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.
It was not my intent to criticize nurses. But in my case none of the nurses on my Mom's ward seemed to know what the other one was doing. The differing information we got depending on which nurse we spoke to made a hard situation that much harder.
So I am sorry if I offended you Ozark but to be honest I don't really care how hard nurses have it etc. etc. And no offense but I've never thought nurses were unrealistically perfect. Actually the opposite in my Mom's case.
As a nurse, one of the most frequent questions I'm asked by families is, "When is ____ (fill in the blank) gonna die?" Despite all of our training, experience, skill, real world experience....we don't know WHEN anymore than anyone else. We can look at vital signs, fluid intake, etc & give an educated guess...BUT THAT'S ALL IT IS. We don't call & tell you to come right away just because we want to torture you or stress you out or pull you away from jobs or families. We don't WAIT to call you because we're hoping your loved one will die while you're still stuck in traffic on the 405. We call when we THINK it's soon "time" but, ultimately, that timing is completely out of our hands! Just as there is no one set pattern to living, there's no one set pattern to dying. The patient in room 25 may appear to be imminently passing but then rally & not pass until 3 days later. Meanwhile, the patient in room 26 appears to be holding their own & passes suddenly 20 minutes later. We are not miracle workers, don't have crystal balls &, as much as I would welcome it, we don't have a direct line to God, Yahweh, Shiva, Krishna, Muhammed or what ever diety you do or don't believe in. If I did & could be certain when everyone of my patients was gonna pass, sure, I'd have the family there "on time" & wouldn't make "false alarm" calls but, no matter how unrealistically perfect the public wants us to be, it's simply not humanly possible.
My Mom died four weeks ago. She was on Comfort Care but it seemed like it was a constant fight with the nurses to make sure she truly was comfortable and was getting enough morphine.
One night they phoned me to come quick cause they thought it was time. I rushed over and sat there for two hours. Then a nurse walked in and said that mom had not received any morphine that day and that was why her breathing had been labored. She wasn't even aware that I had been phoned.
FedUPNOW, What you explain about your Dad's dying, continues to sound so much like my 94 yr old Dad and our experience. Whether it is morphine or not, I still feel his DR. should have recommended something to ease his agitation. I did not experience his dying process as beautiful, as someone said. For me, what I saw was an extremely agitated old man, continually struggling to take his mask, catheter and IV out and pulling the covers off because he was burning up. My Dad was having trouble breathing- he seemed to be drowning- and he couldn't communicate to me what he needed. The nurses all seemed indifferent to my questions and pleas. By the time the doc finally got there, it was only hours before my Dad died. Hospice was never offered and I was too emotional, or struck stupid at the time to ask until it was too late. I was there alone from noon to 2 am. I feel doctors need to be taught to talk straight with the family and let us know when someone is in the dying process.
I'm so sorry for your loss and that your dad had to suffer. Hospice gave my mom morphine and I think it caused her an early death. I think they gave her too much. I was told she had a few hours to live and that wasn't the case. She died 45 minutes later. We had Hospice for less then a day and I wish I never hired them.
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.
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
I think the crack down on prescribing narcotics such as morphine has greatly increased in recent years both due to the abuse of prescription drugs and tighter Govt control over many parts of our lives. This also applies to such medications as Ritalin given to children for ADHD. A paper prescription signed by the Dr personally has to be presented to the pharmacy for it to be filled. At least in NYS each pharmacy has to transmit to the state list of drugs dispensed that day. I don't know what else they have to report. For terminal agitation there are many other drugs that can be used as maridel noted relaxants also anti anxiety, sedatives and antipsychotics. The side effect of these is frequently drowsiness and many on here have felt their loved ones have been oversedated and that has led to unconsciousness and death. Which would you rather have a heavily sedated loved one or one ripping their clothes off, throwing the oxygen mask on the floor and pulling catheters out as fast as the nurse can put them back in, screaming and lashing out at the same time. To avoid the use of drugs would you be prepared to take your loved one home and try to care for them in that condition? It is actually illegal to restrain a patient in a civilian facility although I believe it is allowed by the VA. Morphine is the drug of choice at the end of life especially in hospice because it is so easy to administer and readily absorbed. For those who do not have experience and is slowly dripped into the mouth which has an extremely rich blood supply so the effect is still predictable even when the peripheral circulation is shutting down and an IV or IM injection would not be as effective. It is also very useful in reducing the FEELING of breathlessness. Yes everyone is correct it is a respiratory depressant, but at the end of life the most important thing is that the patient does not feel they are gasping for breath. There are also medications that have an off label use of drying up the secretions in the lungs, again helping the anxiety of the loved one and their carers. In a facility all medications are accounted for dose by dose and the nurses have no discretion to increase doses because if they do they will come up short on the next drug round. If it is felt a patient needs more medication the Dr has to be contacted and change his orders. If the order is written as needed then the nurse can give less often but not more. When the patient is at home the amount for 30 days is still dispensed by the pharmacy but the patient's use can not be enforced, the downside is that they will run out before the end of the month. Lots of things to consider and understand.
