You are the patient, still alert and oriented, able to make your own decisions. What will you say to the nurse?
You have the authority—the durable power of attorney for health care—to make decisions when your loved one is unable to choose. What will you say to the nurse?
Every person and family is different. Some, when faced with the toughest decisions in hospice (like starting morphine for pain management), surprise themselves when they are all in agreement. Other families, who may easily agree on whose house to go to for Thanksgiving, or the right gift for Mom and Dad’s fortieth wedding anniversary, either debate or procrastinate about morphine as an option. And nearly every hospice professional has encountered a chaotic, angry, opinionated—yes, over-the-top dysfunctional—family that seems to go to war when a drug like morphine is a loved one’s suggested next step.
Morphine is an effective, scary, and powerful medication. It often becomes the tipping point for resisting or accepting hospice’s comfort care philosophy.
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What is morphine’s reputation?
It’s not a good medication, but a bad drug. If someone has pain, she or he should take aspirin or Tylenol. If the hospice nurse wants to use morphine for your pain, that’s little different than some “street person” hooked on heroin and always desperate for the next “fix.”
Or worse . . .
Sure, morphine will mask the awful pain, but it makes you incoherent and drowsy. You won’t be able to have any last, good conversations. You won’t even know who’s holding your hand.
And worse yet . . .
It kills you. Everybody can find a story on the Internet or from a friend of a friend about family members giving morphine to their loved one . . . and shortly after that dose, the patient takes a final breath. Why did they die? Was it me that delivered the fatal dosage? Blame yourself. Blame the nurse. Blame the hospice. Blame morphine.
Morphine is none of these things.
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Once, after a hiking accident, an emergency room nurse gave me morphine. No one asked me if I wanted it. With my left limb broken in three different places, any movement caused severe pain. By the time you notice the next comma, (there it was) my pain had dramatically diminished.
For most people, morphine works quickly and efficiently.
It didn’t work for my mother. After Mom’s sudden and serious cancer diagnosis, and following the mixed results of back-to-back surgeries designed to give her temporary relief, she confronted terrible pain. But she’d already instructed the doctors to not use morphine. In the recent past, morphine’s side effects may have caused her to experience delusions. Her wishes were honored and other medications—for Mom, it was dilaudid—helped ease her physical anguish.
Morphine won’t always be the best choice for pain.
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Morphine, when prescribed by responsible medical staff, is a tool for most patients that can be extraordinarily successful at reducing or eliminating pain.
Of course, an overdose of morphine could kill you. But so can water! One of the most troubling public revelations in recent years has been the use of extreme torture methods like “waterboarding.” Words can’t describe my disgust for any form of torture against any creature. But, for the most part, it’s “only” water. We need water for life! But drowning does kill. Flooding kills. Consuming too much water will likely harm you, or even cause death. Too much of anything is bad.
Because of allergies, or prior “bad” reactions (like my mother’s), or when members of a family endlessly argue about using morphine while the patient suffers, there will be other choices for pain management. Every good hospice, and every good hospice physician and nurse, will listen carefully to a patient’s needs and try to respond with appropriate, acceptable choices.
Morphine, administered properly, will not be addictive for a patient with a life-limiting disease.
Morphine, with the guidance of the hospice medical staff, may cause patients to be incoherent and drowsy . . . making communication difficult. But without the medication, the pain will become literally unbearable. A suffering patient will suffer even more. Morphine is never an easy choice, but as options for comfort become limited, it is a compassionate, necessary choice.
Morphine does not hasten death or cause death. The disease is killing you.
Nothing I offer here is easy to write or read. If morphine is being considered for you or your loved one, you are likely in the final stages of a devastating illness. All decisions—including medications—can cause spiritual, emotional, familial, personal, and physical anguish.
When a hospice nurse or physician is suggesting morphine as an option, they are doing so because they are kind, compassionate, and focused solely and completely on caring for you.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)by