I

t 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.

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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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  • Strange , I am in same boat and also from CT
    END near for COPD. I only have one remaining Lung, which is failing after 22 years of Right Lung Removal
    My Doctor today wrote a script for me for Morphine.
    So I wonder is he rushing my end or is he helping me as in this story?
    I do not know dosage yet.

  • Maybe people need to spend at least a year in daily constant Pain (though I fear that may not even penetrate some of the cranial that rule my life), and maybe just then they would see Morphine Medicine/Narcotic-Medicine in a different light.
    Here I am 37 years and 8 months down the road and still with a daily constant Severe Chronic Pain sickness that has ruined my life.
    I was 18 years old then, and i was caused by a drunken driver in another vehicle who caused a head on vehicular collision (18-wheeler truck) (which killed two of my friends 19 & 20 years old, and we did nothing wrong).
    Spent the first more than ten years trying to find an answer to the daily constant Pain that never stops.
    The only thing that worked was strong Narcotic Medicine like Morphine and OxyContin Medicine. Yet I was forbidden to use it for the more than ten years.
    Just when I was starting to lose my mind from too long in Pain, they finally allowed a Pain Doctor to start treating me with Morphine, and who saved my life, and two other Doctors who have followed.
    It took another 10 years to finally get to where I was using a correct working dosage of Morphine Medicine- which is to me a literal- G-d Send, Miracle Medicine, and Life Saver.
    Used Morphine responsibly for 26 years with NOT one measly problem! I still need it to this day. But- then over 9 months ago- the Government just steps in and forces my Doctor to start taking it away from me again, or like the more than ten years Hell they made me exist through.
    It was back to torturous daily constant suffering and NO life.
    My existence has sucked for the past almost 38 years, but at least thanks to Morphine, I had at least somewhat of a life.
    But oh no, they can’t let me have any kind of life. Better to torture me and make me suffer again in Pain for nothing.
    The Pain is all thanks to a C1-C2 fusion not in place exactly right and too dangerous to do anything to it, and a severe head injury that I was not conscious for a month and far from up to par when I first was, and other severe injuries to my head, face, spine, and upper body.
    I did have nerves burned in my neck, one of the many things I’ve tried, but did not work. Though could not reach nerves that may have helped.
    Anyways, why do people insist that I suffer greatly, when what has proven to work is right there on the table, yet they keep it from me due to people I have nothing to do with or am to blame for- as they have shown me that they do care about the lives of drunken drivers, terrorists, and drug addicts.
    NO trial, NO jury, NO judge, NO defense, I am just punished to suffer in torturous Severe Chronic Pain sickness for nothing I’ve done wrong, nor deserve to be treated like this.
    Maybe if I was a terrorist, I would come under the law the U.S. enacted to protect the terrorists on the other side of the world who want to kill all of us here in the U.S., from being made to suffer torturous Pain. Yes maybe just then they would allow me to use the correct dosage of Morphine I once was finally allowed to use, and that saved my life, but has been taken for nothing I’ve done wrong nor deserve right here in the United States.
    Maybe they do this to me, to make me wish that I could be a drunken driver, a drug addict, or a terrorist, maybe that’s why they do this to me.
    I remember my Grandmother who passed away in 1968, she was dying of Cancer and in great suffering Pain, yet they did not give her enough Morphine Medicine (or whatever Narcotic drug it was- Demerol who knows), but they did not give enough of the Narcotic Medicine, for fear it might kill her (go figure).
    Maybe/perhaps- that was a lessen to me, about what kind of thought from other people was to also come and rule me, and direct my existence too in Pain, and with the same warped thought process- the ole tough luck for you and suffer in Pain approach!
    I do know the Law is very strict and over the heads of Doctors, but this truth must be put in place. Morphine is NOT at all a bad Medicine, nor is it dangerous. For just like many other Medicines, if a person uses Morphine wrongly and/or illegally, it is dangerous and can kill you. But that does NOT at all mean that Morphine is bad and should not be used, but rather that a person chose to do wrong, or possibly too an accident happened that caused wrong. But again, it does NOT at all mean that Morphine Medicine is bad. For why else would I consider Morphine Medicine literally- a G-d Send, a Miracle Medicine, and a Life Saver, if such was NOT so! I am also NOT at all the only person with this correct sane view about Narcotic Medicine, actually far from the only person with such a view and being totally relative to Medical/Medicine.
    I also have done nothing wrong, yet get punished for what I have nothing to even do with, nor deserve (or any other person suffering with a Severe Chronic Pain sickness- short term or long term)!

  • I have witnessed this. Time and time again. But in the end it is really worth it. Wish more positive stories were read by families that don’t believe. People deserve comfort in their last days.

    • Nursing home gave one dose of morphine to my mom for elevated pain without informing us. My mother never had a level of pain to require hydromorphone before this.

