I have posted on here many times and answered questions every now and then. Dad passed away Oct 7th 2013 from Liver Cancer . He was in a hospice facility for 11 days until he died. The day before he was admitted he was in the hospital and was talking,eating and very clear headed but his ammonia levels were high and he had been very combative, not eating and wouldn't take his meds for 4 days at his nursing home. ( He was in for a Psych Evaluation.) The hospice worker talked to me about admitting him instead of returning to the nursing home. I agreed to this and arrangements were made. He was transferred later that day and was alert and in good spirits. The next morning he was unresponsive and stayed that way until he passed. They gave him morphine and ativan around the clock. He never got any water but they did cleanse his mouth and moisten it with swabs. It seemed like he could hear me the first few days because I would shake his shoulder and say "dad". His eyes seemed to be moving under his eyelids and his mouth would move slightly. I did ask about them lowering his dosages so he could wake up a little. The nurse said he was getting a very small dosage already. I just wonder if the drugs made him unresponsive and if less was used he could have ate and drank and lived longer. I know it was time for him to go but I'm kinda puzzled about his going from complete alertness and straight into unresponsiveness so quick. The nurses did a Great job. I myself don't know how they do it. They treated dad like he was their baby. So gentle and compassionate. I was just wondering if anyone else had the feeling that death felt a little rushed once their loved one was placed in Hospice.
I think someone has already mentioned hospice generally won’t intravenously supply fluids but that doesn’t mean patients are allowed to die of thirst. In my experience they’re continuously supplied, refreshed up to the point the patient refuses to take them, which in nearly all cases they will. Near the end it becomes too difficult to swallow. You might think supplying it intravenously then is the logical answer but it isn’t much like forcing them to eat isn’t.
In my own experience with my Father the medication he was on made him feel thirsty but trying to give him water simply made him choke as it wouldn’t go down his throat. We asked if he would consider a tube but he wouldn’t. He knew what was going on and why and didn’t want to… maybe he thought it would prolong the inevitable. I’m not a Doctor but I’m not sure if being supplied water when you’re that close to death would actually prolong anything anyway. Takes roughly ten to twelve days to die of thirst unless I am mistaken and anyone who believes hospice allow anyone to go that long without water is mistaken.
I’m sure not everyone is the same but terminally ill people tend to slip in to unconsciousness in the last stages of life (hours to days before the end) and unless everything I have ever read on the subject matter is wrong are not at that stage experiencing any discomfort, distress or physical pain as a result of lack of fluids. The inside of the mouth dries as they’re unable to swallow but that is swabbed and moistened regularly.
As always, has to be said and understood by all of us who read others accounts of the last days of their loved ones lives and general opinion/s some may well have suffered a particularly bad experience and as a result have reason to believe that this or something similar is the therefore the same in every case. We shouldn’t argue with anyone who feels that way. We should rightly sympathise and show compassion as if the loss is not enough to deal with the fact that others might have made it any more unpleasant is incredibly sad but at the same time tell our own stories, give our own account of what we experienced in the hope they will see for many hospice can and do do incredible things… not just for the dying but also their friends and family.
Windytown, The attack you chose on myself and Guilty1 does not belong on this site. As it states, NO NAME CALLING, there's no need for that. Guilty 1 was only sharing exactly what she felt. Nothing mean. Nothing wrong with that. I shared only what was told by a nurse in charge of a Hospice team. As my username says, Be Nice. Nothing I said was mean or malicious. Because I did offend I honestly would like to delete the first comment but I honestly don't see how.
Windytown...Be Nice!
properly administered doses of morphine will relive the patients pain and assist breathing but if the patient refuses his whishes should be honored. it is his pain and his death so he has the right to manage it. if he becomes violent warards family and they wish he can be removed from the home. people vary in whether they wish to remain alert or wait to pass in a medically induced coma. Such things a propol that must be administered in a hospital setting and monitored by an anesthetologist. a patient may become semi conscious on morphine but still rousable. When no longer rousable it is normally disease progression not drug induced. Things move very quickly and as i have posted before many wait till death is knocking on the door before calling hospice.
Hospice is always the choice of the patient and caregivers and a patient can leave at any time if they improve and be later be readmited. No Dr can order the patient enroll in hospice they can only authorize recommend and encourage. this is the reason many patients die within a few days or even during the actual admission. It is not in the interests of a hospice to rapidy kill off their patients. They get paid a daily rate for caregiving not for the number of deaths they clock each month.
Guilty1 and Comeonalready have made exactly ONE comment on AgingCare. They are some kind of death trolls that are preying on hurting people. Shame on them!
Comeonalready, when my dad's brain tumor became so huge it blinded him and any liquid administered to him would result in pneumonia, Yeah it's a big deal! We had to wet his lips with Q-Tips to prevent aspiration.
Comeonback, when you have something intelligent to add to this discussion instead of harming people that are in the throes of real dying situations.
No qualified hospice would say that. My dad had liquids available 24/7 as long as he was able to swallow. Sure, when he went comatose there was no IV with fluids, that's what hospice is for goodness sakes. I don't think you understand the meaning of hospice. It's end of life not keeping someone alive by artificial means. Geez!
