Did Morphine Exacerbate Her Condition?
Dear Barbara, My mother was transferred to an inpatient Hospice. She was alert and talking to us when she arrived. Upon admission, the RN brought up the topic of medications to help her relax. I told her my mom had been relaxed without any problems. The RN insisted she seemed uncomfortable and pushed for morphine. Within 30 minutes of getting the morphine, mom started having difficulty breathing. It seemed like the morphine over-relaxed her. We didn’t even ask about pain medication; the RN brought it up and suggested it. I regret not having the courage to tell her no! Tell me, did the morphine exacerbate her condition?
It is difficult to respond to this question. I don’t have this woman’s diagnosis or medical history, which I would need in order to evaluate whether or not the use of morphine was appropriate or not. But I can say that from all that this woman’s daughter described, I too would ask why use morphine at this time? However, it is quite possible that the hospice nurse assessed pain and discomfort that the daughter did not see, and thought a narcotic could bring more comfort.
The daughter’s description does not suggest pain or even difficulty breathing. However I must take into consideration the difference between professional and non-professional assessments.
Education is so important. Knowledge reduces fear and misunderstanding of the care provided. The daughter’s concerns lead me to question the communication between her and the RN. Did the RN take the time to explain why she was going to give the narcotic? Did she explain the signs of approaching death that made her think a narcotic was appropriate? Did she offer guidance on what to do to support her mother?
 90% of end of life care is Education. People don’t die like they do in the movies, yet movies are our current role models. This leads to unrealistic expectations. If a professional does not teach us how dying unfolds, particularly when narcotic use is involved, I will often get a letter from a distraught caregiver who now mistrusts hospice care.
Something More… about Did Morphine Exacerbate Her Condition?
When a patient comes on hospice the family is often in shock. They can hardly absorb all that they are being told. If they have my booklet, Gone From My Sight and in the above situation, Pain At End of Life, they will have something to go back to after the initial meeting. They will write notes in the booklet. They will read it to loved ones who call to check in. They will refer to it in the wee hours when they are alone and symptoms change.
Originally Published on https://bkbooks.com/blogs/something-to-think-about
