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View Full Version : There's got to be a better way to die.


vee-tail-1
8th Sep 2011, 21:44
Apologies for bringing this up but someone here might have some info on it.
For the fourth time in my life I am watching someone close to me die in hospital.

Once again the dying person is pumped full of morphine, and in this drugged up state they experience intense and terrifying dreams & hallucinations.
The body might well be pain free (although morphine causes severe constipation) but the mind is fully alert and desperately trying to make sense of what is going on.

I don't want to see yet another friend die in terror.... there's got to be a better way to help the dying.

On the two occasions that I had a hospital surgical operation a small jab in my arm put me completely out; no feeling, no awareness, total nothingness, to all intent I had died, only to come back to life lying in a post op bed, and remembering nothing of the previous few hours.

Surely that small jab has to be the most humane way to deal with the dying, rather than the prolonged horror of death by morphine.

1DC
8th Sep 2011, 21:54
vee-tail-1::

Sorry about your friend and your distress.
If it is possible for your friend to die at home with dignity if you call the macmillan nurses on 08088080000 they will know what to do and,if they can, may be able to arrange for it to happen.
Alternatively,if you have a local hospice talk to them, they may be able to help.

1DC

Slasher
8th Sep 2011, 21:59
There are more ghastly ways to go. I've seen more than my
fair share of it over the last 20 odd years. Enough said about
that.

Strange as it may seem I had a VERY loved one bite the dust
with cancer yet she was never in any pain - a little morphine
right at the end (during last hour) but even that was a minor
dose.

Mike X
8th Sep 2011, 22:00
vee-tail-1

Unfortunately, morphine = end.

We're here.

Mike X
8th Sep 2011, 22:03
Please let us know.

corsair
8th Sep 2011, 22:05
There must be another jab that obviates the effects of the morphine?

I know what you're saying about the effect of general anaesthetic. It's an on/off switch. One instant awake then awake, no in-between. You die effectively.

But the question is whether the person really wants to be out of it for their last few days, weeks?

Capetonian
8th Sep 2011, 22:10
I am sorry you have to go through this.

A friend of mine died recently after a flare up of aggressive cancer, but was very aware of everything until just a day or so before she went. The doctor told the family that when it got too much for her, and them, they would reduce the flow of nutrient through the tube and rack up the morphine to bring a peaceful end sooner.

I am not sure if it is correct to say that morphine used this way produces intense and terrifying dreams & hallucinations.

This all raises the question of controlling the time and manner of death, active and passive euthanasia, and the various uses and abuses thereof. It is a frightening subject and there is never a right answer. We can only hope that those we care for go peacefully.

G-CPTN
8th Sep 2011, 22:20
Unfortunately, morphine = end.Not necessarily (though in this case maybe so).

I was allowed morphine (self-administered) after my thoracotomy:-
Thoracotomies are thought to be one of the hardest surgical incisions to deal with post-op, because they are extremely painful and the pain can prevent the patient from breathing effectively,From:- Thoracotomy - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Thoracotomy)

Fortunately for me, the pneumonectomy was for a non-malignant condition.

My current medication does produce intensely realistic dreams that are indistinguishable from reality - though they are rarely disturbing.

I have also received treatment under the influence of a derivative of Valium - which erases the memory of the procedure - maybe that might be the solution?

RegDep
8th Sep 2011, 22:25
Capetonian:

I am not sure if it is correct to say that morphine used this way produces intense and terrifying dreams & hallucinations.


I cannot say anything for the others, but for myself I can say it is true and correct. I have had two times in my "career" heavy opioid ("morphine") infusion, and both times the life was really terrible. Angst and hallucinations. Fortunately, both times my situation went better so I could get out of the pain-killers. The second time I asked to be switched to something else ("anything") and got something else, which was not as bad, until I could do without.

People have very different tolerance to opioids, and that should be taken into account. Full sedation (like propofol in operations) would deprive the dying person of communicating, which many would like to do.

Death is not easy.

Edit: G-CPTN my first was for thoracotomy, but before the time of self-administration. Second was bowel for malignancy (cleared completely) and opiates self-administered. The choice was difficult: which one to take - the pain or the hallucinations. Sometimes the pain felt like the lesser evil.

lomapaseo
9th Sep 2011, 01:18
did not like the hallucinations since I was aware of them and couldn't shake them off.

I'll try more pain the next time.

