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It's been two weeks since the oncologist said she had at most two months to live. I can see dark veins appear going up her torso toward her chest. Due to the doctor's assessment we were told to go to Hospice care despite having an appointment to see the oncologist out-patient to consult and start immunotherapy.



Now, a week later, she is barely communicative with 6mg Dilaudid at every couple hours or so and 200mcg Fentonyl. The staff is great, compassionate, but she looks SO MUCH WORSE here than she did before, as if we're speed running things. Her pain is unbelievable, searing her mind to just screaming, but at the hospital they didn't just stick to dilaudid. Her confusion and respiration is scary. She can't breathe well due to apnea already and the Hospice will NOT provide a C-pap or something to help her breathe despite so much pain meds making her literally heave for air amid her drowsiness. They also won't provide toradol which helped a lot and could diminish the dilaudid needed and fent.



I'm hoping to see what I can do over the phone and if I must see my mother die this week as the doctor suggested then fine, but I don't want to be responsible for making her suffer or losing a chance at better palliative care.



- I can pull her from hospice and bring her to the hospital but they won't provide the intensity of pain meds and she'll be in a horrible state. Plus immunotherapy is entirely out-patient so I couldn't get it started without a friggin appointment first! (It's Monday tomorrow and our appointment was for Wednesday).
- If I leave her here as-is she will definitely suffocate in her sleep at some point, unable to really communicate with me as I stay here with her, unable to attempt immunotherapy.



What would you do?

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EDIT 1: "The doctor's decision" by the way was not the oncologist's decision but Internal Medicine

EDIT 2: One of the nurses, a charge nurse, came in with a rebreather. She says if it does not work then she will begin the arduous process of getting a cpap or bipap or something. She actually did something thankfully. Very sweet woman. Unlike the doctor.
Still, the dilaudid is what's causing the confusion and dangerous breathing. She NEEDS pain meds but like this? And I'm still uncertain if we can't do immunotherapy... It was her last and only chance
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I wouldn’t put her through immunotherapy. I’d do whatever I could to help her pass peacefully. I’m very sorry you’re going through this.
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LastSon Jan 28, 2024
Thank you for responding. I deeply appreciate it. It's just so hard when the chance of SOMETHING was dangled in front of me like this only for...all of this to happen.
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I'm so sorry. The ultimate choice is not yours, it's your mothers. The sad reality is that even young women die from breast cancer and chasing unicorns at this point is unlikely to alter the outcome for your mother. F*** cancer.
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I would ask for morphine to help ease her breathing and be with her as I needed to be.

Is hospice not giving her oxygen? They should be and it is allowed.

May The Lord be with you during this difficult time and give you strength, guidance and peace. I am so sorry that your mom is dying so young.
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Hospice will provide an oxygen concentrator for any patient needing it as part of their services, so not sure why your mom hasn't been put on oxygen yet. That makes no sense to me.
Morphine is supposed to help people breath better as well, so talk to your moms hospice nurse about that too.
The purpose of hospice is to keep someone as comfortable and pain free as possible until they die, so if they're not doing that, call whoever you have to to make sure your mom can die in peace.
You can also ask to have your mom brought to the hospice home where they will be able to administer stronger medications to allow her to die in peace. The hospice homes are beautiful and peaceful and if mom dies within the week, Medicare covers all costs 100%.
It's only if your mom would linger on longer than a week that you would then have to pay out of pocket for her to stay there.
I'm sorry that you're losing your mom at such a young age, but at this point I don't believe there's any going back now.
May God bless you and keep both you and your mom.
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LastSon Jan 30, 2024
The new hospice charge nurse last night provided a rebreather thing that works pretty well. They want to avoid the arduous process of getting a bipap because of how uncomfortable it would make her. I wish they would give her IV nutrition though
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I would see to it that the Hospice bumps up the level of pain medication until your Mom is in a comatose state, below the level of feeling pain and below the level of dreaming. There are drugs to do this. I would DEMAND that she be out of pain even if it greatly hastens her death.

I am a retired RN. Were this me this is what I would want my child to do for me.
Hospice is already on board. I must assume, if your mother was able to discuss it, she welcomed it. They now need to DO THEIR JOB and give your mother comfort, even if it hastens her death.

