Dear Barbara, My dad had severe labored breathing, 40 to 50 breaths a minute. I contacted the hospice RN who recommended 5 mg of morphine every hour. I gave it, as she prescribed. Five hours after his doses of morphine his respiratory rate became 8 breaths a minute, 3 breaths a minute, and then his last breath. I feel guilty that giving him the morphine killed him. I worry that I shouldn't have followed the hospice RN's recommendation. I worry that 5 mg x 4 was way more than a lethal dose. I worry I hastened his death. And then I wonder if he didn’t want to leave - which is what I’ve heard about those that do this type of breathing. I wanted him to have a gentle death and it did not appear gentle.
I'm glad you reached out. Here are a couple of things to think about so you can feel more assured that your dad indeed had a gentle death.
40/50 breaths per minute is way too many to be comfortable (even though rapid breathing can be a very normal part of dying).
Rapid breathing like your dad was doing is exactly where a small bit of morphine (5 mg is small) helps slow down those 40/50 breaths a minute to a more comfortable range.
Eventually, with or without morphine, his breathing would have gotten slower and slower until it stopped BUT before that happened you made your dad more comfortable.
I have not heard that rapid breathing is a sign that the person does not want to leave. At the point in the dying process (hours to minutes or even days before death) the person is working to release from their body (think of the little chick working to get out of its shell) their job is to get out of their body and it is hard work. We, the watchers, are seeing the struggle and thinking something abnormal is happening. It is not. What we are seeing is work to become free of this cumbersome body.
Nothing bad is happening, sad, but not bad.
Something more about... "I Wanted Dad To Have a Gentle Death, But..."
There are two resources that I encourage you to have when helping families understand pain management for their dying loved one. Pain at End of Life and New Rules For End of Life Care, DVD Kit. The film and the booklet will provide understanding and reduce the fear that comes with what the dying process looks like.
14 comments
Emily
I lost my mom over four years ago, but still continue looking to BK for comfort. Reading other’s experiences reminds me we are not alone, and how similar our fears and expectations are. After all this time, the education is still a constant, it has truly helped me to better understand what was happening. I sometimes have to look back and mentally implement what I’ve learned, to better accept the ending stages I saw. It does feel weird at times, like, “she’s been gone, why bother now?” Knowing now what I didn’t know then is sometimes what gets me through the day. In hindsight, most of us are not empowered with this knowledge when coping with end of life.
My mom’s hospice nurse said to give the rx as needed. I did not see that as harmful, there’s nothing else you can do. I recently lost an aunt, with the same direction from the nurse. Family members were making accusations that too much morphine was given, and that’s what killed her. The body doesn’t develop addiction or experience overdose, it’s so that they can be comfortable while trying to leave.
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BK Books replied:
Hi Emily, knowledge is like a jigsaw puzzle, we keep adding pieces and
finally can see the picture. Thank you for your sharing. Barbara
I lost my mom over four years ago, but still continue looking to BK for comfort. Reading other’s experiences reminds me we are not alone, and how similar our fears and expectations are. After all this time, the education is still a constant, it has truly helped me to better understand what was happening. I sometimes have to look back and mentally implement what I’ve learned, to better accept the ending stages I saw. It does feel weird at times, like, “she’s been gone, why bother now?” Knowing now what I didn’t know then is sometimes what gets me through the day. In hindsight, most of us are not empowered with this knowledge when coping with end of life.
My mom’s hospice nurse said to give the rx as needed. I did not see that as harmful, there’s nothing else you can do. I recently lost an aunt, with the same direction from the nurse. Family members were making accusations that too much morphine was given, and that’s what killed her. The body doesn’t develop addiction or experience overdose, it’s so that they can be comfortable while trying to leave.
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BK Books replied:
Hi Emily, knowledge is like a jigsaw puzzle, we keep adding pieces and
finally can see the picture. Thank you for your sharing. Barbara
Charles Elliott
I work with a hospice group in Ohio and we use your books and love the help they give.
I am a Bereavement Chaplain and do support groups. The group I’m in offers groups in all 50 states and some other countries.