Course I'm hoping for a plane crash ... it's more final quicker

I don't need no goodbyes. I kind of know when things are going bad when folks come arround to the hospital bed with a camera.

vee-tail-1
9th Sep 2011, 11:01
Many thanks..
My friend is a 50 year old woman...heavy smoker... had a cancerous lung removed 12 months ago... spent six months on chemo, then stopped and had a new lease of life. Went travelling, camping by the sea, saw lots of old friends, made new ones... then the cancer came back to her remaining lung, and she had problems breathing and panic attacks.
Medics said no hope... moved her to a hospice... gave her morphine... now she knows she is dying and fears death. Her greatest fear and morphine induced hallucination seems to be that her body died but her mind remains alert. No wonder some folk die in terror.
As the post above, when my time comes reckon I will endure as much pain as possible and then just give me that knock out jab and be done with life.
Apologies again for posting this morbid stuff but seeing my friend suffering has really choked me up.

probes
9th Sep 2011, 11:15
No need for apologies. Probably I'm not the only one who read your post, clicked on 'reply' and felt words are utterly inadequate sometimes.
As for your friend... a friend of mine died of lung cancer (she was in her 60ties) and she had NEVER smoked, not even as a teenager. So - you never know.
The most we can do is be there for them if they want it.

Worrals in the wilds
9th Sep 2011, 11:51
Take it easy veetail. As previously posted I saw my aunt die over two years from a degenerative condition.

There are things you can change and things you can't change. You can be there, you can be caring, you can be supportive. You can tell BS stories about what happened in your workday that the person in bed can share. You can listen sympathetically about how the doctors are a collection of know-nothing wankers and the food is inedible. No doubt you're already doing that. At this point in time you can't change the drugs or their effects, so there's not a lot you can do except what you're already doing. No point in beating yourself up about things you can't change.

As the post above, when my time comes reckon I will endure as much pain as possible and then just give me that knock out jab and be done with life.


After the above mentioned experience I've made plans. Tragic, unavoidable accident plans to be enacted in time of need. Unfortunately, in the present legal climate that's all anyone can do.

All the best to you and your friend, and in my experience just being there helps, even if they're non-responsive you don't know what they're taking in. If she is responsive then day-to-day inanities are a great way of distracting her from Aragon knocking at the door. Humans enjoy chatting, whatever their immediate problems. Just my experience. You can't necessarily change the outcome but you can improve the journey, even if it means you walk out with a cheery 'see ya later, I'll bring corn chips tomorrow' and spend the next hour shivering and shaking in the carpark. That's what you can do.

DX Wombat
9th Sep 2011, 12:15
vee-tail-1 what you are describing is typical of carbon dioxide retention which, given your friend's condition is extremely likely to happen. I do not think it is necessarily a result of being given Morphine. Your friend has seriously compromised lung function so she will be unable to get rid of CO2 and absorb O2 properly. My father died from a cardiac condition which meant he became increasingly hypoxic (too little O2) and hypercapnic (too much CO2). He became very confused and irrational over the last few days. Eventually he was given an infusion of Diamorphine which sedated him and allowed him to sleep peacefully until he died. I hope your friend finds peace soon and that you find peace of mind.

VH-MLE
9th Sep 2011, 13:35
Hi vee-tail-1,

Very sorry to hear of your friends (and yours) predicament.

My wife passed away from cancer four and a half years ago (where has that time gone....). While she spent quite a bit of time in hospital over the past 2-3 months of her life, she was able to be at home for her last couple of weeks which was much better for her and for our kids (who were 11 and under). Being at home and in a familiar environment was a much more "comfortable" experience, plus we had excellent palliative care support. If your friend is able to go home (and be suitably cared for), she may well prefer this.

Additionally, my wife's pain was very well controlled right up to the end. She had a very good pain management specialist and our GP also assisted with palliative care. These days it seems that the medical profession has made tremendous advances in this area (although perhaps not in every instance unfortunately).

Good luck.

VH-MLE

hellsbrink
9th Sep 2011, 15:25
When my mother deteriorated to a certain stage due to cancer, our doctor did the decent thing.

He made her take some of her sleeping pills and then turned the syringe driver up so she got the maximum amount of morphine into her that was possible without injecting her with an OD himself.

She went VERY peacefully soon after, and we like to think that she didn't have any "terrors" during that narcotic induced sleep she had.......


I think that is what should be done, although it was technically illegal for it to be done in the country we were in at the time. That's the UK, by the way.