A lot of people here are saying "Morphine would have relieved his pain" without benefit of professional knowledge. For instance, morphine does very little if anything for bone or nerve pain. Hence it wouldn't have helped the person who felt like they were burning up. There are other drugs that probably would have helped or even a combination of more than one drug. Relaxants frequently decrease pain and they also work well for some COPD's. As Moondance said, "Morphine is not
FedUpNow, You are correct, however, right or wrong (Mostly wrong IMO) the law makes it very difficult for them to give Morphine in this circumstance, its very frustrating I know. It could be argued it was murder without the proper paperwork then the argument could 'the legality of assisted suicide'. As I said very, very painfully frustrating.
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.
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.
About 3 years ago, Dad was provided a morphine pump along with home hospice. He had a DNR which the entire family supported. Entire family supported his desire to not have it prolonged. We made this known among all who came to the house. They each knew we had no doubts as to what Dad wanted. Same for Mom. This was well documented in the records and everyone followed through with the morphine. I am sorry so you and your family had to go through such a painful experience. Hospice is a valuable practice that serves to balance our overwhelming desires to save someone, especially a loved one. If done right, everyone leaves knowing it was the best and most humane way of handling death.
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!!!!!
FedUpNow....yes, in your father's situation Morphine WOULD have been helpful and, yes, I WOULD have given it BECAUSE THERE WAS AN OBVIOUS SIGN OF DISTRESS...just as i said in my previous answer. The info that I have was not ecxuses, it is well-known, well-documented, scientifically proven human pathology. It is up to every doctor & nurse to use their professional judgement every moment of every day to provide the best care that they can. Unfortunately, in your dad's case, it sounds like a better job could have been done. In my response I was only trying to explain one reason why someone would appear "breathless" & that that "breathlessness" could very well have been a normal, natural part of the dyijg process.
Dead is dead. One of my daughter's died under VERY MYSTERIOUS circumstances @ at 39. I HAD TO LET GO OF IT for her body was dead & nothing I could do would change that. It is human nature to want to blame. If a DNR was in place~Ferris answered your question. As for what I went through~I simply let it go. There is this thing called KARMA~what goes around comes around. I find some solace in that. Morphine is not a magic drug. It is just a drug that we use to control pain.
As an ex-hospice nurse I have experienced family members demanding morphine to relieve what they assume to be pain during the final stage of dying when, as has already been said, it's really just the normal breathing of a dying person. It is usually accompanied by a "grunt" which surely sounds like what comes with pain but no amount of morphine can change it. I had one particular patient whose daughter demanded morphine for this situation. I gave some but she demanded more. At that point giving more would have been tantamount to killing her which I refused to do. The daughter reported this to my superiors who backed me up. What that daughter really needed was medication for her own anxiety, which I learned later was actually due to long standing problems with family dynamics. Incidentally, giving morphine actually depresses breathing which is not appropriate in COPD.
FedUpNow and Nick222, My Dad kept ripping his oxygen mask off too. This went on for a lot of the last 24 hours of his life. He was in hospital and I was with him. It was really horrible. I repeatedly asked the head nurse why he was doing this and what we could do to ease his suffering. All she said was, "it's the oxygen that does that" There's nothing we can do. My Dad was uncommunicative at this point except for grunts. I repeatedly asked him what I could do, was he in pain?" It was late at night and finally I got the doctor in and asked why he was not on meds for pain. Doctor told me morphine might make it worse. We finally had to tie his hands down so he wouldn't keep pulling his mask and catheter out. I had then ordered Hospice to come to the hospital, but within a few hours he was dead. The doctors and nurses NEVER told me this was part of the immediate dying process. This was 6 months ago and I STILL FEEL ANGER AND AM PERPLEXED over this situation. Nick222, I feel your pain.
Agonal breathing means the patient is going to die soon. Withholding meds is ridiculous at that point. Give morphine for relieving anxiety and breathlessness. Stop the excuses. Been there. Done that.