It is Grief Share. You may want to share this with those needing a support group.
To find a local support group:
Go to Grief Share.org
Scroll down to “Find a group” click there.
Enter your city or zip code and it will tell the closest groups to your location.
Hope this helps.
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BK Books replied:
Thank you Charles. I have put this info on the blog site. Blessings in the
work you are doing. Barbara
I work with a hospice group in Ohio and we use your books and love the help they give.
I am a Bereavement Chaplain and do support groups. The group I’m in offers groups in all 50 states and some other countries.
It is Grief Share. You may want to share this with those needing a support group.
To find a local support group:
Go to Grief Share.org
Scroll down to “Find a group” click there.
Enter your city or zip code and it will tell the closest groups to your location.
Hope this helps.
———
BK Books replied:
Thank you Charles. I have put this info on the blog site. Blessings in the
work you are doing. Barbara
Gloria
This addresses something I just went through today, February 8 with the passing of my mother. She had developed pneumonia and was struggling with coughing and breathing. I was told to give 1 ml of morphine every two hours and the effect was frightening. She had a death like expression several hours before she stopped breathing completely. I feel like it was too much and hastened her death. It is a heavy burden right now.
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BK Books replied:
Hi Gloria, I would have wanted to give my mom the same dosage of morphine
if she was having labored breathing. I hope reading the blog confirmed you
did the right thing to bring her comfort. The expressions were just part of
her working to get out of her body. My blessings are with you. Barbara
This addresses something I just went through today, February 8 with the passing of my mother. She had developed pneumonia and was struggling with coughing and breathing. I was told to give 1 ml of morphine every two hours and the effect was frightening. She had a death like expression several hours before she stopped breathing completely. I feel like it was too much and hastened her death. It is a heavy burden right now.
———
BK Books replied:
Hi Gloria, I would have wanted to give my mom the same dosage of morphine
if she was having labored breathing. I hope reading the blog confirmed you
did the right thing to bring her comfort. The expressions were just part of
her working to get out of her body. My blessings are with you. Barbara
Donna Stawicki
I’ve been an email subscriber for sometime and I have several of Barbara’s books on grief. I lost my stepdaughter 9/5/21 and her father, my husband, 1/24/22 both to Covid. Barbara’s insight into death has been a comfort to me during this time of loss.
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BK Books replied:
Donna, so much loss! I hope you can find a grief support group through a
local hospice or church. This will be a challenging time and you don’t
want to walk it alone. Blessings! Barbara
I’ve been an email subscriber for sometime and I have several of Barbara’s books on grief. I lost my stepdaughter 9/5/21 and her father, my husband, 1/24/22 both to Covid. Barbara’s insight into death has been a comfort to me during this time of loss.
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BK Books replied:
Donna, so much loss! I hope you can find a grief support group through a
local hospice or church. This will be a challenging time and you don’t
want to walk it alone. Blessings! Barbara
Darla
Thank you Barbara. What a beautiful way to process our grief. I will share with my siblings and the grandchildren. The focus now should be in our good memories and love in our heart for him.
Thank you Barbara. What a beautiful way to process our grief. I will share with my siblings and the grandchildren. The focus now should be in our good memories and love in our heart for him.
Susan
Thank you so much for addressing the 5ml morphine dose. My sister and I had to give that amount to my mother before she passed and we have been haunted thinking we hastened her passing. We knew she was going and was having trouble breathing but it’s something we’ve always worried about. Thank you for easing my mind.
Thank you so much for addressing the 5ml morphine dose. My sister and I had to give that amount to my mother before she passed and we have been haunted thinking we hastened her passing. We knew she was going and was having trouble breathing but it’s something we’ve always worried about. Thank you for easing my mind.
Alison
Perhaps I am being too forward / blunt but if a person is in the dying process whether they want to leave or want to “let go” either way the person is dying. NO one can stop death. Hospice does not kill a person who is already dying and neither do narcotics and yes I just lost my mother under home hospice care for several months. It was very difficult to watch even though I have been familiar with Barbara Karnes’ writings for several years. What helped me is that my mother and I talked about what she was going through and how I and the hospice team could make her more comfortable. It gave mom more control, which was something she needed. For me, sometimes I think living in denial is more of a blessing than knowing what was coming.
