Expert: Margot RN BScN CGN - 9/30/2006

Question
I was present when both my parents died.  My dad was in the hospital, with an IV, and was given morphine; my mother at home, and was given morphine periodically by the hospice nurse.  I'm wondering if the IV made a difference, specifically:  my dad died peacefully, but my mother (who had some dementia)cried out for help til the very end.  im assuming she was hallucinating or dreaming terrible images.  Would an IV have prevented this?  What can you tell me about this? is it part of the known process to see "demons" as one dies?  im thinking that since she hadn't eaten in about three weeks, the starvation had something to do with it.  thanks very much for your help!  deborah cowan

Answer
Hi Deborah and thanks for writing,

It's a valid question, but no, the route does not affect the medication, it only speeds or slows the rate at which it can be absorbed and therefore work. IV is the fastest route, followed by muscular injections, followed by oral; but "faster" does not mean "better". The goal with narcotics is to keep a constant level in the system so pain is not allowed to build up - prescribed properly, an oral does every 8-12 hours can be just as effective as an IV drip.

Unfortunately some people do not have a peaceful passing as they can experience hallucinations; these can be due to many factors including Dementia, Electrolyte imbalances (due to decreased intake and a normal part of the dying process) as well as a side-effect of many medications.

I'm so sorry your Mother's passing was not as peaceful as your Father's but it's impossible to know the exact cause. I have see many patients experience the scary hallucinations even when their medications are closely monitored and they are still eating fairly well and have no Dementia - sometimes it just happens, as I said, it can be a normal part of the dying process due to chemical changes that occur in the body.

I hope this answers your questions, take care,

Margot