Without seeing what your father went through it's hard to say but the sudden breathlessness & fighting for breath that you're referring to could simply have been what is called 'agonal breathing' & is a normal part of thw dying process. In agonal breathing, the patient will have periods of more & more rapid & deep breaths that often appear like struggling or gasping that are followed by a period of apnea (no breaths) or shallow breaths. The administration of morphine is a double-edged sword. If he was in OBVIOUS pain then, yes, I would have administered morphine for comfort. BUT, without evidence of pain, giving morphine can suppress the breathing mechanism & actually make the problem worse. As for the mask, there are several types of oxygen masks, each appropriate for different situations. The nurse may not have reduced his oxygen by switching to a different mask, just switched to one more appropriate for his situation. If she did reduce his oxygen, it may have actually been for his comfort. It sounds illogical, but giving a COPD patient more oxygen will actually increase their shortness of breath because it shuts down the body's carbon dioxide receptors & reflex to take a breath.
Not sure if still in use but a few years back there was a flashdrive called Medic Tag. You are able to put ur medical history on them and carry with u. All the hospital hasto do is plug it into a computer and they havebur history. Where I leave they were given free at one of the NH. For my Mom, I have all her info on my computer and I just print it off when she sees her doctor.
From 2004 to 2012 I think Hospice criteria changed.
Not tryingto be rude, but ur questions could have been answered by the Nurse taking care of ur Dad. If then it didn't sound right go to his doctor. Always question. Mistakes do get made. Rehab Tried to give my uncle a med that had put him in the hospital. TG my Aunt asked what he was being given. GF did the same thing. Being sensitive to meds she asked all the time what she was being given. I don't know why hospitals don't contact primaries for background info. Why rehabs don't read reports from hospitals. You have to be informed.
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
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.
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.
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.
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.
So I am sorry if I offended you Ozark but to be honest I don't really care how hard nurses have it etc. etc. And no offense but I've never thought nurses were unrealistically perfect. Actually the opposite in my Mom's case.
One night they phoned me to come quick cause they thought it was time. I rushed over and sat there for two hours. Then a nurse walked in and said that mom had not received any morphine that day and that was why her breathing had been labored. She wasn't even aware that I had been phoned.
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.
For terminal agitation there are many other drugs that can be used as maridel noted relaxants also anti anxiety, sedatives and antipsychotics. The side effect of these is frequently drowsiness and many on here have felt their loved ones have been oversedated and that has led to unconsciousness and death.
Which would you rather have a heavily sedated loved one or one ripping their clothes off, throwing the oxygen mask on the floor and pulling catheters out as fast as the nurse can put them back in, screaming and lashing out at the same time. To avoid the use of drugs would you be prepared to take your loved one home and try to care for them in that condition? It is actually illegal to restrain a patient in a civilian facility although I believe it is allowed by the VA.
Morphine is the drug of choice at the end of life especially in hospice because it is so easy to administer and readily absorbed. For those who do not have experience and is slowly dripped into the mouth which has an extremely rich blood supply so the effect is still predictable even when the peripheral circulation is shutting down and an IV or IM injection would not be as effective. It is also very useful in reducing the FEELING of breathlessness. Yes everyone is correct it is a respiratory depressant, but at the end of life the most important thing is that the patient does not feel they are gasping for breath. There are also medications that have an off label use of drying up the secretions in the lungs, again helping the anxiety of the loved one and their carers. In a facility all medications are accounted for dose by dose and the nurses have no discretion to increase doses because if they do they will come up short on the next drug round. If it is felt a patient needs more medication the Dr has to be contacted and change his orders. If the order is written as needed then the nurse can give less often but not more. When the patient is at home the amount for 30 days is still dispensed by the pharmacy but the patient's use can not be enforced, the downside is that they will run out before the end of the month.
Lots of things to consider and understand.
FedUpNow, You are correct, however, right or wrong (Mostly wrong IMO) the law makes it very difficult for them to give Morphine in this circumstance, its very frustrating I know. It could be argued it was murder without the proper paperwork then the argument could 'the legality of assisted suicide'. As I said very, very painfully frustrating.
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.
One of my daughter's died under VERY MYSTERIOUS circumstances @ at 39.
I HAD TO LET GO OF IT for her body was dead & nothing I could do would change that.
It is human nature to want to blame.
If a DNR was in place~Ferris answered your question.
As for what I went through~I simply let it go.
There is this thing called KARMA~what goes around comes around.
I find some solace in that.
Morphine is not a magic drug. It is just a drug that we use to control pain.
Not tryingto be rude, but ur questions could have been answered by the Nurse taking care of ur Dad. If then it didn't sound right go to his doctor. Always question. Mistakes do get made. Rehab
Tried to give my uncle a med that had put him in the hospital. TG my Aunt asked what he was being given. GF did the same thing. Being sensitive to meds she asked all the time what she was being given. I don't know why hospitals don't contact primaries for background info. Why rehabs don't read reports from hospitals. You have to be informed.
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.