This is no time to be considering more torment for her in treatment. That is my personal opinion despite her youth. I have to believe that Hospice didn't come on board when there was any real hope of recovery or wish to try for it by your mother.
I am dreadfully sorry for this for you, but moreso for your mother, who isn't being spared pain in the manner she should be by her hospice.
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LastSon Jan 30, 2024
I suggested this multiple times but she refused it. She doesn't want to hurt anymore but she also doesn't want to be put unconscious like that. She prefers enduring the pain in the brief moments she's awake because she can see family and friends visit. Sometimes the pain isn't so bad, until it is, and other times she is all but gnawing moans and suffering.

In this, too, I have to honor her wishes. So long as she has her mind, despite what the pain does to her, I can't go against her, and in a cruel way I am glad for her adamant decision on this because I can tell her I love her and she can smile even amid the moaning.

The hospice is doing better for her now that another doctor replaced the previous one. The situation is a living nightmare but they're doing better.

Thank you for your forceful empathy and consideration. I could feel your frustration for our sake. God bless you.
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Here goes. I was 65 when I was diagnosed with stage 4 metastatic melanoma. It was in my liver, lymph nodes, spine and bones. The excruciating pain in my ribcage brought me to the ER where a CT scan showed the cancer. The oncologist said I had 2 months to live, if that. He offered me immunotherapy, a double treatment at one sitting, scheduled to take place 2 days later. A total of 4 infusions was the goal. He said my immune system would be ramped WAY up by the drugs, and would either kill off the cancer, or it wouldn't. The immunotherapy WOULD kick my arse, he said, in the way of side effects he could not say which ones would affect me, just that they WOULD. I was in agony. He gave me Oxycontin and Mophine and Zofran for nausea. I decided to go for it. What did I have to lose?

I went back 2 days later for the immunotherapy treatment and spent the next 2 weeks in bed with a fever of 102 and an unquenchable thirst. But I noticed the pain was gone within a week!

3 weeks later I went in for my 2nd infusion which left me very dizzy with vertigo, so I had to stop all immunotherapy at that point.

My PET scan the following month was clean. No evidence of cancer.

I've been cancer free for 11+ months now. 1 or 2 infusions worked for me. I can't say (nobody can) if immunotherapy will work for your mom, but the answer is definitely no if she doesn't try.

I know how hard and scary and terribly upsetting this is. I am sending you a hug and a prayer that you both have the courage to make the right decision for your mom, whatever that decision may be. God bless you both.
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LastSon Jan 30, 2024
God bless you and I am happy to hear it. But this is what drives me insane!! My mother is a candidate for immunotherapy but she needs an intense amount of pain medicine just minutes after waking up. Dilaudid 10mg shots with Benodryl and 15mg Toradol. She can drink and speak after I had them lower the fentonyl but they won't give her TPN (her bowels are too obstructed to eat).

I don't understand. Every doctor I mention this to gets a pause like "Oh, she coulda done immunotherapy? Oh well..." and then tells me she's gonna die soon. The damnable state of things... If I had Bill Gates money I could hire oncologists to come to our house with hospice care and just do everything in-patient or something! All these doctors needing "appointments" she could never reach, and that she needs IV nutrition and the hospice won't give it since it's "life prolonging" or whatever...

Ultimately though she is coherent, despite moaning in pain whenever she is awake. I told her I would find a place, I'd do ANYTHING to get her somewhere that would consider in-patient immunotherapy with palliative care.

My mom doesn't want it. She is in so much pain and so tired, so deprived, but after struggling for so long in hospitals she finally told me recently to "let her go".

I have the legal authority, I have the love, but as much as it kills me and ends my world I also know that I don't have the right. I can't imagine what this pain of death is like. I don't count her a quitter, and I'm glad you didn't suggest such either.

I am mad with grief but I will remain at her side doing all I can until the end. I love my mother very much. I would have no family or friends if not for her. All I have is because of her. I would rather spend the rest of my life taking care of her rather than lose her, despite our faith in Christ and knowing her eternal happiness. She was never my burden, only my blessing. She says she knows this. She says she doesn't want to hurt anymore. I am broken, but what can I do? There is no miracle doctor willing to go out of their way for her and she has made her decision even before such a thing could be found.

