Morphine: the Misunderstood Medication

medication

My pain raged and roared. It only ebbed if I didn’t move. Which was impossible.

“They’re gonna give you morphine,” one of my companions said.

Another declared, “You’ll get addicted.”

Morphine? Really? Wasn’t that only in the movies? Wasn’t that nasty drug only as a last resort for the worst of the worst?

Whump-whump. Whump-whump.

We heard the whirling blades chopping the air before we spotted the helicopter angling between the mountain ridges. It was searching for a landing spot near where I lay by the circle of rocks from last night’s now cold campfire. At mid-day, several hours earlier, I had busted my leg while exploring the area with a group of kids from the church I then served. On a weekend backpack, we had found an inviting slope of snow—really more an ice field in that part of the summer—and decided to butt-slide down its tempting expanse. As the mature associate pastor, I went first.

Until it was too late, I hadn’t noticed the granite outcropping poking through the snow.

Legs outstretched, derriere gliding across the slick surface, whooping with the thrill of gravity’s pull, I hit the exposed stone at full speed.

At that very specific moment, thirty years old, able to run for miles, able to hoist an overladen pack across the wilderness from dawn to dusk, I was in the best shape of my life.

And then I wasn’t.

My left leg snapped.

Because the other adult with our group hurried down the mountain to the trailhead to seek help, because a California Highway Patrol helicopter was dispatched as the day faded in the Sierra Nevada high country, because the pilot deftly maneuvered onto an uneven pocket meadow swaddled by stunted trees, I was successfully airlifted to the closest hospital.

Whump-whump. Whump-whump.

Soon, I met morphine.

Boy oh boy, did it feel good. Though a Baby Boomer, a “child of the sixties,” I was also a straight-laced, church-going, introverted kid who never once had tried recreational drugs. Maybe a dentist had numbed my mouth. Maybe, after breaking my finger at a summer job, a doctor had given me a local anesthetic.

But a heavy hitter like morphine? No way! Wasn’t it heroin’s bad boy cousin?

And wasn’t one of those kids from the youth group, beside me when I was loaded into the helicopter, correct: “You’ll get addicted?”

I guarantee you, it takes the pain away.

I also guarantee that morphine, along with other medications used in hospice care, is often misunderstood.

Whump-whump. Whump-whump.

The bad news about morphine:

  1. It is addictive.
  2. It can make you drowsy, at times unable to easily talk/listen.
  3. Many families have conflicts; medications like morphine for a loved one may trigger old or new debates.
  4. Some family members might steal the drugs for their own use/abuse. (See #1.)
  5. Since it’s often a caregiver rather than a hospice nurse who gives the dosages to the patient, some think a “last” dose was what “killed” their loved one.
  6. Regardless of any first or last dose, some believe morphine is what kills you.

The good news:

  1. Addiction doesn’t matter if you are dying.
  2. Pain is a fearsome thing.
  3. Morphine’s ability to reduce pain increases the possibility of some quality of life—communication, rest, staying home with loved ones—in the final weeks and months.
  4. It often can help with breathing. (Ask your nurse about this good news!)
  5. After training by hospice nurses, various forms of morphine can be given at home by family caregivers. (Of course, some think this is less-than-good news.)

Look . . . proof!

The bad news list is longer! Good loses!

Even as a non-medical part of the hospice team, I could identify more positive or negative aspects of morphine. Any nurse or physician (especially those involved with hospice or palliative care) would lengthen each side based on their education and professional experiences. Regardless of any rational pro and con discussions about morphine, it will inevitably trigger deep-felt reactions. Sadly, I also suspect it’s easier to argue about morphine than to discuss dying and death.

What if I compared morphine to water? All of the time, humans need water. But too much or too little can be a disaster for individuals or communities. The torture known as waterboarding takes “simple” water and transforms it into a frightening experience. Some of the time, especially nearing death, a dying human needs a medication like morphine. But too much or too little or if morphine is used in the wrong way . . .

My modest goals for Hospice Matters have always been to provide enough general information about hospice for caregivers, hospice patients, and grievers so that:

  • Ignorance and fear are reduced by gaining knowledge.
  • Those dying, caring for the dying, and grievers can ask better questions when seeking support from health care professionals.

In nearly everything I share about hospice, I consider repeating: it’s the disease that is killing you/your loved one. We clever humans are adept at ignoring the obvious. When a person becomes a hospice patient, several physicians have agreed that she or he has six months or less to live because of a fatal illness.

Whump-whump. Whump-whump.

Isn’t it unfair to compare my singular encounter with morphine to a hospice patient’s situation?

Even as the medication alleviated my agony in the emergency room, I was scheming to rebuild my body. I was young. Respectfully fearful of an opioid’s addictive powers, I ceased pain-killers as quickly as possible. Six months after my left leg was broken by a rock in a very hard place, I was jogging around a track.

This, though, I humbly offer: don’t add to the suffering. Morphine, when used properly, helps hospice keep you or a loved one more comfortable.

(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.)

