Hospice Care/morphine drip

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Question
QUESTION: My sister will be in the hospital for three days to get morphine drip. From there she will go into hospice care. I do not know the dosage but will this drip seriously curtail her ability to communicate and shorten her time? Her pain is extreme and she doesn't want to prolong this in any way.

ANSWER: Dear Cecil,
You have ask a very good question and seeking accurate information is helpful to avoid misunderstanding of the medication.  Before I answer your question, I encourage you to continue to ask questions of the medical team now caring for your sister and then hospice will also be able to help you through the process and help you to understand the entire process as it impacts your sister and you.
1. Morphine is given to help with pain.  It is not just given at the end of life.  Many people receive morphine.  
2. Morphine comes in a pill, liquid drops in mouth and the infusion of morphine, which I think you refer to as a drip.   The infusion is usually administered by a pump in which a continuous infusion is given and then the patient can give themselves a bolus (an extra dose if the pain is not controlled)  The bolus often is used if a certain activity increases the pain and maybe suggested to administer before the activity to keep the pain from being so great.   
3.  At first she may sleep more as she has less pain and can get better rest.  Some people sleep to escape pain and consequently poor sleep and rest.
4.  Remember the goal of the morphine is for comfort, quality of life, and is not for promoting death.   
I hope in some fashion this has been helpful and feel free to get back with me for further questions

---------- FOLLOW-UP ----------

QUESTION: Jan,
  My only experience with this type of situation was several years ago when my father was going through the same type of scenario. His pain was such that his days were miserable. The doctor told us that morphine would keep the pain down but would shorten his life. Since life expectancy was very short anyway we chose to give him the medication to give him some sort of comfort.
  It seems that my sister in dealing with similar circumstances. I know that morphine is powerful stuff. In Korea we had to be careful with how many vials of this stuff was given to wounded marines because he could die from it. Is our bodies defense systems compromised or less able to resist the cancer? I guess I just need to know what she is going through
so I can deal with it a little better.

Answer
Dear Cecil,  
Today with monitoring smaller doses of morphine can be given with the pump and maintain a continuous infusion at a level the patient considers comfortable.  This means the medication can be titrated to comfort.  In this method death is not hasten but allows the body to take its natural course due to the invasion and assault of the cancer and any metastasis.  This eventually leaves the body in generalized organ failure.  
I strongly encourage you to discuss this further with the hospice team.  They should have some hands on information and should take the time to address all your inquiries. The main thing now is for your sister to know she is not alone.   
Please Keep me updated as to how this is going for her.

Hospice Care

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Jan Reeves

Expertise

Hospice care is care for the end of life and dying patient and family. Hospice provides support with focus on quality of life issues. End of life does not mean the patient will have pain. Pain is one of several symptoms hospice will focus on for quality of life for the time reamining. Hospice takes the journey along with the patient and the family.

Experience

I have been a hospice nurse for 17 years. I teach basic pain for hospice staff and advanced pain class for hospice nurses. I am a bedside nurse and visit patients in their home of choice or nursing home.

Organizations
Hospice Palliative Nursing Association Internation Association of Hospice and Palliative Care

Publications
in process

Education/Credentials
I have a BSN and am certified in hospice and palliative care for 7 years.

Awards and Honors
Bloomington Hospital Research Fellow

Past/Present Clients
This would violate the HIPPA--patient right to privacy

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