The Morphine Myth
Morphine has a reputation as a strong and dangerous drug so why does hospice use it? When used properly, morphine has several very helpful purposes. While it is not a medication to be taken lightly, there are a lot of misconceptions out there—especially with regards to hospice care.
Morphine is a naturally derived medicine in the same class of opioids as codeine, hydrocodone and oxycodone. It is used to treat sharp, acute pain and it also relaxes the lungs and makes it easier to breathe—a common ailment of those that require hospice care. With reduced pain and easier breathing, the hospice patient can eat, sleep and maintain a higher quality of life with comfort and dignity.
Amid our nation’s current opioid crisis, many myths persist regarding morphine’s legitimate use. These myths result in less than optimal pain and symptom management for hospice patients, but the confusion infused by these myths into the decision-making process can often lead to highly complicated grief for loved ones following a patient’s death.
Dr. TJ Hawkins, Ph.D., Bridgeway Hospice’s Director of Program Services, notes that in over 10 years of experience as a Grief and Bereavement Counselor, he has seen many loved ones struggle greatly from issues of anger and guilt regarding the circumstances surrounding the use of morphine at the end of life. Sometimes these complicated grief factors can lead to serious cases of depression and can highly debilitate their post-loss life. Dr. Hawkins recommends approaching the use of this drug with an open mind and seeking a thorough education of the uses of morphine from your healthcare provider.
Many hospice patients never even take morphine because they don’t need to. It is the degree of pain that the person is in that determines the medication. Hospice practitioners start with the mildest form of medicine and work from there. If it is appropriate that the patient be given morphine, the initial doses are low and slowly increased until they relieve the person’s pain and shortness of breath
While morphine has a reputation as a dangerous boogeyman and a hard drug, it is also a valuable tool for improved quality-of-life for hospice patients. Opioids properly administered in a healthcare setting are nothing to be afraid of. By reading this, you are already doing the right thing by researching and learning more about the topic. Take your time to consider the benefits of this medicine to your loved one’s comfort and dignity.
We all know it’s not easy to be a caregiver. Taking care of someone else is very rewarding and often necessary, but it can also be very costly. Caregivers are more likely to have a chronic illness such as high cholesterol and blood pressure. Caregivers are more likely to abuse alcohol, tobacco and other drugs. Studies have estimated about half of all caregivers to be clinically depressed. Additionally, caregivers have a rate of death about 1.5 times higher than non-caregivers.
If you are a caregiver, this may not even surprise you—caregivers know all too well the demands and consequences of this selfless service. We highlight them here only to emphasize the importance of self-care—or caring for the caregiver. While you may not be able to remove a strong illness from a loved one, it is within your capacity to take care of your own needs which will allow you to continue providing the best possible care.
First of all, carve out some time to take stock of the situation and your state within it. Think honestly about what is stressing you out, exactly, and why. Identify the things that are within your control and those that aren’t. Accept your feelings as they come and without guilt. Think of things in as positive of a light as you can and your feelings will follow. Set some goals for yourself as far as de-stressing and healthier life choices go.
Your mindset, feelings and overall well-being can also be affected by your physical health—and maybe more than you think. Exercise, for instance, leads to better sleep, reduced depression and increased energy. Our diet affects our whole self as well. So, while it may seem impossible to eat healthier or find time for exercise while caregiving, even a little bit can go a long way. If you are meeting with a doctor with your care-recepient, talk to the doctor about your own health and concerns.
Just as the person you are caring for relies on you for support, you too need someone to lean on. Perhaps this is just a friendly ear to listen, or it could be hands to help with daily chores. Think of people that could help and then find a good time to ask. Let your helper choose a way to help you, such as errands, relieving you of some care-giving duties, etc. but remember not to push too hard. Some people, even those very close to you, may be unable or unwilling to help. Don’t let this come between your relationship, simply ask someone else. Help comes from the most unlikely of places so don’t be afraid to ask those who weren’t the first ones you thought of.
Finally, don’t be ashamed to take advantage of respite care. Respite care is a benefit offered by Bridgeway Hospice and other hospice organizations to hospice patients in order to relieve the caregiver for up to a week at a time. Eventually, you will need this time, whether from a hospice or someone else, to allow yourself time to rest and recharge. Just as you can’t pour from an empty vessel, you can’t care for others when you haven’t cared for yourself.
If you’re reading this, chances are high that you’re interested in hospice care. While not an often-discussed concept, it is a very important and highly beneficial option for terminal diagnoses. Consumer Reports and The Washington Post recently published a great story outlining the benefits of choosing hospice care sooner than later. According to a recent study , most people that choose hospice care wait too long to do so and at the expense of their symptoms and quality of life.
