Question:
My father is 83 yr old. 20 yrs ago he had triple by-pass heart surgery for blockages. The doctors told him he had "maybe 5 years to live". Well, fast foward to 20 yrs later and the ole ticker is still ticking, although he started having weak spells and "near heart attacks" where he would have chest pain, difficulty breathing, cold, clammy sweats and a weak feeling....couldnt make it from the bed to the bathroom anymore. He said he felt like he was nearing the end. He wanted to die at home and NOT a hospital. MY SISTER is a SUPERVISING gereatic nurse at a local home, so with her experience, no one objected when she took over his health care at home. She "put him to bed" and arranged for hospice services and support. Granted, he is/was weak and "failing", but was/is in NO PAIN as his problem is "just" a bad ticker that could go any minute. Nevertheless, they put him on heavy doses of liquid morphine......saying that it would help to "relax his system and his heart. Of course, we thought we would lose him pretty quick, but that was nearly 7 months ago and he is still with us, still in the bed laying flat on his back for 7 months.Now, he has gotten addicted and immune to the morphine so they put one of those Fentanyl patches on him (strength 25) but are still loading him up with the liquid morphine on top of that, and also she is giving him adavan morning and night. Mind you, this man is not and never was in any pain, and didnt have any problems breathing until now. I think he is being over-medicated, and now, since he isnt eating or drinking anything in months, he is dehydrating and his kidneys are failing. Little did we know that hospices plan, as my nurse sister agrees, it to follow through with this "planned euthansia". Of course he will die of organ failure if he doesnt get hydrated. I want to discuss this with my father in one of his (rare) lucid moments,.to let him know he is dying of dehydration and nothing more, and to let him know he has an option of getting re-hydrated......he dosent have to die from kidney failure. My beliefs, and I am not alone in my thinking, is that sis put dad 'to bed" too soon, and that we should have been treating him for his bad heart, and not put him on hospice....and most certainly NOT have plied him with so many heavy duty narcotic drugs since he WAS NEVER IN ANY PAIN. I am thinking he is being over-medicated. I have heard that fentanyl can cause breathing distress. I hate to see him die from dehydration and I am going to ask him myself and make sure that that is the way that he wants to go.....I MUST let him know that he has an option to RE-HyDRATE and perhaps live a little longer until his ticker does finally give out,....on its own. Imagine what troubles I am causing to all my siblings and my mom who has to watch it all. I am told to just "be quiet" and let him die like this (dehydration). I dont think he knows that his kidneys are failing and that that will kill him quick,...(He says he wants to live!) I just want to make sure that he knows what is going on with his own body and the options he still has. I am wondering about the doctors prescribing morphine and fentanyl for someone who IS NOT in any pain? Any advice will be greatly appreciated, as I think either the doctor "over-prescribing" or is hospice what is killing my dad. All he has is a bad, weak heart, hes just getting old and frail.....should he be on morphine and the patch, being that there is no pain, and the side effects are awful,,,,delusions, labored breathing, restlessness, etc. What can be done if we (the other kids) are not happy with the current treatment? We cant say anything to my sister, the nurse, as she gets very defensive. it is a terrible time for us all. Shall I just be quiet and hold my tounge? I dont think so, espically since they expect me to do my part in is care, which I have been doing up to this point,but now I have ISSUES with giving him his (medication/morphine/adavan) etc. as i think he shouldnt be on them...He souldnt be on hospice at all, as he could live a while longer in no pain until his heart quits. My sisters logic is that "she wants him to go peacefully in his sleep",.....its a planned euthansia if you ask me....and I'm not for it. What to do?
Answer:
You sure are in a tough spot and I can't really give you an answer as to what you should do. I can tell you though that morphine withdrawl can be horribly painful. Look up morphine withdrawl and look at the symptoms of withdrawl. Then think about if your dad, in his frail state, can handle that.
When you say "near heart attacks", could it be that he was having heart attacks only not severe ones? It certainly sounds like it. My grandfather had several heart attacks before he died and he never knew it. A doctor discovered previous heart attacks through testing after he had a major heart attack. He asked us how many heart attacks did grandpa have. We told him none. He said grandpa had several in the past. We never knew.
I don't understand why your dad was put on morphine, atavan or fentanyl with no pain. I suspect only your sister can answer that. I'm sorry I couldn't have been of more help to you.
Love and hugs,
Barb
Answer:
Barb, thanks for reply. I am aware of the strain that morphine withdrawal can have on him, being that his system is so frail and compromised already due to dehydration, and I am no health care professional but I am thinking a gradual withdrawal suplimented with "mild sedatives." I also under stand that he could die in the "re-hydrating" process,....as too much shock to his system. Of course, he would have to be made aware of these risks before making the decision to rehydrate or not....does he want to just lay down and die from dehydration, or would he rather "die fighting" to stay alive a little longer?. That is a question that needs to be put to him, .....only no one is saying anything to him about it, and I dont have the courage myself for I surely will encourage the wrath of some other family members just by bringing it up.
