry he had to suffer like that.
I found this on a website about morphine overdose symptoms: "Because it may cause the development of respiratory depression, morphine should be used with caution in patients who have asthma or COPD." This may be why the medical providers didn't administer morphine. They were trying to save his life by not introducing a factor which may have caused him even more difficulty breathing. I know that is of little comfort to you in your loss, but it does answer the question of 'why'. Was he admitted to hospice at that point? In hospice, they are supposed to accept that the patient is dying and provide any pain medication needed. This is what they did with my dad back in 2004. My friend whose mother passed in 2012 had a very different experience with hospice. Her hospice personnel told her that there were regulations on the usage of control substances (even in hospice) and that the facilities were monitored for the amount of medication used vs patient load. I suspected someone in that facility of abusing the patients meds leaving the patients without all the drugs they needed..... it can happen, but it is not common. I hate that my friend had such a horrible experience with hospice. I am sorry that you and your loved one suffered as well
My Dad's oxygen saturation was 96%. He had MRSA and fluid in his lungs. He kept feeling like he was drowning from the fluid in his lungs. Also, he thought he was on fire. This was not "pain" as doctors and nurses narrowly define it but morphine would have reduced his respiration (irrelevant since he was within 20 minutes of dying anyway), and reduced his anxiety. He wasn't in pain as they define it unless you see the emotional pain of panic. He didn't have dementia but he didn't understand why all the nerve endings in his body were misfiring giving him the sensation of being on fire. This could have been, and should have been, alleviated with morphine. Instead, when the doctors asked me to step outside for a moment, they gave him epinephrine to restart his heart (UTTERLY RIDICULOUS) on a terminally ill 91 year old with metastatic cancer throughout his body and bones AND battling MRSA!!!!!
None of us wishes to loose our Loved Ones. We must remember there is (to some of us) an after-life. This gives us some peace. To not watch them suffer any longer. Sure we miss them and we think we will never see them again. I am a Christian so I have a different view on this. I don't expect nor do I condemn those who feel differently. I believe that dying is harder on the care giver and family than it is on the one dying. I don't know much about Morphine except that I get it every 12 hours by pill. I find that my RA is still very painful, so I wonder just how much morphine actually helps. My heart goes out to everyone on here. This is not an easy life and the end is more like labor before birth. Once the death process starts, some take long, others don't. We will all have different experiences and I thank God that this site is here to help us through the process starting at the care giver stage. Thank you - ALL of you
Hospice care has really changed it seems like to me. 7years ago my mother was on hospice and had a brain tumor. She had morphine at an early date and a morphine pump put in. My dad passed last summer. He had had a stroke, ending stages COPD, and even to apply to hospice was very difficult. They said he did not have a DX for hospice. My sister and I are in healthcare and knew that he had less than 6 months to live and was appropriate and appealed. He died 2 months later in great pain, and had little to no pain meds. When we asked why it was because they said he told them he was not in pain, however he was unable to really communicate this! We could tell from his facial expressions, etc. He was in nursing home. We were very disappointed and felt there had been a real pull back in meds and ability to apply to hospice. I was very disappointed and felt that the agency was "paid" for very poor work. BTW, hospice is very expensive if you look at your medicare bills.
I am so sorry to hear your utter pain and anguish. It sounds horrible. Certainly no one would want this to happen, to themselves or a loved one. If you have a way to file a complaint (I don't know how, sorry) you should do so, and don't hold back in describing your dad's obvious discomforts, as well as the effects it had on your family, to have to watch this. You must speak out on this. Even if you don't get any "resolution" at least you can vent and let them know how awful it was for you, and in so doing maybe other families will be sparred a similar time. Best Wishes.
There are also times and situations when morphine is not needed but with my Dad, that was not the case. When I came back into the room, against nurses orders, I saw my father had cardiac arrested and they were about to do pump and puff on him. I shook my head no. He had had two epi pushes and both had failed. It was time to say I love you and let him go.
My husband was in the ER and a doctor I did not know was caring for him. AND, the hospital did not advise me that he was under investigation (he eventually did loose his privledge to work in the ER. I found out about three months later when his face was on the front page of the newspaper.