My dad had a DNR. He was kept comfortable until he passed.
Comeonback and tell us how horrible we are if you dare. In my mind you're just internet trolls that want to hurt people that have already have enough life changing pain in their lives.
And I am delighted to learn that your mother is doing well. I wish her complete remission.
My dad was on hospice for two and a half months. He required morphine for the pain in his last week. Sometimes cancer takes people down quickly. I'd blame the disease, not the hospice. Let go of the guilt.
i believe the low blood pressure and the tea coloured urine are also end signs? i forgot to mention the ascites, her abdomen was so tight and swollen.
Dhilbe, the nurse did pop in 2 or 3 times, she could have been monitoring mum in a subtle way, while talking to me.
the fact that the hospice nurse made a point of saying to me, this is not going to hurry anything along, makes me think they are aware of some opinions about hospice. i cling to that. at the time we were offered a room, i had no idea whatsoever about what some people think about hospice. i had no signal at my mums so could not google anything.
so lovely to find this place. thank you.
Pain-medication is top of the chart... any dose is constantly checked after administration, for multiple reasons,... allergies... other reactions, and relief status to the patient condition...
Morphine is often given for severe pain relief, and has been so thoroughly studied as to it’s effect on the lungs.. that the dosages are very strictly assigned according to patient condition.
You may not have even been aware of the fact that the nurse walking in - is not just talking to you - but at the same time quietly counting your Mom’s respiration... very important with morphine... to check on the difference between her respiration count prior to the morphine shot and respiration ½ hour or so later... the count of which has to match a certain standard or else other measures would be taken to increase it or otherwise change it... If nothing was given to her later, the dosage and breathing was within parameters....
I’ve got to run now, but hope to answer more Qs later, and I wish you well till then..
At the end decisions regarding his care even at home, to a certain degree when and what was administered by the nurses was more up to us than him. Not to say he wasn’t aware before it happened he most certainly was but I’m not sure he was completely aware as to the affect they would have on him. Once administered in the quantities they were to all intents and purposes we had already lost him… within two days however he was gone, gone.
My relationship with him over the years was not an easy one although older age allowed us both the chance to be a little less stubborn and a lot closer as a result. I was someone who found the fact he’d always been a big and strong man reduced to an old one by time, long before the cancer heart breaking so those last few months were possibly the hardest of my life. The last days and moments I am sure will stay with me forever but I know we did the right thing by him. He was a proud and pragmatic person who would not have wanted to be as he was.
I find myself now longing for something that I know can never be and yet I still do it… and that is to know he is OK, wherever he might be. NOT that he was OK with what happened, just OK.
I think in nearly all cases we love our family and friends dearly. We may have been as close as close can be all our lives or distant and spent time with them infrequently but the finality in death and the fact it robs us of any chance to love more or make up, find a way back, to build bridges, a chance to make things better, or to just say sorry and so on is hard to accept. Letting go is the hardest thing to do. Anything that might bring about that finality we naturally find abhorrent and completely alien to us but we must. Not for us but for them.
You wouldn’t fret on the first day of your holiday that it will end in a week or so… so it is with life. We the living, the lucky cannot and should not contemplate the finality that will be the very end of our lives nor the physical and emotional torment of terminal illness, face the end and somehow let go of life and everything in it but just for a moment try…
You/we cannot save them. All we can do is hope we can make their last days, hours, moments peaceful.
I would bet a fair sum you and mom said all the things to each other that ever needed said before she left this world, and missing that one last chance you would have loved to have will not matter so much in the light of eternity....but sorry for your loss, and know that most everyone second guesses something, it's only normal, even if you made all the best choices you possibly could. The whole year full of first milestones since a death of a loved one can hit you hard in the most surprising ways - here's hoping you have friends and family who understand and support!
After diagnosis mum spent 3.5 weeks in hospital,I visited several hours daily.on coming home we were put under local non profit charity hospice which has a fab reputation.i moved in as sole carer,only child of an only child so no help and her dementia husband living there also. I adored my mum and am glad I was there for her. But don't know what to think about her last couple of days.
The specialist hospice nurse visited several times over a couple weeks,she was lovely and in the absence of a family member to share all my concerns, she listened and understood.
Mum was stage 4 advanced,was eating very little,could barely stand with frame, on the Wednesday on trying to help mum up she was suddenly in agony when moved from lying, but wanted toilet, no way could I move her, I called the carers, they couldn't move her and called paramedics,end result after 2/3 hours very undignified and painfully mum used commode and was put in bed.i remember they said her blood pressure was low, now she had high blood pressure for most of her life. She managed to use commode the following day too but honestly I was so scared of dropping her. Her urine was dark syrup colour and she said she felt something was blocked. Later that day (thurs) she was in considerable pain, I was on phone to hospice, panicked and frightened, the nurse came and gave mum an injection of what they called just in case meds, this wore off pretty quickly and mum was in pain again so another half dose given. Mum felt she would be sick and dribbles of something brown were coming from her mouth. Nurse said they had 1 vacant room at the hospice and tbh the relief I felt was massive, I was constantly frightened of what might happen and guessed mum was nearing the end as she was so so frail and ate very little etc. she did say at one point while crying with pain that she wanted to go up. So mum was taken to the hospice,nurse did warn me there was a risk she might die on way after being moved and was I ok with that but I felt having medical staff taking proper care and as she said to me, doing all the practical things while I could just be s daughter not carer for last few days was the right way. She made a point of saying when offering the room, this is not going to hurry anything along. So I fully expected to chat with mum agsin, mentally she was 100%.
