It was mid-October 2008 when the medics rolled the elderly man through the glass-enclosed lobby.

To his left was a sweeping view of the Long Island Sound and bright orange and crimson trees, but the view was nothing to him.

Before making the 15-minute ride from Yale-New Haven Hospital to Connecticut Hospice, the man was told he had maybe three days before his heart would fail completely. He couldn’t catch his breath. His eyes were wide, his fingertips dusky from lack of oxygen.

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His hospice doctor, Joseph Andrews, was desperate to ease the man’s breathlessness. “For patients, that’s more terrifying than pain, paralysis, or the inability to get around,” Andrews said. “It’s the worst thing.”

Another doctor suggested morphine might help.

The drug relaxes the muscle walls of blood vessels, Andrews said, increasing capacity and reducing the lungs’ urgency. Coronary arteries can also more efficiently carry oxygen-rich blood away from the heart.

The man’s doctors knew well that too much morphine can stop the lungs completely, so they tried just a tiny amount: one-quarter of a milligram.

Morphine is seen by many physicians and laypeople as a sort of single-purpose, liquified grim reaper, and understandably so: It is dangerous and addictive. Older physicians in particular were typically not trained to use it, Andrews said, and can resist recommendations to use morphine even for cancer patients with severe bone pain, for fear of killing them.

Morphine’s reputation as a killer underscores one of the more persistent myths surrounding hospice care, namely, that it serves as a grey market euthanasia service for the terminally ill, where the drug is given in generous doses to every patient — even those who do not want it.

Talk to any experienced hospice nurse or physician and they’ll tell you that such notions can lead to significant complications: family doctors refusing to prescribe morphine for dying patients who are in extreme pain; relatives refusing to give a dying family member prescribed morphine, or exhorting them to reject hospice care completely and opt for the ICU.

Hospice clinicians get it. People don’t want to risk killing someone, even if it means seeing their loved ones suffer. Clinicians also understand that they share some of the blame, for failing to clearly communicate the methods, goals and expectations of using  morphine. Because the medication is often prescribed during a patient’s final decline, family members are sometimes left to wonder if, in agreeing to the treatment plan, they have helped bring about their loved one’s death.

Morphine can have other less lethal side effects that require vigilance, and doctors and nurses are not always clear about those potential complications either. Still, clinicians say, it can be frustrating to encounter people whose misconceptions lead to unnecessary suffering for patients.

The elderly man was tall, slightly heavy-set. He’d been a teacher. He was quiet, loved to read books. His wife was alive but he’d lost her to dementia and a nursing home. His three children were nearby, though, and the grandkids. He was well-loved.

And now his children came in, looking like they were going to a funeral. They asked if they should call people to come say goodbye, and Andrews told them it was probably a good idea.

He asked them to consider morphine. It was worth a try, they said. They made their calls. They braced.

Their dad went to sleep, which was something.

He woke later to smiling faces. His breathing had eased dramatically, his skin color had returned to normal; he was fully alert, wide awake. He chatted with visitors. He told his life story.

He got six more weeks like this.

Andrews said he remembers countless stories about how morphine had helped patients with respiratory distress, as well as patients with severe pain. Most recently, a patient had been immobilized by her cancer pain until she received small doses of morphine. She promptly flew to South America to spend time with family members.

Control and mobility, Andrews said, are among the most important factors in improving a dying patient’s quality of life.

Soon after the man’s breathing eased, he started a new routine. Twice a day he’d ask his children or grandchildren or nurses to bring his cap and his overcoat and they’d wheel him to the waterfront with his oxygen tank.

He’d stay as long as the gathering cold and darkness allowed. He saw the tides flow and the leaves fall and gulls and boats pass. In early December he began sleeping more, and then he slept entire days away, and then he died.

But that November reprieve.

“It was one of the best morphine stories I can remember,” Andrews said. “He had a great run.”

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  • WHY WOULD THEY HAVE GIVEN MY 96 YR OLD MOTHER MORPHINE AND ATAVAN? I AGREED TO IT ONLY BECAUSE THEY ARE THE EXPERTS. BUT 3 DAYS LATER SHE DIED. ALSO I DID NOT SEE THAT SHE WAS BREATHING EASIER, SHE WAS SIMPLY SLEEPING CONSTANTLY.

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  • Hi well yes am familiar with all this can you getting a phone call from your dad and hearing I can’t breathe ring a ambulance
    Then the next day seeing your dad in hospital not knowing what has happened and then being told your dad has a collapsed lung still not knowing the diagnosis my dad asking if they can operate and they saying no and then finding out a few days later that my Dad has incurable Cancer?
    He lasted 5 weeks and then he died firstly he looked well I couldn’t tell my dad I was so distraught that every time I left the ward I was sobbing my heart out they did tell him in the end and when they told him that they couldn’t do anything he wanted to go home then they didn’t have enough staff then my dad said I could look after him I would have done if I was a nurse but I wasn’t he got angry and told me to go home ! I was even more upset I was losing my dad they didn’t have enough staff to look after him they didn’t cover him up they didn’t move the commode I said how long has this been here mind due it was 5.30 in the afternoon and the commode had been there since 10 am !
    I told them to move it now and they did Cos I lost my temper and as for oxygen and morphine they wasn’t happy to give him extra oxygen or morphine until I told them to but only a little bit of morphine 10 mls Cos I know how dangerous it was In the end my dad deteriorated and went unconscious I don’t know why people lose conscious when they have cancer maybe it’s the body shutting down but we were told to come in at 10 am we stayed with dad and then at lunch time they said we have to put a needle in I should of asked what the needle was I was in shock maybe it was morphine I don’t know I wish I had asked dad died at 3.30 pm November 1st 2010

  • The “catch” here is the competency of the medical doctors and staff administering the drug. It’s a losing battle for family members and friends to know or prove whether or not the morphine administered to their loved one merely eased the pain of death or actually caused death when it occurred within minutes of being administered. I was within inches of my son’s face when an unidentified staffer came in with 2 full vials of morphine (I asked what it was) to make him “more comfortable,” and within minutes he died.

