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Hospice Death


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Old 04-23-2016, 07:07 PM   #1
54wolf
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Hospice Death

I just cannot get over the recent loss of my best friend . She was placed in a hospice by her family because what her family called quality of life issues due to complications from chemotherapy .
She was never told what they where going to do with her there thinking it was just an alternative to hospital to regain strength . This is what I thought as well when they told me . 2 huge red flags got me checking things out . First the family was told the morphine she was being given would last 6 to 8 hours at the hospice versus the 2 hours it worked at hospital . How can it work better 1 place versus another ? 2nd red flag she would be given an anxiety medication so she would not panic when she woke up but could not move .

What do they mean she cannot move ?
I checked with a relative whom is some kind of nurse who used to run an tnd of days ward at a hospital .
In these situations a patient is given morphine for pain though no it does not work better . They are given a muscle relaxant supposedly so they will not thrash around and hurt them selves but really is given so the family does not visibly see what the patient is going through . A catheter so the patient will not even try to fight through the muscle relaxant to pee Finally the anti anxiety med to further keep them from fighting .
Lastly the remove all IVs that would provide fluids and nutrition. The patient is left to lay there all but unable to move , often in pain but unable tp communicate this to anyone , hearing all that is going on around her but unable to respond . As dehydration sets in cells in the body burst releasing toxins . The body is eating its self trying to live . This can go on for days and in her case lasted 4 days .

MY Questions is ; How is this not murder ? How is this humane ? How is this not Torture of the helpless ? Would it not have been more humane had the intention been to end her suffering to have simply put a pillow over her face and ended it quick ?

Yes she had a living will which I never got to read but this was not about life support but was to deal with pain . Had the pain been properly handled (up until the day before move to hospice she was being given pain relief in pill form which she would promptly throw up) that might never had been a consideration .
How do I live with myself for letting this happen ? So many mistakes where made . Worst by me not being more involved from day one in her treatment , I trusted her family to do the right things . Her Husband is a very smart well off man so ignorance or money where never an issue . I had chose to treat her as if nothing was wrong to give her relief from all the well meaning but advice giving friends and family . I never doubted a second she would beat this till I went to the hospice and saw she was doped up with no IVs .

I am a very smart man who makes a living getting people to do more than they ever thought they could . Had I jumped on from the beginning I believe with all my heart she would be here today . Outside of my beautiful wife this woman was the best friend I ever had . Loyal and supportive and when she needed me most I let her down .

I cannot stop wondering what kind of monster I am to have betrayed her . The moment when they came to her hospital room to take her for the move to hospice she was laughing and joking with everyone in the room ( She had finally been given a pain relief shot versus pill ). At seeing the stretcher she started panicking not knowing what was going on . It was I that told she was going to a better place so she could get some rest as I held her hand calming her down .I had no idea what was really going to happen . What a betrayal on my part . I should have known and fought it .

Last edited by Administrator; 04-23-2016 at 09:12 PM.

 
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Old 04-23-2016, 10:31 PM   #2
Harri3t
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Re: Hospice Death

I am so sorry for the loss of your dear friend. Both my parents died in hospice care, one at home and one in a dedicated hospice facility. I thank God for that as I believe their suffering was eased at the end of life. I hope I can relieve some of your anguish because I think you may have been given some incorrect information and may be assuming some things that aren’t true.

The criteria for hospice admission is a terminal illness with a life expectancy of 6 months or less. To be admitted to a hospice facility as one of my parents was, I suspect your friend’s death was very near, in days rather than weeks or months.

Certain muscle relaxants and anti-anxiety drugs may be given with morphine as adjuvant drugs, meaning they increase the effectiveness of morphine so that morphine may need to be given less often. In addition, when there is muscle/skeletal pain as might be the case with cancers invading bone, muscle relaxants may act to reduce pain as well. They are relaxants not paralytics as you seem to suggest.

A second reason these may be given is to reduce painful jerking called myoclonus sometimes seen when the by-products of morphine metabolism build up as organ systems fail and the removal of these toxins from the body is slowed or stopped. A third reason is to increase sedation and lessen anxiety.

Fluids are usually stopped as death draws near because they can lead to more discomfort such as increased edema and fluid congestion of the heart and lungs that can cause breathing difficulties. Not knowing her condition I can only guess that a catheter may have been inserted as a comfort measure to keep your friend dry and limit unnecessary turning that may have been painful for her. Urine can also quickly cause skin breakdown and more pain.

I know your loss is still raw but to my mind these are comfort measures to allow a dignified death and is not murder or even euthanasia. Hospice was my parent’s choice and I would chose the same for myself if suffering a terminal condition when end of life draws near. I would hope you would honor your friend’s wishes as I am sure her living will was not drawn up lightly or without discussion with her husband nor was her transfer to hospice done without at least her husband’s knowledge and consent.

It is never easy to lose a loved one, and your love for her is clear but please do not feel guilty. I hope in time you will reconcile yourself to your loss and find not only peace but also joy and blessings in knowing and remembering such a dear friend.

 
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Old 04-24-2016, 12:49 AM   #3
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Re: Hospice Death

Hi there. I too am sorry for your loss, but please do not beat yourself up over what you do not understand.

Hospice is specifically used for patients who are seeking comfort measures only; and a patient can only qualify for hospice when they have <6 months left to live and a terminal diangosis. In the case of most cancer patients, hospice is only brought in when there are days left to live, because up until then either the family or patient is still seeking a cure or too hopeful to give up.

