Monday, October 18, 2021

In Grief: Did I Hasten My Father's Death?

I would rather be punished for making the right decision than live with the guilt of making the wrong one for the rest of my life.  ~ Shannon Messenger

A reader writes: My father passed away recently and I’m struggling with so much guilt. He had been battling cancer for nearly ten years. It started with prostate cancer and then spread to bones and I’m not sure if to a different area as well. He did radiation, chemo, oral chemo, and other treatments as well.

Recently nothing was working for him. He started having nausea, stopped eating solid foods slowly, lost strength, they discovered a tumor on his lower back so he had a week long dose of radiation. He was getting weaker and weaker and had pain. He stopped walking and then was bedridden. He was drinking boost shakes, eating very little oatmeal/yogurt. When his oncologist and home health care agency recommended it, my family decided to enroll him in hospice. 

I took him to the ER on a Tuesday because he was experiencing constipation. The nurse practitioner pulled me aside and sat me down and told me that my dad was at the end of life. I  didn’t understand it. He was admitted and given a blood transfusion since his hemoglobin was at a 3. He stayed there for two nights. He was released on Thursday and his hemoglobin was like 7ish. I thought he was better. But he was released with low blood pressure, oxygen because he was being released to go to hospice at home. I stayed the night with him on Friday at home. At that point he wasn’t swallowing his pills. He would take them out of his mouth. So I crushed his pills and mixed them with water, and gave them to him in a medicine dropper around 9ish p.m. He hardly slept that night. He was responsive and would call my name. He knew I was there. Saturday morning came and I attempted to give him the meds again, but he wouldn’t swallow them. He would take them out of his mouth. So I did the same again around 9ish a.m. He continued to be awake and responsive. He knew who we were and he would say a few words here and there. Hospice came that day too and gave him a fentanyl patch and he was also taking liquid morphine. That day we took turns with him and he knew who we were. He even prayed his rosary (quietly in his head). His fingers would move as he would move them on each bead. Around late 5ish p.m.-6 p.m. I noticed a change in his breathing. My sister called 911 and he was taken to the ER in an ambulance. He ended up going unresponsive and then passed away around 7-8ish p.m.

I feel guilty because I crushed his pills. One of the pills was an extended release morphine 30 mg that he had been taking for a while now. The bottle did not say to not crush. I feel guilty because they gave him Narcan at the ER and removed the fentanyl patch too. I was left thinking that I caused his death with the crushing of the pills and morphine. I was left thinking that I caused an overdose. I was left thinking that I sped up his death. I tell myself that he was responsive even after I gave him the medications. He never knocked out. I try to tell myself that an overdose usually happens quickly, but I can’t seem to grasp it in my head because I feel terrible that I crushed the medications. I spoke to a doctor and he told me that I didn’t cause his death nor did I speed it up. He said it would have to have been more crushed pills than one. Also that my father was tolerant at this point and that his behavior after taking it didn’t show an overdose reaction. The reason why I was so traumatized about crushing the extended release morphine is because I read online that you aren’t supposed to crush it because it can lead to death. Will you please help me?

My response: My dear one, my heart hurts for you as I read your story. I am so very sorry for your loss. Clearly you love your father dearly and you did everything possible to make his final days and hours as comfortable as possible.

From what you've written to me, I believe without a doubt that you are NOT responsible for your father's death. Clearly his body was shutting down ~ and when this happens, even if he had swallowed every ounce of morphine or whatever else you tried to give him, his body was no longer capable of absorbing it. At that point in his dying, the tissues in his body could not have absorbed that morphine normally, whether it was crushed or whole. 

I hope with all my heart that you will let go of the guilt you are carrying over this. Think of it this way: If you had the power to cause your dad's death, then you also had the power to save his life. But you didn't have either of those powers. Both outcomes were totally out of your control. It was the disease that caused his death ~ and nothing that you have done.