Lovely hospice staff made me up a bed in mums room,I do remember talking to a doctor but tbh that part is a blur, I think I just gave details etc. mum was on a syringe drive pump but was sleeping peacefully. With it now being 11pm it didn't occur to me she was unconscious, rather I thought out of pain and therefore sleeping. I expected to see doctor next day as after she left, just nurses at the hospice, all very nice and caring and made me tea and happy to listen/chat even at that time. Mum passed away about 4am, I was in the room awake and know she did not suffer. I went home about 5 and didn't see doctor again.the nurse who had visited at home and offered the room called me the following evening but tbh I was a bit in shock so didn't think to ask any of the questions I now ponder.
Just to add, the nurse noticed massive purple staining all over her lower abdomen when she was admitted, which I have since googled and found is a sign, I think, of internal bleeding.
The things I wonder are: did mum did of internal bleeding? Was she showing all the end signs? Did the hospice give too much meds? It seemed she went in and died. Would she have died at home that night anyway and if at home with just me and dementia husband there what she may have had to go through. Did I do the right thing?
This has been consuming me. I saw the hospice counsellor who reassured me they were able to be very accurate with their doses and that you had to place trust in the medical staff. She let me waffle on and was so nice.
Sorry for the long post, thank you for reading, would appreciate any thoughts. I feel so alone as my thoughts chase round in my head. My heart goes out to everyone affected like this. I have spent most of the day reading this entire thread since stumbling on it this morning and simply had to post. God bless all
To qualify for hospice a patient must have a prognosis of dying within 6 months (not 2 weeks). No one can predict exactly when death will occur and many people are on hospice for longer.
Morphine and other drugs are available to keep the patient out of pain and severe anxiety. They are to make the patient comfortable, not to hasten death.
My husband was on hospice at home. I was given the drugs to administer as I saw fit. We didn't use the morphine at all, because my husband wasn't in pain. I did use pills for anxiety.
The nurse advised me not to "push" food, but to make food and beverage available if he wanted it. He ate a lot of popsicles! The day he died he had a normal breakfast and did not care to eat the rest of the day.
If the stories you were told are fully true, then I agree it is heartbreaking. And probably violates laws and care center regulations. This is why I wonder if your MIL might be mistaken about what she observed.
I went back through the journal I had
Been keeping of her disease
(Glioblastoma),messages, emails and pictures,
I could then see how she was really suffering. In some of the messages I was praying for God to end her suffering. Even though I knew she was dying it was still very devastating when it actually happened. It doesn't matter now if hospice did
R did not hasten her death. She was pain free and comfortable until the end.
This thread is incredibly long and it has been hard to keep up. Some people have had great experiences with hospice. Others think that their loved ones were "over medicated" and that this overmedication is what caused their loved one's death. It really needs to be looked at on a case-by-case basis. In your case it's clear you did nothing to contribute to his death. Please be at peace.
Blessings
It seems that the event of him losing control of his bowels was new? I apologize if that's not correct. From my experience with my dad, they lose all control of bodily functions at the end. The body more or less lets go/sets the soul free of your loved one.
One lorazepam or another won't make a difference either way. It's not cyanide. Get that idea out of your head, please. You did not kill your dad. The disease killed him. I have a FIL aged 84 with bone mets. It's progressive.
Please let the guilt go. You don't need forgiveness. You didn't do anything wrong, seriously. He was 90. The lorazepam didn't kill him, cancer did. Please allow yourself time to grieve without any blame.
My MIL (dementia) has been on hospice for 17 months. They are a big help to me and to her. They never force meds - it's all about her comfort. They provide much appreciated advice and send an aid to bathe her 3x/wk. That's a big deal to me as she is on this long, long, same, same pattern for now.
My wonderful husband was on hospice for 2 weeks before he died. In his case the cancer was causing excruciating pain..........unending pain. Hospice did medicate him in efforts to try to get him some relief. Unfortunately, his pain was relentless and nothing really helped. (His tumor had taken over his abdominal wall and was thickening so rapidly that his digestive system could not metabolize any pain meds). We had a port etc but it was a nightmare. Cancer pain was torturing my sweet husband and I had to watch :(
Hospice helped us as much as possible. Even placing an n/g tube which is not customary but it helped with the pressure because he was totally blocked. Hospice never abandoned us (like the medical community did). They stayed
with us till the end and I am grateful. Very grateful.
Back to my MIL's case...................she is still here after 18 months on hospice. She is comfortable (howbeit cantankerous) and I occasionally give her hospice prescribed meds when she gets agitated and frustrated. And it helps. I appreciate hospice. I really do.