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Dr. Andrew Rynne

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1871 Questions

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Posted on Sat, 5 Jan 2019 in Head Injuries
Question: I already entered it in the first box. I not a good typest will you see it? Should she have gone to the hospital what could be done. I would be a mess to if i could not keep anything down and coughed a lot but. She was very discouraged and when asked if she was in pain said yes. So the gave her morphine. Is this end of life?
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Answered by Dr. Dariush Saghafi 3 hours later
Brief Answer:
Hospice Care

Detailed Answer:
Thank you for your inquiry regarding your grandmother of 94 years old. I understand that you are not necessarily an accurate typist but I believe I've been able to capture the essence of your question which revolves around whether or not she may entering a final stage of life based upon how she has been treated with morphine, etc.

By definition when patients are placed in Hospice Care it is because there is a prediction on a physician's part that they are suffering from a terminal illness and are not expected to survive more than 6 months. Of course, such a definition is approximate at best since NOBODY has the ability to predict exactly when a person is going to expire or exactly when they should be placed into a service of hospice since miraculous turnarounds happen all the time.

If she is aspirating everything that she is ingesting because of some GI disturbance which her doctors have determined is incurable then, it certainly would be very uncomfortable for your grandmother to be having to deal with this situation without some sort of relief. It sounds as if the morphine was given to her to reduce pain but we also know that in the setting of a hospice patient morphine is also used when trying to making breathing distress better. Unfortunately, there is the collateral effect when given in high enough doses to cause respiratory depression which does reduce oxygenation to the body overall....but there is generally less aspiration when given and less coughing.

If your grandmother still retains her own power of attorney over herself in terms of medical treatment then, it is entirely up to her if she would like more aggressive diagnostics or treatments performed. The doctor would not have acted to put her under hospice care unless the durable power of attorney consented. If you disagree with the decision to treat her in this way then, perhaps you can have a discussion with either your grandmother or the power of attorney and come to another point of decision so as to look into WHY she may be having trouble holding things down.

However, as it stands and if today represents nearly a week since she's had anything by mouth then, unless she is being supported by IV fluids (at least) and some kind of parenteral nutrition (unlikely in a hospice setting) then, hospice protocol will keep her as comfortable as possible using morphine or morphine like drugs. They will not perform diagnostic tests of any sort nor perform any procedures thought to be HEROIC such as resuscitation until when she does succumb to whatever the disease process is that has put her in this position.

Therefore, I do believe the use of morphine is for the purpose of helping your grandmother battle pain as well as relief her of the difficulties she is having of breathing and aspiration. However, it is also likely a signal that her doctors and health care team believe she is in the final phases of her hospice stay. If you wish her to be further treated or diagnosed for some underlying medical cause you should speak with her or whomever is designated as her DURABLE MEDICAL POWER OF ATTORNEY.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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