We don’t want to talk or think about it. It’s rarely pretty. Some fear what happens afterwards, and we’d rather cling to what we do know, even if it’s not all that great.
Death scares most of us, partly due to the fact that those of us who witness loved ones dying often see them in pain. The last week of Marshall’s life continues to haunt me and my son, Joe. We witnessed Marshall in periods of extreme agitation, scratching at himself and visibly uncomfortable. He’d claw and grab at anything in sight including his own body.
A minute dose of morphine (.25 mg) and Ativan relieved his irritation for several hours until it wore off. Since the medications were initially ordered on-demand, we’d call and wait for a nurse to administer them and another 30 minutes for them to work.
The cause of the agitation is due partly to withdrawal, which I didn’t understand until later. Once on hospice, all medications are discontinued with the exception of those considered “comfort drugs.”
When administered properly, small doses of morphine and Ativan help alleviate this agitation and the process of death. But all too often, at one’s end of life, these medications are administered upon request as in Marshall’s case, which results in spans of time as long as an hour when the loved one is in tremendous discomfort. This scenario is one I’ve heard often from other family members watching their loved ones in their last days, as well.
The alternative is to allow a designated family member to administer the drugs on a regular schedule that considers the need of their loved one, which I was finally able to do for Marshall in his very last days. The patient can then remain at rest until they pass.
Families are often concerned that the morphine will accelerate death. However, no evidence suggests that opioids administered correctly at the end of life will do this. In fact, it may help a person to live a little longer because it eases shortness of breath and pain, reserving their energy.
Strangely enough, I was given it in 1976 while pregnant without any side effects or complications. After a stressful confrontation with my first husband, I went into labor in my seventh month of pregnancy. My obstetrician believed the baby to be too small for a healthy delivery and so admitted me to the hospital for 8 days with an alcohol and morphine drip.
Even at the time, I thought the remedy to be bizarre, but labor was delayed. I remained on complete bed rest until I delivered my first child. Lisa Ann, 7 lbs, 8 oz, was born nine days after my due-date.
As with my pregnancy, morphine offers positive health solutions in the correct circumstances. Used in minute doses, it’s often the solution to easing end-of-life pain and agitation.
However, it’s important to note that morphine does come with high risk for addiction and danger when used inappropriately. Doses over 200 mg are considered lethal. Some people can react to doses as low as 60 mg. And even when the normal dose of 20-30 milligrams is administered, the patient may experience slowed breathing, mental disorientation, pale skin, change of heart rate, insomnia, and gastrointestinal complaints.