The study’s author, Dr. Thomas Michael Gill, goes on to say that if hospice is delayed too long, its benefit may be reduced.
People who put off hospice care might spend months in and out of hospitals, with their families struggling to attend to them. “At some point, patients and their families and doctors realize that hospice is appropriate, but that happens perhaps later than it should,” says study author Thomas Michael Gill, a professor of medicine, epidemiology and investigative medicine, and the Humana Foundation professor of geriatric medicine at Yale University. “When folks are referred to hospice only in the last days of their life, it’s difficult to have a meaningful benefit.”
The study followed over 750 people over age 70. More than 40% of them entered hospice toward the end of their lives but the average time they spent there was less than two weeks. Dr. Diane Meier, the director of the Center to Advance Palliative Care explains that these people could have avoided many hospital visits and suffering of symptoms by choosing hospice care earlier.
Many of their most debilitating symptoms—including pain, nausea, depression, and shortness of breath—decreased substantially only after hospice began. That means many patients might have been suffering needlessly for months, says Diane Meier, M.D., the director of the Center to Advance Palliative Care and a professor of geriatrics and palliative medicine at The Mount Sinai Hospital.
Health crises, emergency-room visits, and hospitalizations can become routine toward the end of life, and “that is a very distressing and stressful experience for patients and family members,” says Meier. “Remaining in your own home [something hospice makes possible], a familiar place with familiar people, is safer and offers better quality of life.”
Common reasons people may delay hospice care are often rooted in misconception. For instance, hospice is not a death sentence. Patients may leave hospice care at any time and it does not have a time limit—only a standard time of six months which can be extended.
“Many people are fearful that if they choose hospice, they won’t be able to return to mainstream medicine should they improve or new treatments become available—that’s not true,” says Meier. “Hospice is not a one-way street.”
And some evidence suggests that hospice patients actually live just as long or even longer than similarly ill patients who are not in hospice.
So, when is the right time for hospice? Meier lists two main criteria: difficulty with self-care through daily life as well as debilitating symptoms such as pain, shortness of breath and depression. Hospice helps with both of these factors. According to Dr. Gill, the most important factor of all, however, is honest communication.
“It’s challenging to have honest discussions with patients and families about death and the dying process,” says Gill. “But leaving the conversation until the very end makes it more difficult.”
So, you’ve decided to try volunteering with hospice and you want to know how to get started. If you haven’t yet made this wonderful and life-impacting decision, check out our article on the benefits and rewards of volunteering with hospice.
Bridgeway Hospice is a great hospice to volunteer with and, if you’re in the Atlanta area, we have a location near you. The process is thorough, but you will have someone guiding and assisting you throughout the time you are with us.
Bridgeway serves all of Metro Atlanta stretching through Northeast Atlanta and into the Athens area ( Click here to see a list of our locations ). As a volunteer you are welcome to volunteer as little or as much as you are available. No long-term commitment is needed to volunteer with Bridgeway Hospice.
After initial contact is made through phone or email, a volunteer coordinator will contact you to set up an orientation meeting. This first meeting will mostly be an informative session including a comprehensive training program. Topics range from hospice philosophy and services offered to individual needs and boundaries. This meeting is important to determine how you can best serve the patient through your strengths, skills and talents.
Bridgeway Hospice’s volunteer coordinators try to set honest and real expectations for new volunteers into what can be an impactful and rewarding volunteering endeavor. “I give them the true facts of what this experience could be and what to expect. Volunteers often tell me ‘it was exactly what you said, and I appreciate it,’” says LaShonn Waller, one of Bridgeway Hospice’s volunteer coordinators.
After the first meeting, the local volunteer coordinator will match you with patients based on their proximity to you, and the needs of the patient relative to the volunteer services you can provide.
On the first day of volunteering with a hospice patient, the volunteer coordinator will accompany you on the visit. This initial visit will be rather short and also include caregivers and other staff to determine if it is a good fit for you both. Additionally, the volunteer coordinator may take you to meet other patients in this same manner on the same day to determine which patient will be the best fit for you.
The coordinator will keep you updated and current, especially with regard to the patient. “I have 35 volunteers and I talk to each one of them every week to give them updates and just to see how they are doing,” Waller says.
Volunteering with Bridgeway Hospice will help you gain great personal satisfaction from knowing that you have made a positive impact in another person’s life. For more information please contact any of our wonderful volunteer coordinators at www.bridgewayhospice.org/volunteer/