Thanks so much for your feedback,...and oh yeah, the reason sis gives for the morphine'fentanyl/adavan is to "keep his system calm",.....I think that was the Dr's idea, despite the NO PAIN thing. I think they should have started out with mild sedatives....NOT the heaviest narcotics known to man. I am not saying sis isnt dedicated and doing her best, under the circumstances that we all thought he would go quick.....just think 7 mos. later, its time for a re-evaluation of the situation and it doesnt look like that is going to happen. I am dying right now to go see him, but it is hard for me to look at him laying there dying of dehydration when he dosent have to.....thinking, "does he even know he can maybe be spared this kind of death with re-hydration? I dont know if I can go and see him and keep my mouth shut about it. Right now, my psycholigist advises me to "detach" myself from the situation for awhile.... but thats kind of impossible too....it is ALWAYS on my mind.
Answer:
Mulekistwoman, this is a very good idea to post and have our conversation online. I am your sister that can't be there much as I live 4 hours away. I'd like to get Dad's doctor in on this conversation. Like I said last weekend, though it was discounted as I have not been there doing my time with Dad(how do the opinions of these online friends count?) our sister the nurse has done a phenomenal job. I won't rebut your comments as we have all tried to tell you the facts. If you truly believe this chosen path was wrong you have waited a long time to speak. That is why I think that this is a new idea for you and may be a coping mechanism. It is hard to see Dad deterioate. You have always been a fighter but I beg you don't fight your family on this. It is creating a TREMENDOUS amount of stress for Mom. Go see Dad's doctor, hospice workers but don't talk to Mom. I do not object to your talking to Dad as he knows all of us very well. But if you stress mom it will stress him.
Answer:
ElbonaP, my sister, as to what you ask about my seeking other opinions from members of this board, who are strangers to me, is because everyone on this board, the "caregiver" section, if you'll notice, has "been through it" with a loved one in some way, shape or form. I figured it wouldnt hurt to seek advice and/or opinions from people who have or are going through the same thing. Make sense? As for your comment that I "waited too long" to question or complain,....be advise that I did not understand that the idea was to let him dehydrate and die from organ failure. I thought we were just trying to keep him comfortable until his heart gave out. I just recently,within the last week, and Gerri confirmed it, realized that his kidneys are shutting down / failing and that is the first step toward death and organ failure is what will kill him - not a heart attack. I would have said something earlier if I had known he was on a "planned euthansia" plan. Did anyone ever stop to think / ask daddy if he wants to die from dehydration? If its all about what he wants, someone should ask him, and I dont feel strong enough for that right now. Maybe the main caregiver or wife should be the one to talk to him about this. Me, I am on the verge of a nervous breakdown myself. Too bad about Mom. I always thought we could talk about anything but I guess not this time when it really matters, important stuff.. Heck of a time for her not to have any opinion. Dad should know what is happening to him and that it is preventable. It should be up to dad which way to go. He sould be made aware of that option. We always joked about who was in charge of Daddys health care, and the asnswer was always, #1dad, if he is in his right mind, then ma, then sis gerri the nurse. I dont know anymore who is in charge. I worry about ma too, thinking she must be suffering withdrawal from the liquid morphine and a cut-back in the strength of the patch. I dont know all what elese they are giving her, if anything, to help with the withdrawal. From what I have read about morphine, IT SHOULD NEVER HAVE BEEN PRESCRIBED TO HER IN THE FIRST PLACE AS IS NOT[b][i]for people with compromised lungs or breathing problems - nor is she deathly ill nor in intolerable pain either. I dont hink talking to their doctor will do any good, naturally he is going to defend himself, after all, he is the one writing all of the prescriptions. I get more info from other doctors and health care workers I talk to....like Dr. Silverstein at Bennington Hosp who told us emphatically, Ma was being over-medicated and dad quite possibly also. She couldnt understand why either of them would be on such heavy pain medication for such a long time, with neither of them in pain. These concerns are not something I "invented" out of an inability to cope. I think I was coping very well until I learned about the "planned euthansia" which is what hospice is all about. I am just finding out, realizing what is happening with him. I dont think it is too late to TRY and save him from that kind of death, if he wants. Thats all. If he dies trying to live a little onger, so what? At least we can say he fought. We know his heart could stop anytime,...but meanwhile, if it dosent stop right away, maybe he can live awile longer and live a quality life with us, eventhough he may never get out of bed or walk again. There would be good times if he wasent so doped up all the time. Just my opinion, abiet an "un-professional" one, - it is based on what I am hearing from them, and others familiar with the issues, the diseases, and the drugs..You suggest talking to their Doctors. I suggest you talk to dad....in person when (and if) he is feeling strong again. By the way, are you planning another trip down anytime soon? You are always welcome to stay here if you need temporary quarters.