Struggling mightily with guilt

[caringformom]

My dear mom passed away recently after 4 years with lung cancer. When she was diagnosed 4 years ago, the cancer has spread to her brain and bones but she was able to defy the odds. However, during the past few months of her life, her cancer spread to her kidneys and form new ones in her brain. She spent 10 days in ICU during the last weeks of her life with the following problems: acute kidney failure (both of them); infections, pleural and pulmonary effusions; pneumonia. She was put on the bipap machine to help her breathe. Without it, her O2 dropped within minutes and she can't breath. Her platelets were consistently below 10,000. The doctors refused to do any surgeries to remove the fluid from the lungs because of low platelets, said she will bleed to death and doesn't think it will help her because of the agressive spread of the cancer. Also, because her kidneys are not functioning well, it will do no good for the pulmonary edema. They basically told us that the end is near for my mom.

My mom last wish was to be home and not die in the hospital. My family took her home on hospice for the remainder 4 days of her life. At home, she is no longer receiving antibiotics for her opportunistic infections, no more daily platelets therapy and no more lasix to drain her edema. I helped took care of her as best as I can. My mom was unconscious most of the time at home. During the first 2 days at home, she was able to only her eyes slightly at times to recognize family and friends. Those small moments were precious to her and to us as we said our final farewell to her.

During the last day of her life, she has severe hypotension (e.g. 70/40), fevers (101), kidneys no longer produce urine, fluid build-up in her throat and she cant cough to bring them up. Her eyes were dilated and she is no longer conscious, her finger tips were bluish and her lower extremities were pale and cold. Only the upper body parts were still warm. Her breathing was very rapid. We were not able to get any consistent readings on her O2 using the oximeter because the blood flow is not going through her fingers as they were in previous days. No matter how hard we tried to alert her, she doesn't respond. During the last few hours of her life, she bled through her nose and poop everything out. When she passed that early morning, her family was with her and it was special. She was very relaxed and her face showed no pain and she seemed very at peace taking her last breath.

For me, I am struggling very much dealing with the loss. Yes, I love her very much and I was happy that she finally doesn't have to suffer anymore. She was really in pain the past few months of her life and it broke her kids' hearts to see that. Here is the reason why I'm struggling. It's because I am feeling severe guilt of whether I had hasten my mom's death by asking the hospice nurse to give my mom morphine (sublingual: lowest dose) and xanax (lowest dose of 0.25 mg through GI tube) 1 hr after the morphine. I made those decisions because I thought my mom was in pain. Although she was unconscious and couldn't verbalize her pain, I was worry she was in pain based on her facial expressions. My mom passed 4 hrs later that morning and I have been blaming myself for it because I'm thinking the drugs caused her to go. I made those decisions not knowing anything other than that I want my mom to be comfortable. If I was wrong, why didn't the hospice nurse object to it?

After doing more research on the xanax after my mom passed, I was concern that it was a bad idea since her vitals are not good (severe hypotension of 75/47, low pulse of 65). After the xanax was given, the vitals didn't changed much for the pulse and respiration rate but the blood pressure dropped to 71/39 (1 hr after), 70/41 (2 hrs after), and 69/35 (3 hrs after) , and then she died at 3 1/2 hrs after. At 16 hours earlier that day, her vitals were very bad at 69/35, then she improved to 78/45 later that day.

I felt awful because I am convinced the xanax did something to her and push her heart over the edge and she died. If I had known better, I would have not given her the xanax. WHY WOULD YOU GIVE SOMEONE XANAX WHEN THEY'RE UNCONSCIOUS?! Me not knowing that at the time and I made the best decision possible in favor of comfort care doesn't make myself feel any better.

People tried to tell me my mom was near death and it was just her time, that I didn't know so it's not my fault, and it was not the xanax because the dose was too low to kill someone (I disagreed on this part, it may push her over the edge because her vitals are bad already), that my mom would have appreciative all that I've done for her as a caregiver and she would not be upset at me, in fact she is glad she doesn't have to suffer anymore, that it was her pneumonia that eventually stopped her heart/breathing, not the comfort drugs.

Please, doctors out there, anyone??  did I hasten her death? or was it just conincidental she passed 3 1/2 hrs after the xanax?...I'm so hurt by even thinking I have anything to do with it, especially I've been taking care of my dear mom out of compassion for so long...:(

[AHP84]

I'm very sorry for your loss. I've also recently lost my mom to cancer and pneumonia and whatever other infections ravaged her body.
Mammo really said it best--there's not much I can add to it. Please don't let this guilt eat at you like it is. My mother was also given morphine and Ativan (another type of anti-anxiety drug like Xanax) when she was unconcious. The nurses told me it was to keep her heart and breathing rate steady, because even though she was unconcious by what we could see, her brain may still have been alert to what was going on around her without her being able to express it. The only way to know would be her heart and breathing rate, which, if she was distressed in any way, could have taken her life quickly and painfully as she would suffocate.
I was also responsible for making decisions for my mom's comfort care. It is a really tough place to be. All I wanted was for her to be pain-free and comfortable, but that basically meant she was unconcious and non-responsive until she passed away. There is no easy way to make those decisions, and just know that other people, even those who have never suffered the loss of a loved one, won't hold you responsible for the death of your loved one because of decisions about comfort care. I think those of us who are "in charge" of the comfort care are our own worst critics.

[mammo]

I am so very sorry for your loss.  Please know that they would never give your mother any type of medication simply because you asked them to.  They need permission from the doctor and everything is taken into consideration as far as her health is concerned. There are very strict rules and regulations that go along with giving a patient medication and they won't stray from this due to litigation. If they indeed gave her the medication then it was because the doctor knew it would not harm her....their job is to preserve life...not take it.  Please stop beating yourself up over this....you didn't hasten her passing.  Find peace in knowing that your mother knew she was loved and it meant so much to her that you gave her such loving care. Your mother would not want you doing this to yourself and wants you to be happy again.  Losing your mother is tough enough without you feeling as if you hastened her passing.  It truly was just her time to go and suffer no more.  I hope this helps, and we're always here for you...if just to vent or to talk.  Big hugs and take care.