The question you asked about morphine can easily be explained. Morphine in a pill form is given in the hospital - or in an IV- either way, it is extremely low dose and morphine in general is fast acting and short acting. Meaning it kicks in quick, but only lasts a few hours. Usually less than 2. When given in a hospice setting it is given as Roxynol; (a type of morphine) which lasts longer, is usually given subcutaneously (under the tounge) and is combined with an antianxity drug to help keep the patient comfortable (usually Adtivan or Xanax). This lasts much longer and does a much better job of keeping a patient comfortable, Because it can be given under the tounge, the patient doesnt even have to be awake, thus the hospice nurses are giving it to keep the pain at bay- NOT waiting until the patient is complaining, as many patients in their last days cant complain.

As for "staving" a patient. In the final days of life, patients no longer need hydration or food. In fact, doing so, can actually cause compications. The body organs are shutting down and forcing fluids or food can cause either Edema or choking. Hospice NEVER withholds food or water, but it is never forced on a patient. It is what is known as "comfort' only. If the patient will take it, sips of water or ice cubes are offered, if they dont want it, it is no longer important they have it. Please try to keep in mind that your friend was actually dying. It can take days to actually die, or it can take weeks...it doesnt take minutes.

No it would not have been more humane to put a pillow over her head. This is called murder. A living will talks about how a patient wants their last days to be in the case of an irreversible outcome. Obviously your friend was at the end and her family made the decision to honor her wishes. This was not for you to read or be a part of, but to honor as her friend. Try to realize that hospice is actually THE MOST humane way a person can die, as there is absolutely no pain, and she was attended to round the clock by people trained to administrer comfort measures (her wishes).

Its so hard to lose someone, but you have to believe that your friend is no longer in pain and is free from the confines of a hospital bed. She wasnt going to get better, and allowing her to leave this world pain free with her family sourrounding her was all that could be given. I would want the same thing if it were me.

Hospice offers social workers and chaplains. They are available to EVERYONE who loved her. You have the right to sit down (or talk on the phone) with either of these. Call the hospice company and request that a chapain sit down and talk with you about how you are handling this...they will be happy to try to offer you some comfort.

I am sorry for your loss, but please try to look at this as the posiive thing it was. Your friend wouldnt want you to be angry with her family or yourself.
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Old 04-24-2016, 03:02 AM   #4
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Re: Hospice Death

Thank You for the Kind words . She had beat the cancer but developed fluid on the brain causing her great pain and Nausea . She was to weak at this point to operate on from the chemo. Because she kept throwing up the pain pills she was in constant pain and getting no rest . Had the pain been addressed she would have regained her strength . Her father had the same cancer and was twice put in a hospice and came out of it . The first time he lived 3 years as it went in remission and the second time he survived 6 months till his heart gave out . Nothing I was told said she was terminal but it was a quality of life issue . Her own mother whom I have known much longer than I knew her disagreed but was overruled by her husband .. The worst they never told her what was going on .I am told the first evening at the hospice she was talking and laughing and even ate some ice cream. She never woke up again . I could not be there as my own wife is not well . Had she had the tests half way through her treatment that the doctor wanted they would have known of the fluid build up but the insurance would not pay for it .Earlier tests had shown something on the bran but because the doctors said it was not cancer it was basically blown off . Her husband could have easily paid for it .
i offered but she refused to let me . I should have found a way to sell her on letting me pay for it . From beginning to end I failed to do all I could have to help her . I could have sold her on the tests m I could have gotten her to eat m and drink to keep her strength up . Instead I chose to be an escape of the pain and suffering she was going through . Had I not trusted some one else to her treatment she would be her .

 
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Old 04-24-2016, 12:34 PM   #5
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Re: Hospice Death

54Wolf,
You need to stop beating yourself up. Unfortunately cancer is not curable and if she had cancer, eventually it would have killed her. The Fluid on the brain is a result of the cancer she had- not a separate issue. Had they removed the fluid, yes, she might have had more time, but this was HER decision, not yours. She didnt want it done, she didnt want you to pay for it and she had a living will spelling out her wishes. Honor them by remembering the good times and not by being angry at what you couldnt do.

Even if she had let you do what you wanted, the sad truth is eventually the cancer would have won. You said had the pain been addressed she would have regained her strnength. You cant know this. She may have rallied for a short time, but eventually the pain would have returned and it would have started all over again.

It sounds like your friend went through an awful lot with chemo and radiation. Its quite possible that she gave up wanting to "live" like that and was ready to give in and die....did you ever talk about that with her? She didnt allow herself to be put on hospice because she wanted to live- hospice is thoroughly explained to a patient and their family before consents are signed. Even if her husband signed them for her, she knew what the possiblity was when she signed the living will.

You need to grieve...and to be able to remember her in her best times...not beat yourself up over something you had absolutely no control over. Remember she and her husband discussed the "what ifs" when they drew up the living will. That should bring you some peace.

Im really sorry for your loss. Please seek out the chaplain or grief counselor from the hospice...they will be happy to help you through this difficult time. Hopsitals also offer grief support groups. Im sure that the Social Worker at the hospital would be happy to put you in touch with them so you can begin to heal. This is not easy...and what you are feeling is normal...but you cant blame yourself or anyone else for decisions she made with her family ahead of time.

My heart goes out to you.
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