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"And yes, she was in hospice and had as much pain med as she could have."

And yet she was in pain. I understand your distress and I seriously wonder whether this was a kind of palliative-care-malpractice on the part of the hospice.

It was at leat 25 years ago that Dr. Jose Espinosa, an expert in geriatric and terminal cancer care, testified that in all his years of practice " --- but he had seen "intractable doctors and nurses."

And if this was true 25 years ago, I daresay it's even more true now: acupuncture, narcotics, and other pain relief exists which can truly eliminate severe pain in terminal patients. (I say "in terminal patients" because some of these measures would cause side-effects which would not be acceptable for non-terminal patients --- for instance, a pain med that destroys liver function in 8 months --- whereas that is perfectly appropriate for a person who has not that long to live.)

I have heard that some doctors hesitate to- give "cocktails" of narcotic meds at effective doses because they are afraid of legal scrutiny of their use of controlled substances.

In any case, it makes me angry that there are hospices which lag behind in effective comfort care. Here's a good thing to read: the article on the left side of the page about better approaches to end-of-life care.

I wonder if “pain” comes in different forms, not just the physical ouch that we understand as relatively healthy but the all body-encompassing kind that comes when all systems shut down and only bloody bile is left to come out of a catheter for days. She had much more morphine than would kill a horse at that point, but the body keeps getting used to the amount, and needs more. There is always a break-through of the pain med before any doctor will increase the amount, I think that's a legal requirement, not sure. Being at home, it would sometimes be hours before the increased med could be given. In the meantime, it was torturous beyond belief. Every case is different, I know. My Mom's was just horrifying.