    • my dad just died sunday. he was not sick. did not have cancer as they put on the death certificate. i had been fighting for weeks to get him off the morphine. his last day they asked to increase the frequency to every six hours. i reluctantly agreed. another nurse called me and told me to please cancel that. she had a great day with my father and didnt even believe that he belonged in a nursing home. i called to cancel right away but then he was dead by 7pm.

  • Reply to Mary,
    I am truly sorry you feel this way about Hospice. I am a Hospice aide by day and a CNA by night. I know a lot of people believe that morphine is a silent killer, but I don’t think it is. I have had patients that has been on morphine for 20 years, and are still on it now that they are on Hospice. Currently I am sitting with a patient, as her time is nearing. Last stage breast cancer. She was on Norco for a while, until it stopped treating the pain. She wouldn’t sleep and cried in pain constantly. She has now been started on morphine. Low dosage, but she is still on morphine every 2 to 4 hours. She doesn’t cry in pain nearly as much now. It has helped with her breathing. Her body isn’t wearing her down, she is resting. She smiles and tells you she loves you. Holds your hand, and while on Norco she did neither of these things. Her vitals are good and she is holding on strong.

    Sometimes people hold on until they get what they want or need. Maybe she needs to see a loved one. Sometimes, people go in a way we think is horrible and we question or blame things. Its all in God’s time, not ours. Trust me when I say, if one of my loved ones needed morphine during their last days, I’d give it to them. I watched a very special woman deteriorate for over a year. Her family refused morphine. She cried for Jesus if you touched her much less do the things necessary to keep her clean. Her body was so broken down. Constant pain. Yes, she was treated with Norco and tramadol, but no relief came from those.
    Trust me when I say we do not administer morphine to cause death to come faster. We treat the pain so they can pass peacefully.

    Many prayers for you and your loved ones. I’ve been right where you are before. I once thought the same thing until I had to watch my uncle suffer from, liver and colon cancer. He slowly passed away. He was miserable and in a lot of pain. He gained his wings Oct 4, 2017.

    • Hi Steph,

      I guess not all hospices are created equal. I believe you when you say you administer morphine when needed. But what about a hospice nurse who literally told me to keep my wife on morphine constantly, regardless of pain. I don’t buy it. My wife can be pain-free for 3,4,5 days in a row and then need morphine for a really bad headache. Why should I keep her on it non-stop in that case? That I think is why hospices at large have a bad rap. Because it really does look like they are trying to speed up the inevitable. You mention God in your post. To me, as long as my beautiful wife is breathing, there is still room for a miracle. Whether that miracle comes as complete healing, or via a new drug that comes along, or via a friend of a friend who knows what to do, I don’t know, but either way it’s still a miracle.

      I’m not following hospice advice by keeping my wife sedated. Morphine has side-effects and they are not good. I avoid it if I can. This way I can enjoy her company when she is awake and we can still laugh and remember old times. You can’t do that when you’re sedated.

      THanks,
      dan

  • My dad had cancer the last days of his life were awful he was either drugged up with morphine as he was asleep all the time he could not talk his eyes were closed then his breathing changed after they told me they were going to put the drip in at this stage I just thought they were giving him it to relieve pain it must of been a high dosage of morphine there were stages where it seemed he was holding his breath I told dad to breath he held his breath for 42 second s then he died oh my god I screamed dad dad I shook his shoulders the nurse cane to me and handed me a leaflet now my Aunt has Cancer same as dad they can’t do anything for her either she’s in a cancer hospital her breathing is not good but they won’t give her oxygen that she needs only morphine you say morphine is a silent killer well they are doing this to my Aunt now just giving her morphine I know she hasn’t got long it’s so sad she’s 79 years old was married but her husband cheated on her she never remarried again so sad my dad was left a widower and only had me and my brother but I was there for him at his side when he died I love him so much and I hope his in heaven now and my family seem to suffer from cancer a lot my other aunt had cancer and was Mis-diagnosed they said it was a virus she had cancer and it was to late to save her
    Drs think they know everything but they don’t the worst thing is they were treating my dad for a blood disorder nothing else and all along he had cancer but they wasn’t looking for that by the time they found it he had only 5 weeks to live

  • Sorry to hear that Mary. Just lost my dad earlier today. He had liver Cirrhosis. He was literally turning to a skeleton before our eyes. SO when hospice came in and gave him morphine for the last week or so, finally he wasn’t suffering. Yes its not going to cure anything,but it really helps for easing people’s pain before they go.

  • I am going through this with my step dad , he has cancer in his brain, and all through his body. He is now on morphine which has made him very comfortable until Gods Almighty Angels come take him to Heaven.
    I will miss him so very very much!

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