I strongly encourage you to read some of the works by Barbara Karnes, RN. She is a hospice nurse who's spent her entire career educating families about dying and death. See, for example, all the titles listed on her blog, here: Something to Think About: a blog on end of life

In one of her booklets, she writes:

In the days to hours before death a person’s body is shutting down. Nothing works right. Circulation is slowing down (mottling, very low 60/40 blood pressure). It is circulation that makes medications work. Medications taken by mouth, skin, or rectum take a long time to be absorbed into the blood stream. Even longer if the circulation is compromised, which it is when a person is dying. If you give a narcotic other than through an IV (let’s hope most people are not getting IV’s in the days to hours or a week before their death from disease) it is going to take a VERY long time for this medication to work.

If you give morphine to someone who is in the dying process hours before death and they die shortly after you administer the medication they most probably did not die from the drug. They would have died with or without the narcotic.

I don't know if anything I can say will help to alleviate the guilt you are feeling, my dear, but I hope this article will help: Guilt in the Wake of A Parent's Death ~ and be sure to see some of the related articles listed at the base.

Afterword: Thank you so much! Your words did help and what you shared as well. Yes, I loved my father dearly. He was a wonderful person that will be greatly missed. A lot of it is that I’m not educated on the dying process and the medical field. I feel like I’m the only person who has crushed extended release morphine and given it to a dying person. Have you heard of others doing the same? Am I not alone in this? I feel like I should have known or had common sense about it, but I didn’t and the bottle didn’t say either. I did what I thought was okay to do but now I regret my actions. What you shared makes so much sense! I will make sure to read the information you suggested. Thank you so much. I will be forever grateful.

My response: My dear, your question reminds me of Abraham Lincoln's famous statement, 
I do the very best I know how - the very best I can; and I mean to keep doing so until the end. If the end brings me out all right, what's said against me won't amount to anything. If the end brings me out wrong, ten angels swearing I was right would make no difference.
If I could find ten others whose actions matched your own (that is, having crushed extended release morphine to give to their dying father in a sincere effort to ease his pain) I doubt if it would help to relieve the load of guilt you are carrying on your shoulders. That's because the feeling of guilt isn't always rational or justified ~ it just IS, and there is no way that I or anyone else can talk you out of it. You will let go of it only if and when you decide that you have punished yourself enough, that you are NOT guilty as charged and that you are worthy of forgiveness. The only one who can forgive you for this is YOU.

If you feel a need for your father's forgiveness, by all means write him a letter and say all you need to say about this. Tell him why you did what you did and how you feel about it now. Ask for his forgiveness. Then imagine the response he would write back to you. And if you still find that you cannot let go of this guilt, I urge you to schedule a session or two with a qualified grief counselor, or find an in-person grief support group whose members can help you to examine your guilt more objectively so you can come to terms with it. The hospice that served your father should be able to offer bereavement support at no cost to you for at least a year following his death ~ or at the very least, they can refer you to someone who offers such support. I also encourage you to read my article, Grief AndThe Burden of Guilt.

Please know that I am thinking of you and pulling for you. And I've a feeling that your dear departed dad is doing the same.

Afterword: Yes, you’re right. I need to find it in myself to forgive myself-something that I’m struggling with so much. It’s the fact that I read horrible things about crushing morphine (on the internet) that has me guilting myself. That’s the main reason why I’m terrified and why I feel the need to find someone else who has done the same (maybe a nurse or expert that can say they’ve done it and it’s been okay). 

I repeatedly read your response to me about it not being the morphine and how the morphine couldn’t be absorbed at that time since his body was shutting down and it makes perfect sense, but then I remember what I read online and I feel terrified all over again.

I will admit that I am doing a lot better since you replied to me with that response. It calmed my fears so much. About the information I read online about crushing morphine I will have to find a way to understand that what I did for my father didn’t affect him in that way. You are a medical professional with experience with the dying and I can trust your expertise with what you’re telling me. I have no such experience so it’s difficult for me to grasp it in my head. 

Your responses to my question were so full of peace and assurance and they made me feel that it wasn’t a big deal like I’ve been thinking all along. You made me feel like it’s okay that I did that.

You are absolutely right about a support group or counselor. Ever since I let this out of my chest with you it has helped so much. The fact that you believe without a doubt that it was not my fault and that it was the disease that caused his death also alleviates my guilt. I appreciate your genuine kindness and assistance to a complete stranger like me. Thank you.

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