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“My aunt had a stroke then a clot went to her lungs. They started morphine and she died. Did the morphine kill her?” (Question posed by the son of one of my frail elderly patients.)
I explained to this sixty-something gentleman that a lung clot causes great distress in breathing and I would assume the morphine was started to give his aunt relief. Morphine is a powerful pain killer with a side effect of slowing breathing (respiratory depression). We use this side effect to bring relief when people are struggling to breathe at the end of life.
The son then asked, “Can’t you use something else?”
I explained that morphine comes in a liquid, and when someone is struggling through the dying process, even if they are no longer responsive, we can put the equivalent of a quarter teaspoon under their tongue and help to ease the breathing. We can change the dose and the frequency very easily to keep the person comfortable.
“But isn’t that killing someone?”
No. After twenty years of working with the frail elderly and watching them struggle at the end of life, I can honestly say that morphine calms the whole person. In turn, family and friends and staff at the bedside find calm also.
Creased foreheads unwrinkle. Muscles between ribs stop working so hard. Arms and legs stop flailing. Slow deep breaths replace rapid panting shallow ones. The heart rate returns to normal. Perspiration dries.
And when I prescribe this medication, the nurses have very specific orders, for pain or shortness of breath or breathing more than 24 times per minute (normal is 12-20), and to hold the medication if the rate drops below 12.
So if it’s time to let go and to make someone comfortable, I hope this article clears some of the myth and mystery about morphine so those hard decisions are just a little easier...