I took my husband home to die. The nurse and her husband (our pastor) came to my house to assist me while he died. (on her own) She did change the oxygen mask. I can't remember why. My husband died within 6 hours of coming home. He was very comfortable but as you stated his breathing did change. He taught me how to die. Many will not understand this, but it was a beautiful process.
Our Hospice here is excellent. It is up to the PCD to prescribe hospice. Our primary care DR. did not think my husband was near death. His nurse came to the ER and apologized to me about the way that was handled. Hospice would have started the next day (but he died that night). BUT, the hospice nurse showed up while he was dying. Our nurse called her. I doubt at that point she was authorized to administer anything. I have not heard any stories of people being refused morphine during the dying process.
Oregon is being targeted by the Feds due to high abuse of drugs. So, it is difficult for anyone to get any drugs here. It requires a hand written script and must be carried to the Pharmacy and is only for 30 day supply. The stupid druggies have ruined it for the elderly.
I would think I will have difficult in dying as I already use morphine every 12 hours. Tablet and very low dose (for RA). Eventually, I doubt morphine will even work for me. I don't know.
I would scream to get whatever my Partner needs in his final hours. But, I would also be praying with him.
I would suspect from what you've said, FedUpNow, about your father receiving code drugs & CPR that your father did not have end of life documents like a DNR and/or they were not on file at the time. Again, it's a legal & emotional tightrope that medical staff is walking. If they don't have a DNR & they don't do anything, they can be liable for neglect, malpractice, murder, etc. By giving 2 doses of Epi before stopping when you asked them to, they have legal grounds to stand on that they did *something* & it didn't work. As for being ushered out of the room before they started coding him...not only will a code room fill incredibly quickly with all of the personnel required to be at a code, but it's also done with the lived ones in mind. Do you really want your last memories of your loved one to be someone shoving a tube down their throat with a fountain of vomit splashing across Dad's face (happens often w/intubation) & the sound of breaking ribs as someone starts jumping up & down on his chest? Codes aren't pretty & we do our best to protect families from the ugliest stuff all while trying to save a life.
Am I saying all nurses & doctors are wonderful & blameless? Heck, no. In 28 yrs of nursing I've encountered some awesome nurses & doctors & some awful nurses & doctors. After all, we are human, too. BUT, I am saying that medicine is a difficult profession that often doesn't have clear cut, pretty, wrapped up in a bow answers or outcomes & we deal with that on a daily basis.
He died 2 months later in great pain, and had little to no pain meds. When we asked why it was because they said he told them he was not in pain, however he was unable to really communicate this! We could tell from his facial expressions, etc. He was in nursing home. We were very disappointed and felt there had been a real pull back in meds and ability to apply to hospice. I was very disappointed and felt that the agency was "paid" for very poor work. BTW, hospice is very expensive if you look at your medicare bills.
I took my husband home to die. The nurse and her husband (our pastor) came to my house to assist me while he died. (on her own) She did change the oxygen mask. I can't remember why. My husband died within 6 hours of coming home. He was very comfortable but as you stated his breathing did change. He taught me how to die. Many will not understand this, but it was a beautiful process.
Our Hospice here is excellent. It is up to the PCD to prescribe hospice. Our primary care DR. did not think my husband was near death. His nurse came to the ER and apologized to me about the way that was handled. Hospice would have started the next day (but he died that night). BUT, the hospice nurse showed up while he was dying. Our nurse called her. I doubt at that point she was authorized to administer anything. I have not heard any stories of people being refused morphine during the dying process.
Oregon is being targeted by the Feds due to high abuse of drugs. So, it is difficult for anyone to get any drugs here. It requires a hand written script and must be carried to the Pharmacy and is only for 30 day supply. The stupid druggies have ruined it for the elderly.
I would think I will have difficult in dying as I already use morphine every 12 hours. Tablet and very low dose (for RA). Eventually, I doubt morphine will even work for me. I don't know.
I would scream to get whatever my Partner needs in his final hours. But, I would also be praying with him.
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