Over here, in cases like that, euthanasia is legal. And it should be everywhere. After all, we would never let a dog or cat suffer like that so why do we make ourselves suffer when there is no hope, why do we prolong the agony for the person concerned as well as the ones who have to suffer seeing the suffering?

Mimpe
9th Sep 2011, 16:13
They may be able to change the type of narcotic..there are 4-5 different types that can be given as an infusion. When you have too much narcotic you can hallucinate or even become agitated. She is very fearfull.Also something like a midazolam predominant effusion may help her anxiety.

If she has fluid on the lung they might be able to asist with a chemical pleurodesis. Palliative care is a very skilled profession and the whole picture has to bo looked at..there may be many little things that can help.

G-CPTN
9th Sep 2011, 16:57
My father-in-law was stoic throughout his life, never wanting injections for dental work and not complaining when he hooked himself in the nose with a fishing-fly when casting - merely asked me to 'pull it out'.

He was a lifetime pipe-smoker and when not lit it was frequently in his mouth. His work colleagues remarked that the thing that they remembered about him was the tobacco-smoke haze that pervaded his office and the corridor outside it, so it was no great surprise when he finally went to hospital and after an exploratory operation was diagnosed with stomache cancer.

He lost weight until he was unable to stand and contined to lose weight unil it seemed that there was nothing left to lose.

Eventually he told the GP that he 'had had enough' and we were informed to say our goodbyes as he was likely to pass away in his sleep during the following night.

We will never know how much he suffered (he wasn't one to complain) but we recognised that help was available to release him when he decided that it was time to go.

My own pain threshold is much weaker, but I wonder what advances have occurred over the last 20 years?

OFSO
9th Sep 2011, 17:37
I am very sorry to hear what has happened to so many people.

In the case of one of my parents we suspect that while in hospital she was given enough medication against the pain she was suffering to ensure that she would not suffer any more. The difference between a dose to relieve pain for a short while and a dose to relieve pain permanently is very small in the case of a person terminally ill or in a feeble state of health, and I trust members of the nursing staff to do what is necessary.

And I hope that when my time comes I have such professionals around me.

Hellsbrink, you are so right. It hurt like hell (and still does) that I had to have my beloved cat put to sleep last year, but as ever it is the patient who is most important, and the pain caused by his terminal condition had to be stopped. It is shameful that in so many countries we are not allowed to treat human beings with equal compassion.

vee-tail-1
9th Sep 2011, 17:43
Thanks everyone, really appreciate your posts PPRuNe at it's best.

gingernut
9th Sep 2011, 19:56
Sorry to hear about your friend vee tail.

They should certainly not be suffering at this stage, and there are drugs, which used alongside morphine, that could prevent this. (the health professionals call these "adjuncts")

There are all sorts of ports of call that maybe able to help, (apart from PPRUNE:)), such as the MacMillan nurses, or palliative care team, but at this trying time, you've got enough on your plate than to have to chase these people up.

It's important that you let the person in charge know that you are distressed, and what you are distressed about.

Hope you're ok, let us know how you get on.

overun
9th Sep 2011, 22:18
Vee-tail-1. Your question has helped me a lot.

Ten years ago my mum was admitted to hospital for surgery on the heart when cancer was found in a lung, advanced enough to give just a few weeks. A tough old bird, no one had a clue before hand.
The part that horrified me was, drifting in and out of "naps", she woke, looked at me, plainly frightened, and in a strong voice called out " What are YOU doing here ?

l never understood that, it`s always hurt to think of it.

At the end, l found she had been refusing all medication for several days, which l couldn`t understand either.

l was way too far out of my comfort zone to ask the medical staff what was happening.

DX Wombat
9th Sep 2011, 22:44
I used to tell the parents of babies in the NNU that we were there to help them and that nothing is trivial until proven so but that we could not help them unless they spoke to us as we were not gifted with the ability to read minds (a gift which would have been very handy at times.) So, remember, no matter how trivial or insignificant you think the problem may be if you do not mention it we cannot put your mind at rest. PLEASE ask you will NOT be wasting our time.

vulcanised
9th Sep 2011, 22:52
Coming up for eleven years ago my mum had a massive stroke.

After a brief examination the doctor suggested they could keep her alive indefinitely, but her quality of life would be close to nil, or they could simply leave her in her unconcious state, do nothing and see what happened.

In other words, her life was in my hands. I chose the latter option, believing that would have been her choice, and she died a few hours later.

Wish I could be absolutely certain I made the right choice.

sea oxen
9th Sep 2011, 23:04
vulcanised

I have been in a similar position. I shan't tell you what happened.

