I often do some of my best thinking during those hours at night when I am awake. Recently, as I tried to go back to sleep at 3:30 AM, I started thinking about comfort care and morphine use during the end of life process.
Picture this: there is breathing distress while the hospice nurse is present. She advises a “bit of morphine.” Many times I have done that very thing.
Often, the family's first reaction is "No, I don't want to start morphine." To them morphine is the “last resort." It is scary and they don’t want to be at the stage where morphine administration implies—-the end is close.
Back to my 3:30 AM thoughts: Comfort to us caregivers means our person is sitting up in bed, talking, smiling, interacting with us. Where in reality, as end of life approaches, comfort means our special person is sleeping, not agitated, their mouth is open, they look awful but are relaxed and comfortable.
This difference in expectations is why families think “Hospice killed my mom. She was fine (interacting but in pain or distress) before they gave her morphine. Then she was sleeping and died.”
The gentle way to die is to relax AND morphine and Ativan do just that. Comfort is relaxing enough to let go.
Our role models from movies and TV show us that dying is gentle, often poetic, certainly not scary or messy. Movies make dying look comfortable.
Real comfort as death is approaching for most of us (not all but most) is a bit of Ativan to relax the restlessness and a bit of morphine to ease the increased breathing challenges —-and pain if it is present.
Another whole blog is needed about how dying is not painful, that disease causes pain. But for this one my thought is there is a difference between a family’s interpretation of comfort and hospice’s.
Something more… about Movies make dying look comfortable. What do you do when it’s not?
The opioid epidemic has us, understandably, afraid of narcotics. We seem to read about the dangers daily. Giving our special person a drug that we hear so much negativity about is frightening. That is why hospice agencies use my booklet, Pain At End of Life to educate their patients' families. Remember, knowledge reduces fear. The way a dying body processes medication is completely different than it would be in a healthy body. Support your families with this education so that the dying experience can be less fearful and more connected.
5 comments
Perhaps we end of life practitioners need to be more specific in our teaching about what the end might look like so we can help guide the families’ expectations. A person who has never witnessed a death before will have no idea what will happen and with no frame of reference, why wouldn’t they expect it to look like the movies?
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BK Books replied:
Hi Joan, I absolutely agree. Thank you for sharing. Blessing! Barbara
This was very helpful, Barbara. Apparently, this is a common fear amongst us who have a very limited experience in this. Your booklet “Gone From our Sight” and this above reading was very calming for our family, who experienced these fears almost to a T. The Hospice team are like angels.
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BK Books replied:
Hi Joe, thank you for sharing. Blessings to you and your family. Barbara
This helped me, Barbara. It’s as if you were talking about my husband and me.
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BK Books replied:
You are welcome, Karen. Blessings! Barbara
I agree, everything about dying is based on imagination, fear and ignorance ( almost). Yes, in “make believe land” there is some one near the bedside, weeping, silently holding the hand of the person close to death. But really, unless almost prodded by someone else most want to stay clear hoping to be gently informed when the end came, " Well, she’s gone now".
Time is a luxury, a gift, but a horrible commodity in the possession of one who squander s time anyway. Hospice helps dole out the time, giving a measure to everyone. I’d say the best part of any day is having the good fortune to have a hospice agency in place early. Watching the passing of life, with grace and appreciation of the medications used to support that departure is transformative. Thanks for your advice and education!
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BK Books replied:
Thank you Rahab. Blessings! Barbara
My husband was in a terrible auto accident when he was in his thirties. He lost all signs of life twice, and, after he was brought back by CPR, told me that actually dying was very painful. He did not mean all the pounding on his chest that brought him back. He lived 48 years after that, and I hope his final passing was not as painful. All this to say that perhaps morphine might help with that pain as well.
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BK Books replied:
Hi Elinor, thank you for sharing. Blessings! Barbara
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