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Comments

  1. Back in 1945, when I was six and my Daddy had cancer and was on morphine, he and I read a bedtime story (he taught me to read when I was three). Two days before my seventh birthday my Mom told us Daddy had died during the night. My Mom later told us that he tried to deal with the pain during the day as much as possible so he could participate in our lives. So my last memory is not of a drugged, semi-responsive person, but of a Daddy who bonded with his little girl who loved books as much as he did. So my thought is that there have to be discussions and agreements as to when and how much to sedate.

  2. My Mother was in hospice at the end of her battle with ALS. I cared for her until I couldn’t then she went to a SNIF. We talked openly about the when for morphine. My mother was certain she didnt want it. I understood her fear. When the breathing became hard and she tried to come to grips with the end, she agreed to try a small amount. Waves of nausea hit her. It took time to ease her body into adjusting for it. Soon she slept better. She was more aware and peaceful as the time closed in. I came in one afternoon to see her in horrible pain. The nurse said she couldnt have any more for 4 hours. I called our hospice team and they took care of the misunderstanding. After that I realized I needed to stay with her. I took over under the hospice’s guide guidance. When she was ready and we had all said our goodbyes I crawled in bed and held her in my arms. The sun shown brightly after days if rain. I whispered in her ear ” Mommy, its a good day to fly”
    Morphine gave her a respite from the pain and helped us to help ease her transition.

  3. I have been a nurse for 18 years; out of those 18 years I have been in and out of hospice for 12 years. Every time I thought I should try another field of nursing I was quickly drawn back into a hospice care role. I appreciated your article on morphine…. This is quite frequently a challenging topic to discuss in end of life care; challenging with patients, families, facility nursing staff, and even some physicians. It rings so familiar when you touched upon the fact that it is the disease process killing the patient, not the morphine, and the fact that keeping the patient comfortable at the end of life is the goal; not to hasten death. I have often had the conversation that no one should have to fight to their death, and when properly used, morphine is not causing anything to happen that is not already happening; it is allowing comfort and quality at the end of life.

    • Sherri:

      Yes, morphine always seems the “challenging topic.” Thanks for your kind thoughts and even more for your good work! Take care!

  4. I could not even finish the article after I read this =

    Since it’s often a caregiver rather than a hospice nurse who gives the dosages to the patient, some think a “last” dose was what “killed” their loved one.

    That’s where I am and that’s where I have stayed for over a year now.

    I did everything the nurse told me to do. First she told me to get rid of all the medication other than the new ones she was bringing. She told me they would help with breathing. I wondered about the blood pressure meds and the nurse told me not to worry. Just give what she brought.

    I didn’t recognize the drug as morphine. It had another name so I really didn’t know until I thought it was too late.

    As breathing became more labored I was told to increase the dosage. I did everything as I was told keeping a scrupulous account when each dose was administered.

    When death came, I called hospice and was told a nurse was on her way. It was a different nurse than the one I knew. It was this nurse that told me I was giving MORPHINE and I nearly had a heart attack right then and there! WHY didn’t anyone tell me???? I would not have been so compliant had I known. And then, I remembered that all the other meds were taken away. My God – I killed her. Yes, I still believe it. I have nightmares. i wrote to Hospice about my fear. I’ve not heard back from them except to get form letters which are no more than advertisements for me to come to one of their sessions. I can’t go. I just can’t. So here I am – a year later and no real resolution. Every time I think about it…I relieve those last moments and wonder what if?

    • Pat:

      Thanks for sharing this painful memory, and ongoing question. We know each other “online,” but not in person. I was not with you or the “patient” you were caring for. Everything I say will be, at best, a guess. But that guess is that you did everything in the right, best, proper, thoughtful way. And all I can do is repeat what I said in this post: it’s the disease that is killing a patient, not the medication.

      Though please ignore me (!!!), there may be some benefit in talking with a grief counselor at the hospice.

      Your fears, and your nightmares, are shared by others. How can we not have the self-doubts and troubling questions? But, again my guess: you helped someone who was dying from a fatal illness have a less painful and more comfortable death. That was and is a gift.

      • Thank you, Larry. The other part which I didn’t share is that my Spiritual Director died, too. Not at the same time but a little before.

        Different denomination call these Spiritual Directors by different titles. Some are Spiritual Guides, some Companion Seekers. These are people who are trained to be an objective person with you on your journey. They cannot be a friend of yours – well, they can be friends but in a different way. They’re not the person you go to the symphony or ball game with – they’re more like a “professional” friend. In Divinity School we were encouraged to find one.

        For quite some time I thought since Roy died, I didn’t need anyone else. I learned enough to go it alone.

        Wrong.

        The long and the short of it is that I have found a new Spiritual Guide and for the time being, it is working well. You were right. I do need help. Thank you for all you’ve done for me and continue to do.

    • Carol:

      Sorry to learn about your experience with your husband. My email address is listed at the bottom of the “About” section on this webpage.

  5. I didn’t get to say goodbye to my beloved sister. The morphine took that away from me. She never woke up. Could it have been possible to not give her quite so much for long enough for us to say goodbye?

    • Bonnie:

      I am so sorry this happened for you with your sister. Not being able to say a goodbye is a painful memory.

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