Please value every day of your life. May God bless you. Listening to my mother's night pains scrapes my soul, but at least I also hear her sleep and dream, and when she awakes I am here for her. I don't know if that's a blessing or a trauma. All I know is that I am here for her to the end.

Thank you. ANd thank you ALL for posting and replying. I cannot fathom such a wonderful supportive forum. God bless all of you. Thank you so much. Even though we're just words on a screen, your comments and opinions have helped me not be alone. Thank you.
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I'm so sorry to hear what you and your mother are going through. Opioids are not good for the immune system (I absolutely understand why she is getting them now and I'm just commenting) I'd be curious what an immunologist would say about this combo if she started-it would be counterproductive.

Also, qualifying for immunotherapy requires a certain level of health, given what you describe I wonder if she would still qualify. Immunotherapy side effects can be brutal.
I know how difficult this is, I have done it but please honor your mother's wishes to to "let her go" she is being clear and direct with you. Please don't make her struggle further.
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lealonnie1 Jan 31, 2024
An oncologist administers immunotherapy, not an "immunologist". Opioids are always given in conjunction with immunotherapy and chemo to control cancer pain and are not "counterproductive " to treatment.
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My son's bone cancer met pain (supposed to be the most painful way to die) is being handled by methadone with hydromorphone (Dilaudid) for break out pain.

Fentanyl was okay at first, methadone has done better.
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While on Hospice "curative" treatment can not be administered.
You can elect to discharge from Hospice, consult with the oncologist and make a decision from that point.

Your mother should NOT be in pain. If she is experiencing pain then Hospice needs to step up and try to alleviate the pain.

My heart goes out to you but I think from your description mom may be past the point where a curative treatment will "cure".
I also think that the treatments will cause her stress, pain for no good outcome.

Doctors want to push the treatments because they are taught to "cure" they do not know how to let a patient, a person die with peace. There is a lot to be said for the "quality" of life VS the "quantity" of life.

((hugs))
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LastSon Jan 31, 2024
Thank you so much. The first time in my life I practically felt a hug via text. Your opinion and compassion are unspeakably precious and help me, as many here have. Thank you so much again. ((hugs)) to you too. I promise to do all to help her have peace.
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Your mother has made her decision according to what you posted to us below. She has said "I don't WANT it".

I will tell you right now, that I as an 81 year old woman facing down my second bout with the big C would haunt forever any child of mine that went against my wishes to be allowed my final exit from this life. I think it is cruel to do so. And I think it is cruel to argue it with your mother. She has already TOLD you her wishes. Please honor them without questioning and without argument.

People stay mired in woulda/shoulda/mighta in order to avoid the hard work of grief. That is now unavoidable. Please encourage hospice to medicate your mother below the level of pain and dreams and please support her wish for relief. WE ALL DIE. She is dying. Please support her without questioning.
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LastSon Jan 31, 2024
Don't worry. I accept the painful reality and honor my mother's last wish.
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I would talk to the Oncologist and get their Opinion on hospice and the drugs Being administered . There is a 20 % chance of recovery with immunotherapy . What are your Mothers wishes ? I Know when I was in Pain I was given Morphine with No adverse effects .
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AlvaDeer Jan 31, 2024
OP has said below in response to other queries that "she does not want this" meaning the immunotherapy. Like many, according to grief counselors, families wish to blame doctors, treatments or lack of, anything to avoid the walk toward grief, which is so final and so devastating. I hope this OP honors his mother's wishes, or I feel he will have a lifetime of regret for not doing so.
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What would I do? I'd have a long talk with hospice. If your mother is supposed to be on comfort measures that means exactly that. Pain meds, anti-anxiety meds and anything else that they may want or need to be out of pain.

My father was in hospice. I still gave him drinks and food because he wanted them. A person does not have to die of dehydration or starvation so as not to prolong their suffering. If your mom needs some oxygen they can give it to her. If that has to be done through the hospital she can go there.

If your mother has made a decision and is unable to communicate now, it's up to you to make sure it gets carried out.
You're not to blame for making her suffer or for depriving her a better chance at palliative care.

Your mother decided what she wants now. Is she a religious woman? Now would be the time to bring in some clergy of whatever faith you are so she can get right with God.
My friend, I've worked many hospice cases and this can be a real comfort to a person.

