Dear Barbara, My grandmother had lupus for 20+ yrs. Her platelets and red blood cells got very low and ten blood transfusions and plasmapheresis did nothing. They said she had a blood infection and her body was basically killing the red blood cells. In a few weeks she could no longer walk on her own or use her hands. Her final day they gave her morphine and took off her oxygen mask. Before the morphine she was alert and talking to us but after she was completely checked out and then unresponsive. Would she have stayed alert without the morphine? Would she still be alive? I was the only one in the room with her when she took her last breath and my heart breaks over whether we made the right decision. She passed yesterday morning.

From your description of your grandmother’s illness her body had entered the dying process. It was shutting down, unable to combat the disease that she had lived with for so many years.

It sounds like she was given morphine to ease her transition from this world to the next. Not knowing your grandmother's medical history I cannot say if the morphine was appropriate or not. What I can say is it did not kill her. She was dying whether she had morphine or not and she was dying then, not later.

I know that may sound harsh but at the point she was given the morphine her circulation was not able to work in the normal way, plus it was her blood that was not healthy which makes circulation and distribution of the medicine less timely and effective.

For your question, "Would she have still been alert if she hadn’t been given the morphine before she died?" Dying is not like it is in the movies where we say something important and then take our last breath. In real life in the hours to even days before death a person is generally non responsive (non responsive to their environment). They may be talking, even moving about, but not making sense and movements are aimless. They are not alert as we think of alert.

That is how people die and from what you have told me your grandmother died well. Nothing bad or pathological was happening. She died the way people die and she did it well. It is very sad when someone we love dies but from what you have described her death was not bad. It was relatively quick without a great deal of suffering.

Having someone we love die is devastating, a loss we have to learn to live with. Let go of how she died, it was not pathological, and savor the time you had with her. We have limited control over the time that we die. Your grandmother died with only you there. That was her gift to you. She choose to have you there to support her as she left. She could have died when you left the room. What trust she had in you.

You might write her a letter. Put all of your thoughts and feelings about her and your relationship on paper—the good and the challenging— and then let go, burn the letter, and throw the ashes to the wind.

Something more about... Would She Still Be Alive?

It is the job of the hospice staff to educate families on the normal, natural way that people die. Families need to know what to expect when their loved one is given a narcotic. Offering end of life resources to families will help reduce their fear and give the hospice good CAHPS scores. I suggest GONE FROM MY SIGHT and PAIN AT END OF LIFE.