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.
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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.
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.
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
Such wisdom and help in your answer to this.
“Sad, but not bad”
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
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