You did the right thing. There is no need to agonize over it. God rest your mother.

SO

DX Wombat
9th Sep 2011, 23:06
Vulcanised - without a shadow of a doubt that was the right thing to do. The fact that your mum died only a few hours later is indicative of a massive stroke from which she would probably not have recovered. What you did was give your mum some dignity and comfort for the last few hours of her life. A very courageous and horrendously difficult decision but most definitely the right one. You can be proud of yourself and I'm sure your mum probably would be too. There is a very fine line between endeavouring to keep someone alive by all means available and striving officiously to do so.

probes
10th Sep 2011, 06:09
Vulcanised - absolutely right. In a similar situation I did the opposite - not given the option, though, just trying to do something - and still feel bad about the couple of lousy days she got. All the wires and tubes... No. You were right. Sometimes one can't do anything, just be there and let go.

OFSO
10th Sep 2011, 07:47
Vulcanised, indeed, you made the right decision. Rest easy about it.

goudie
10th Sep 2011, 08:30
Wish I could be absolutely certain I made the right choice

Vulcanised Yes, you did the right thing.
Was in the same situation a few years ago with mum. She was 94 and on being asked, I chose for her not to be resuscitated. Never had any regrets. She wasn't enjoying her last years.

On a lighter note, my old man use to joke that he wanted to be 'shot by a jealous husband' when he was 90...never happened!

Slasher
10th Sep 2011, 08:37
But it'll probably happen to you and me both Goudie! ;)

Lon More
10th Sep 2011, 09:57
A friend of mine died recently after a flare up of aggressive cancer, but was very aware of everything until just a day or so before she went. The doctor told the family that when it got too much for her, and them, they would reduce the flow of nutrient through the tube and rack up the morphine to bring a peaceful end sooner.
That's how my ex went.She was able to make her goodbyes and then just slipped away. However I believe it's against UK law? I heard something recently about clinics in Switzerland where the patient chooses the exact moment and self administers the drug.

sea oxen
10th Sep 2011, 10:29
Lon

It's Dignitas. Not inexpensive for a quid's worth of pentobarb.

For a time, a loophole allowed for euthanasia in the Northern Territory until some Bible-basher[0] from Victoria closed it down.

The GP who started this ball rolling runs tourism trips to Mexico (I hear). I gather it's a wonderful country, all sorts of souvenirs to bring back. He also teaches chemistry to the elderly - if you get my drift.

The Nodderlands also permit assisted dying, from what I have heard.

SO

[0] I hasten to add that not everyone who worships God is a sanctimonious pr1ck.

OFSO
10th Sep 2011, 11:56
I hasten to add that not everyone who worships God is a sanctimonious pr1ck.

Thanks SO, I feel better about my own relationship with God now, but just wonder what brought you to make that statement ? (True though it may be).

vulcanised
10th Sep 2011, 13:05
Thanks for your messages of support folks.

gingernut
10th Sep 2011, 21:03
vulcanised , Doctor's are duty bound to explore all the options- I suspect he phrased the question thinking of his own mum.

I don't know the exact details of your mum's case, but it sounds like you made the correct decision.

What would your mum have said?

vulcanised
10th Sep 2011, 21:21
I think I know but I can never be absolutely certain.

It's what I would say if I was in that position.

A long term friend of mum's, going back to their schooldays, suffered a milder stroke not long after her, and they kept her going for another year. Although she was fairly mobile her mind was disintegrating and her daughter (now in her 60s) had the experience of looking after her like a doubly incontinent child, with a little help from a part time carer.

Seeing how that turned out made me a little happier about my decision. Mum would never have wanted that.

sea oxen
10th Sep 2011, 23:02
OFSO

some use their relationship with the Almighty to justify their meddling in others' affairs. I offer them every encouragement to them to catch up with their maker in person and talk things through as soon as possible.

Kevin Andrews, in my opinion, has the morals of the back of Linda Lovelace's throat.

ISTR a documentary doing the rounds back then of some poor devil who was succumbing to prostate cancer. He made it to the NT and I think he was the final person to be able to use this route before Andrews put an end to it.

SO

overun
15th Sep 2011, 00:22
l`ve never really understood the concept of morals in opposition to sexual acts. Sexual arousal and breathing, for instance, seem as one.

l have, though, been stuffed up the `arris countless times by licenced colleagues which is certainly immoral, but, alas, the norm these days.