Perhaps I am being too forward / blunt but if a person is in the dying process whether they want to leave or want to “let go” either way the person is dying. NO one can stop death. Hospice does not kill a person who is already dying and neither do narcotics and yes I just lost my mother under home hospice care for several months. It was very difficult to watch even though I have been familiar with Barbara Karnes’ writings for several years. What helped me is that my mother and I talked about what she was going through and how I and the hospice team could make her more comfortable. It gave mom more control, which was something she needed. For me, sometimes I think living in denial is more of a blessing than knowing what was coming.
Darla
Hi Barbara,
I wanted to be with my father when he passed on but was kept from him by his wife. She would not allow his family or hospice to be a part of his end of life journey. We did not receive any details of his final moments, only that he collapsed. I was very close to my father and regret not being more forceful with her. It has been just over a year and I still morn him and do not feel we had proper closure.
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BK Books replied:
Hi Darla, I’m sorry you didn’t have any closure for your father’s death, so
sad. You might write him a letter. Write from your heart all the thoughts,
feelings, sadness, regrets, love, that you have for him. Let the tears
flow. When all is down on paper burn the letter and scatter the ashes to
the wind. In moving forward let how well you go on living be the tribute of
your love for your father. Blessings! Barbara
Hi Barbara,
I wanted to be with my father when he passed on but was kept from him by his wife. She would not allow his family or hospice to be a part of his end of life journey. We did not receive any details of his final moments, only that he collapsed. I was very close to my father and regret not being more forceful with her. It has been just over a year and I still morn him and do not feel we had proper closure.
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BK Books replied:
Hi Darla, I’m sorry you didn’t have any closure for your father’s death, so
sad. You might write him a letter. Write from your heart all the thoughts,
feelings, sadness, regrets, love, that you have for him. Let the tears
flow. When all is down on paper burn the letter and scatter the ashes to
the wind. In moving forward let how well you go on living be the tribute of
your love for your father. Blessings! Barbara
Lily
Such wisdom and help in your answer to this.
“Sad, but not bad”
Such wisdom and help in your answer to this.
“Sad, but not bad”
Shelly
Hi Barabara, If you feel any of this is inappropriate, I won’t be offended if it’s deleted. Especially the last part regarding the morphine/oxycodone at the end.- Shelly
I think it’s important to remember that when people are present when someone dies, be it a loved one or a friend, they have their own feelings about what the experience was like. When they talk to someone else about that experience, they may say something like, I wonder if he didn’t want to leave. The person they told this to may tell someone else what the first person said, but say it as if it was fact. Then it’s shared repeatedly and eventually finds someone who’s parent is dying. It leaves very sad and frightening emotions.
I’m sure that there are differences in how someone who’s otherwise healthy metabolizes a medication like morphine when compared to someone who’s dying. I can’t say I know for sure. About 5 yrs ago I had tremendous lung pain for which I was given morphine and oxycodone. At 8am and 8pm I took 75mg of morphine and at 2pm 30mg of morphine. At 11am and 5 pm I took 80mg of oxycodone. That’s a LOT of medication. Not only was I still alive and breathing, but I functioned like a normal person, not as someone who was on the medications. I was even able to drive, although probably not legally. That was far more opiate drugs than the 5ml that this person gave their father. I’m no longer on those medications, but the point is, the individual did not give their father enough medication to cause their father to die. You gave him a comfort that I hope someone will give to me when I die. I have a very big fear of having a difficult death.
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BK Books replied:
Hi Shelly, thank you for confirming my message that 5 ml of Morphine is
very small. You are living proof that morphine when used properly for pain
relief is helpful and not deadly. Blessings! Barbara
Hi Barabara, If you feel any of this is inappropriate, I won’t be offended if it’s deleted. Especially the last part regarding the morphine/oxycodone at the end.- Shelly
I think it’s important to remember that when people are present when someone dies, be it a loved one or a friend, they have their own feelings about what the experience was like. When they talk to someone else about that experience, they may say something like, I wonder if he didn’t want to leave. The person they told this to may tell someone else what the first person said, but say it as if it was fact. Then it’s shared repeatedly and eventually finds someone who’s parent is dying. It leaves very sad and frightening emotions.
