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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  • To Sheila, it matters a lot who is with you at the end stage. I was with my Mother as she was dying and was able to communicate with the nurses that she needed more pain relief. Had I not been there she would have died in agony.

    • Kaye,
      Totally correct! Dying people have “reduced sensorium” and can’t negotiate well on their own behalf. Also, hospitals are understaffed and overworked these days. When one of my children had to be hospitalized, years ago, I or a family member stayed w\ him around the clock, to make sure his needs were being heard and met.

      I worked in VAs where many people died alone, and it was a terrible and terrifying thing to see.

      Best,
      Sheila

  • this was a great article. My wife is in a like type situation the morphine has reduced her breathlessness. She is home with hospice and we are managing it day by day.
    thank you

  • When I was a medical student in 1976, doctors were regularly using marijuana to ease pain and to decrease the nausea and vomiting that came as a side effect of chemotherapy. It also helped the patient regain appetite—lost appetite is another side effect of chemotherapy.

    The problem (in Colorado!) then was that marijuana was illegal and a lot of hoops had to be jumped through in order to use it for this or other therapeutic reasons.

    If ibuprofen, or the equivalent, provided sufficient relief, why did your mother take the morphine? You could have supported her in her decision, and perhaps you did. It’s a tough and scary time, but one must not sacrifice all of one’s choices to medical staff. You or your mother know your bodies and, while nurses can be pushy, never let them push you into doing something that you don’t think is right for you.

  • Sandi,

    It appears that your mum was not given a choice. That’s the problem with medicine today, it does not give people enough choices. They want you to take only drugs. Drugs do not heal. It is my belief and the beliefs of more doctors everyday, that hemp oil and other cannabis products can relieve pain, Morphine is not the only pain reliever available. But doctors don’t want to give hemp oil and cannabis products because they don’t require prescriptions. So the drug companies cannot make money off of them. If you will google Dr David Allen, MD, you may see a lot of information. He is a retired Cardiac surgeon who now studies cannabis, in California, I think. You may even be able to contact him by phone or email. Tell him about your mum’s situation and see what his reply is.

  • Sandi,

    Sounds like your Mum was killed by the doctors. They are killing more people than they are helping to heal, I think. Medicine is a wholesale fraud and I am not the only one who thinks so.

    • Bill
      I believe you are correct thank you for your reply. My mum was not end of life and certainly it was not discussed with me or my mum to give her Morphine. The Hospital I feel murdered my mum. I have put a Complaint into the Health Care Comission and the Hospital have been asked to forward her records, they would like to meet with me. I am so heart broken. Everyone has the right to refuse medication and not be bullied into taking something they don’t want. Any ideas on what to ask Bill for this meeting would be appreciated.

  • My mother 76 never took morphine …Nurse walked in and said I have your morphine.Both my mum and I told her it was wrong. The nurse argued with us said yes it’s charted. My mother was sound of mind and we said who and why. Panadol was sufficient for my mum’s pain relief. She said the Dr. Despite our pleas my mum took it and by 9.30 next morning she was dead from Cardiac Arrest. So from 10.00pm till 8.00am 4mls every 4hrs could that of killed her.. thank you

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