I am so sorry for your situation and I hope your mom goes in peace.
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I'm so sorry your mom and you are suffering through this horrible situation. The only thing I can add is that my mom is in hospice with respiratory failure, and they are giving her the opioids to EASE her breathing. It is not the opioids causing your mom to gasp for air, it sounds like, if anything, she is UNDER medicated.

My mom is also receiving benzodiazepines (minor tranquilizers) for her breathlessness and resulting anxiety. She is still coherent because she is not at the end of life yet. However, when the suffering gets too great, I was promised that mom would be given a high enough dose that she would basically be asleep through it an not suffer.

I know this is a different situation, and idk if you have fully made the decision about immunotherapy. But if your mom is not going to be receiving anymore curative treatments and she is at the end of life, I would insist that they give her enough pain and anxiety meds so that she does not suffer. That is the whole point of palliative care and hospice. God bless you.
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LastSon Jan 31, 2024
Your suggestion is what we are doing already, don't worry, and thank you. I hate that anyone else is suffering similar to what I am now. I'm sure you love your mother very much and I'm so sorry you have to feel this pain of losing her too. I will pray for you and your mother, that you have the peace and grace and inexplicable comfort through this. I hope and wish only for your best through this nightmare.

God bless you, sincerely. The difference in our situation doesn't compare to the exact same pain of loss we endure. Thank you for replying.
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The contradiction here is that in one of your responses that she refused this therapy. You say she cannot breathe but IS SHE COMFORTABLE? Do not confuse end of life breathing with lack of comforting medications. I have worked with many patients who have switched from a rule of rescue to a rule of comfort care. I have asked about need for oxygen however there are studies in the palliative world that indicate oxygen can be used for the feeling of shortness of breath but does not change the trajectory of the apnea episodes or labored breathing. You have already mentioned in several of your responses that if allowed to wake up, she will be in tremendous pain. Please re read my first sentence. I suggest that you seek the help of the hospice grief councellor.
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LastSon Jan 31, 2024
The posts are not updated specifically. I'm sorry. Yes, she was having trouble breathing but now she is comfortable with the new medications being given and she was given a rebreather mask in case she has too much trouble breathing at night. She is barely conscious whenever she is awake due to the intensity of the medication, but I realize that if I were to diminish the medicine she would literally start screaming mindlessly from the pain, barely coherent.

As of now the hospice, with the new doctor, is being gentle and attentive to my mother. It is hard for me to watch this unfold as I am living here in the room with her as the process proceeds until she is inevitably passing. My emotional state aside, I acknowledge that were it not for the magnitude of the medications she would be in horrific agony, and thankfully the new doctor has sorted the medications such that they are continual, effective and keeping her comfortable until I am forced to say goodbye.

I know of hospice horror stories, of patients being drugged to death etc etc But I saw it first-hand that my mother literally cannot be awake for long without the pain of death ruining her. I saw it myself, every day, how the staff NEEDED to increase the dose of dilaudid to try and chase the pain. The new doctor was wiser and suggested adding Benodryl or something to amplify it's effectiveness. It works. However without any of this my mother would just exist in suffering. And her breathing is better on this combo of meds, too, it seems.

Thank you for caring enough to want to get a clearer picture of things. Thank all of you and God bless you. As stated before, my mother's condition has declined rapidly, faster than doctors expected, and while she was still able to speak she reassured me and held me to a promise of this: let me go, and don't let me suffer as I go.

I am keeping that promise. I am encouraged by all of you here, both with forceful concern and tender sentiment.
Thank you.
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As hard as this is, I believe mom is making the right decision LastSon. While immunotherapy worked for me to get rid of the cancer for now, it also left me with an audio vestibular toxic reaction that seems to be permanent. Unrelenting and severe vertigo/dizziness and a loss of hearing, with very loud ringing in my ears 24/7. And an iris inflammation in both eyes that won't go away. So, nothing is free. And there's no "cure" for stage 4 cancer anyway......just a chance to live longer. But at what cost, is the question? I can get around some now, but for 10 months I was chairbound or bedbound, questioning if I should've even HAD those 2 treatments?