I’m sure that there are differences in how someone who’s otherwise healthy metabolizes a medication like morphine when compared to someone who’s dying. I can’t say I know for sure. About 5 yrs ago I had tremendous lung pain for which I was given morphine and oxycodone. At 8am and 8pm I took 75mg of morphine and at 2pm 30mg of morphine. At 11am and 5 pm I took 80mg of oxycodone. That’s a LOT of medication. Not only was I still alive and breathing, but I functioned like a normal person, not as someone who was on the medications. I was even able to drive, although probably not legally. That was far more opiate drugs than the 5ml that this person gave their father. I’m no longer on those medications, but the point is, the individual did not give their father enough medication to cause their father to die. You gave him a comfort that I hope someone will give to me when I die. I have a very big fear of having a difficult death.
———
BK Books replied:
Hi Shelly, thank you for confirming my message that 5 ml of Morphine is
very small. You are living proof that morphine when used properly for pain
relief is helpful and not deadly. Blessings! Barbara
Monika von Vultee
My husband died Sept 22. 2020 in hospice I was with him till the nurse woke me up and told me he is in the dying process now.I freaked out because I could not watch my husbands last breath and run home. It haunts me still today. I knew he was dying I used to be an RN but was unable to watch that last breath of my husband
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BK Books replied:
Oh Monika, yes, we sometimes do things out of fear that we regret later.
I’m guessing that is what made you “run home”. You might write your husband
a letter. Put on paper all your thoughts, your regret, your tears,
everything you would like him to know about your life together, everything
your heart needs to say to him. When finished burn the letter and scatter
the ashes to the wind. Moving forward let how well you go on living be your
gift to your husband. Blessings! Barbara
My husband died Sept 22. 2020 in hospice I was with him till the nurse woke me up and told me he is in the dying process now.I freaked out because I could not watch my husbands last breath and run home. It haunts me still today. I knew he was dying I used to be an RN but was unable to watch that last breath of my husband
———
BK Books replied:
Oh Monika, yes, we sometimes do things out of fear that we regret later.
I’m guessing that is what made you “run home”. You might write your husband
a letter. Put on paper all your thoughts, your regret, your tears,
everything you would like him to know about your life together, everything
your heart needs to say to him. When finished burn the letter and scatter
the ashes to the wind. Moving forward let how well you go on living be your
gift to your husband. Blessings! Barbara
Emma Acker
Loved this entry! Thank you Barbara! The chick imagery is so helpful. Also, “sad but not bad”.
Emma (we connect on Insta I’m @endoflifedoulanyc)
Xxx
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BK Books replied:
Hi Emma, having a visual image helps us “picture” what is happening. I love
the chick image too. Blessings! Barbara
Loved this entry! Thank you Barbara! The chick imagery is so helpful. Also, “sad but not bad”.
Emma (we connect on Insta I’m @endoflifedoulanyc)
Xxx
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BK Books replied:
Hi Emma, having a visual image helps us “picture” what is happening. I love
the chick image too. Blessings! Barbara
Lindsay
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BK Books replied:
Thank you Lindsay for the alternative wording. Blessings! Barbara
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BK Books replied:
Thank you Lindsay for the alternative wording. Blessings! Barbara
Laura
I love the reassurance you provided to this caregiver Barbara and the reference to the chick getting out of their shell. I’m going to use that analogy with future families I care for at end of life.
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BK Books replied:
Hi Laura, the chick analogy really seems to describe what the last days to
hours are like as death approaches. Blessings! Barbara
I love the reassurance you provided to this caregiver Barbara and the reference to the chick getting out of their shell. I’m going to use that analogy with future families I care for at end of life.
———
BK Books replied:
Hi Laura, the chick analogy really seems to describe what the last days to
hours are like as death approaches. Blessings! Barbara