      Aunt visited 4 days later to find mom with severe pain in arm. Nursing home coincidentally only let us know of pain and that they were starting morphine same day, very shortly after my aunt’s visit – still not informing us of the morphine or pain from 4 days earlier. Did the nursing home only inform us at that time because there was a witness to the arm pain?

      We visited next two days to find she did have pain in arm and mark on face, and seemed spacey from the hydromorphone. We asked nursing manager for help considering the mark. Nursing manager told us she would have doctor look at my mom, but Doctor has later said to us and to the nursing manger that she was never notified of anything.

      My mom is not mobile and can only slightly move arms so it is hard to see any way she could have caused the arm pain or mark on her face without some other person being involved.

      4 or so days after we last visited my mom’s friend visited her. The friend informed us she was near death – again the facility did not inform us of this extreme decline or that she was in such bad shape. Sure enough we visited quickly and she appeared to be very near death, looked extremely dehydrated, and was very hard to wake or stay awake – the hydromorphone knocked her out, and she was not able to accept food or water likely for a period of days. The facility was not tracking her fluid intake, and was not monitoring for the effect of the hydromorphone mixed with her other medications. Appears she was left to die.

      We as her family immediately asked for the hydromorphone to be stopped, and we were told it would be, and she was attempting to refuse the medication. But she continued to get at least one dose afterwards – we are not sure how many.

      We were visiting for many hours over the next 4 days to try to protect her life and pouring water down her mouth. At no point during those 4 days were medical diagnostic services or help offered to her or us to see the cause of her arm or other issues, or to see if this was a reversible situation. She had a history of UTIs, which is a reversible medical problem. She was not near death before this, and no one talked to us about end of life procedures at any time.

      Hydrating her helped her situation and she was looking visibly better each day but still not well. All along she had the desire to eat and drink – it was hard to hydrate her because she couldn’t keep her eyes open enough. At one point she told us “they are trying to kill me with drugs.”

      Once the hydromorphone was stopped you could see it became much easier to feed her. A morning nurse did help us get a blood test to check for dehydration and mentioned after 3 or 4 days of us trying to hydrate her that we could ask for an IV to rehydrate her. After speaking to my sister, we asked the evening nurse for the IV (on a Saturday) – the evening nurse said it may need to wait until Monday when the Dr is in – that nurse also said even though the result of the blood test was to push fluids, that he did not want to because she was not able to swallow. I also sent an email to the doctor of the facility that night asking them to do something to help her and asking why end of life procedures appeared to have been started without our knowledge or approval. That doctor luckily did help the next morning just in time because mom was very pale looking again Sunday morning. An IV and anti-biotics (in case of a UTI) have stabilized her and she is looking much better, but her ability to swallow has been impaired through these events to the point that we are not sure if she’ll be able to sustain herself without the aid of a feeding tube and/or periodic IVs. Tests have shown she was still very dehydrated even after we were pouring water into her for 3 or 4 days. She is still improving, but I fear that these events have caused or greatly hastened death which now maybe will occur over the next weeks or months.

      Beware of morphine/hydromorphone. For my mother it seems like it was used in a way that almost resulted in her death, after some unreported event that caused pain.

      The facility is now saying the hydromorphone was given for pain in her back and they knew nothing of arm pain. They are also saying there was some kind of stuff growing in her urine, but it’s inconclusive if it was a UTI. They also say they xrayed her arm and there is a “peculiar irregularity” but they are not sure what/if anything occured. They are also now asking us to consider making decisions regarding her end of life. They have conceded some mistakes were made and a series of miscommunications occurred, and they had the nerve to “thank” us for the learning opportunity.

      Beware – long term care facilities can be a death trap – visit and watch your loved ones closely. If my aunt had not visited we likely never would have known about her arm pain, or any hydromorphone being given. If my mom’s friend had not visited she probably would have died without anyone being informed of the true reasons.

      To me it looks like my mom had an unfortunate event affecting her arm that was unreported to family, and then hydromorphone was administered in a way which caused a quick decline and brought her near death without reporting it to family, and without offering medical help. It is a horrible situation. My mother would not want euthanasia in any form, but it seems like it is sort of unofficially “built-in” to the system under the guise of “pain killing” even though she was not terminal and even though she never agreed to or wanted it.

      I can’t get over how my aunt could recognize and see the severe pain in mom’s arm so easily but we were not informed and it was not in the chart. I can’t understand how mom’s companion and we could so easily and immediately see how grave of a situation she was in yet we were uninformed and it was not on the chart.

      I suppose morphine and other drugs can be helpful and used responsibly. However it has recently become very apparent to me that they can possibly and easily be used in an irresponsible or criminal way to bring about death or effect euthanasia under the guise of pain killing without any repercussions.

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