Part 2: MORPHINE
Just like the word hospice, the medication morphine often has a negative connotation as well. Many people who are not educated and even some who are, believe that administering morphine will put the patient in a comatose-like state or sedate them so they can’t enjoy their last few months, weeks, days or hours. Some even fear that morphine will kill the patient or hasten their death. However, hospice philosophy of comfort uses small doses of morphine that alleviates the pain without sedating the patient. Morphine is given on a regular schedules basis like every two hours, so that the pain remains on a baseline without peaks and valleys of discomfort.
Why do we prefer morphine?
Morphine is fast acting with a moderate half-life, meaning that in just 20 minutes the effects of the medication can be felt and will continue to be felt without subsiding for 2 to 3 hours. Morphine is preferred because it treats pain but also helps with the anxiety that comes with the dying process. It helps the heart stop working in overtime and become more regulated which also decreases discomfort. It calms respirations to a normal pace. Morphine helps keep the patient more lucid while comfortable. The closer one gets to imminence of death, the more morphine will be utilized to alleviate the racing heart, slow uneasy breathing, decrease shortness of breath and stop terminal restlessness.
An example of what might happen when a patient is within hours of end of life. They may be experiencing terminal restlessness in which everything in their body is alive like a live-wire; their heart is pounding out of their chest making them short of breath, making it hard to catch a breath which makes their oxygen saturation limited which could lead to hypoxia or hallucinations. Hospice administers morphine to help the patient be in a state of comfort. Within minutes, the heart relaxes and normalizes, the breathing regulates, oxygen increases, and the body can finally relax completely. Sometimes the loved might think that the morphine causes a patient to die but really happens is that the patient’s body relaxes enough and the fight is over. Human bodies are created to ‘fix’ itself and that struggle will continue painfully without the morphine to help relax it. When a patient is close to death their body is literally fighting to stay alive, fighting to endure which is why all those uncomfortable symptoms occur. The morphine lets their body relax to tell their body what their mind and soul already knows that it’s ok to pass. So, no the morphine doesn’t kill them, nor does it make death possible, it only gives enough comfort to the body so the body itself is comfortable enough to pass. It is the heart stopping and respirations ceasing that makes that patient pass.