I wish you peace and acceptance, and the knowledge that you've been a wonderful son to your mother in her time of need.
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LastSon Feb 1, 2024
God bless you so much, Lealonnie1. I deeply mean that. I hope that you are able to enjoy life despite the suffering after effects, and know that your care too has helped me a lot just as the others'. I really appreciate your words.

I lived with and adored my mother, taking care of her every day for the last two years until now. We had been separated previously due to my Crohn's issue needing a doctor from NY (I still had NY Medicaid at the time) but I can be grateful for the time I had with her before this. Thank you.

I love her forever, and I know she loves me.
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I am so so sorry for you and your mom. 66 is young.
The very best any of us can do is to be present for our loved ones and minimize their suffering. You are doing both. I hope you have some support for your grief.
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Hello Lost Son,
First, I just want to send all my love to you and your family.

My mom was just released from the hospital 4 days ago with terminal metastatic colon cancer. She was first admitted New Year’s Eve because she could not stop vomiting. The doctors placed a naso gastric tube to help empty her stomach and a parasentisis to help clear her ascites. The initial plan was to get her strong enough so she could go back on chemo, but after a couple of weeks, her doctor said that she was not strong enough and discontinued chemo treatment. Her oncologist says that she’s not a candidate for immunotherapy; and my family and I continue to wonder whether or not we should seek a second opinion, but we don’t want to put my mom through more hell.

She was in the hospital for 44 days, dealing with a naso gastric tube that is emptying the contents of her stomach that causes her incredible pain in her throat and made it very difficult for home health companies to want to take her due to the inexperience with this naso gastric pump (which now my family and I have become pros in) as well as the risks of aspiration and infection.

Unfortunately her surgeon informed us that she was not a candidate for a gastric bag due to her distended intestines and ascites. So after WEEKS of waiting for our hospital to provide us with a naso gastric pump, that helps keep her from vomiting, we finally were able to find a hospice that would take her.

Right now, she is on a hybrid mix of palliative and hospice care and is receiving TPN, but it took FOREVER for us to find a home health company that would take my mom’s case with the naso gastric tube and the TPN. Most of these companies seem to not want to offer TPN for terminal cancer patients as they think it’s just prolonging life, or that it’s pointless and I also am not surprised to learn that there is no financial benefit to them to offer it in these cases.

My family and I have been going back and forth deciding whether or not we should go for a second opinion. Right now, my mom is still lucid and her pain is fairly manageable and coming mostly from her tailbone pressure wound she got in the hospital and of course the occasional surges of pain and discomfort from her cancer that, for the time being, seems to come and then go quickly. My mom is avoiding taking the morphine and Ativan hospice has provided, and absolutely does not want to die. The fear and anxiety is tremendous.

I write all this to share my compassion with you and tell you that you and your family and your beautiful mother are not alone. I believe that all we can do is ask our loved one who is suffering what they want and continue to check in with them as their condition changes. In my opinion, once the physical suffering and pain becomes so great, we have to push tooth and nail to get hospice to provide more powerful pain medications and do THEIR job! You do have the right to switch hospices at any time.

This cancer is a NASTY and painful disease. I am continuously shocked everyday by just what exactly is going on in my mom’s body and all I want for her is to have peace and comfort.

I’m hoping that while my mom’s pain is still manageable and she is still lucid that she can speak with her therapist and maybe an end of life doula/specialist about her fears and anxieties around death.

i don’t know about you, but this whole experience has taught me to plan my own death the best that I can, and begin the work now considering end of life wishes as well as my relationship to death. It breaks my heart to see my mom experiencing so much anxiety and fear and though I know this is totally normal and I’m SURE I will feel the same way when it is my time, I just hope that I can have some sort of plan in place to help guide me and my mom through these fears.

Finally, our healthcare system in the US is total sh*t. I can go on and on. My mom’s hospital appealed to Medicare to stop covering her hospital stay b/c she is terminal. disugsting
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Please understand that every life has an end. Some people die very young and others last until over 100. But we all have to die. I would stay with hospice to make your mother’s last journey as comfortable as possible without grasping at straws. I understand you wanting to hold on to her but what you are seeing is the dying process. I am sorry that your Mother is dying but don’t succumb to unusual methods to keep her alive for only a short period of time.
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Make your peace with it, make her comfortable and let her go. I’m sorry.
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