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Didn’t realize it at the time, but my father was killed by morphine. The whole family gathered around his bedside for a 24 hr vigil while he was dying. They kept him on morphine to “ease his pain.” He slept peacefully around the clock until he was gone. My older sister died recently. I visited her in the hospital just a couple days before she died. She didn’t feel well but was talking and joking with us. Was surprised to learn the next day they sent her home to die. I went to her home and the family was gathered around her bedside as she slept, on morphine to “ease her pain” right up to her last breath. My brother’s father-in-law who was healthy and worked every day of his life even though he’d been retired for thirty years and was up on a ladder pruning a tree when he started having problems catching his breath. I mean when you’re over ninety years old you might sometimes have trouble catching your breath when you’re working hard. They took him to the hospital and they put him on morphine to “ease the pain” and he was dead within 24 hours. I visited him too with the family gathered around waiting for him to take his last breath. I’ve seen it happen enough times to realize this is not right. When I was in the hospital after they amputated my leg they put me on morphine. I was drugged up and basically out of it. They kept me in bed 24/7 wouldn’t even let me get up to go to the bathroom. They had some kind of device hooked up to me where if I ever felt pain all I had to do was push a button to inject a dose of morphine directly into my IV. Good thing I finally realized what was happening and had them disconnect it. Was up a couple days later, in therapy, then got the heck out of there. Was never so glad to get home in my entire young life.

Thanks Jim.

We had my mother in law’s pain managed quite well with Fentanyl patches and oral opioids for breakthrough pain for her metastatic bone cancer. We cared for her at home around the clock 24/7 for months and she had very little pain. We had it titrated quite well, and coordinating with her oncologist and our pharmacist, we gradually increased doses of one or the other as breakthrough pain occurred. We had a visiting home hospice nurse (my mother in law’s decision, not ours) who was concerned one day when mom had some pain in her side. In hind sight, it was a met in her rib cage, but the hospice nurse wanted her checked out at the hospital. My wife had been with her 24 hours a day for weeks, and when she was admitted, they told us to go home and get some rest. They admitted her to hospice on the hospital floor for “pain management.”

They discontinued her Fentanyl patches and Vicodin and started her on the hospice pain protocol, liquid morphine, at 5mg every two hours. That didn’t touch her pain. When we stopped in the next day, she was writhing in agony, saying, “Lord, please take me now. Lord, Please take me now.” We were beside ourselves, we had managed her pain for months with very little major discomfort. We asked the nurses what the hell was going on, and they said, “Well, she has to request the pain medication, and she hasn’t requested any.”

She didn’t know she had to request it, she didn’t know where her nurse call button was, and she couldn’t reach it due to the pain if she had!

So we had to stay there at the hospital and go request it every 2 hours for the next two days. And 5mg of liquid oral morphine is NOTHING for someone who had been on Fentanyl patches and oral Vicidin for breakthrough pain for over a year.

She deteriorated rapidly and we had to BEG them to increase the morphine dose. They started her on long acting morphine pills (MS Contin) and we finally got her back home and spent days fighting with the hospice and their pharmacy contract company to get her back on the Fentanyl and Vicidin.

We were talking to a pro-life Catholic hospice during this for advice, and they wanted to know what the local hospice was planning for pain control once mom could no longer swallow, a point which was rapidly approaching. The local hospice said they’d simply give her the MS Contin pill as a suppository. You don’t roll over a woman with a history of spinal metastasizes and vertebral pathological fractures to give them a suppository for pain control several times a day!

She was becoming incoherent, repetitive, could no longer carry on a conversation, and was rapidly dehydrating.

So I finally blew up and coerced them (I won’t go into details, but it wasn’t pretty) into putting her back on the Fentanyl, and starting an IV for hydration. (It took them 5 days to get the IV order filled!)

As soon as she was rehydrated and the morphine was washed out of her system with the IV hydration, and the Fentanyl patches took effect, she was able to talk and carry on a normal conversation once again, and had better pain control without agitation or confusion compared to the morphine.

Our experience with hospice was not the wonderful experience others desribe. It was a harrowing experience in which we had to fight 24 hours a day for proper care. And I don’t have the energy to relate the battles we had to fight for proper care for my father in law, who passed away at home under hospice care (again, my mother in law’s decision, not ours) two years ago.

And why did they insist on the morphine instead of the Fentanyl? We’re still not sure, but Morphine costs pennies and makes the patient quiescent, which makes for less demands for active care and assistance. Fentanyl is expensive and the patient can maintain their activity level.

So that’s some of my direct experience of palliative care (in Fr. Gerard’s case) and hospice care (in my mother in law’s case) so my opinions on this subject are not based on hearsay.

And I’m in routine contact with the Hospice Patients Alliance, which fields calls and takes emails on cases like these every day. The stories are harrowing, and incredibly sad.

There are still some really good hospices and palliative care services, and even in ones that are questionable, there are truly angels or mercy doing their best in a terribly imperfect system.

But it is an industry that needs intense scrutiny.