A Question for OncDoc about pulmonary embolism

[NowakowDA]

I don't want to bother you with a trivial question but something has been eating at me since my mother died two months ago today. I have come to believe that as a result of actions or my inaction I contributed to my mother's death.

My mother died on Thursday, July 29th of this year. Every since that event, I have been reliving her last night in my mind over and over again. I am my mother's only son and I was her sole care giver during her illness. She was diagnosed on June 3rd after an xray taken on May 22nd showed a mass in her right lung. It was inoperable. An MRI on June 20th revealed that she had two tumors in her brain. She had fifteen WBR treatments and was due to start radiation treatment on her lung on Friday July 30th. She was on 4mg of Dexamethason twice a day from June 20th till the end of her wbr treatment on July 20th. As her wbr treatments drew to a close, Mom started going down hill rapidly. She was very weak. She slept most of the time. Toward the end she could not get our of bed to go to the bathroom or even use the bedside commode. She suffered from confusion and a mild delirium (sundowning). She went on hospice care on Friday July 23rd.

The last couple days of her life she was barely responsive and could not walk or even stand up. On Thursday they 29th, she would not eat or drink anything. She had a blank look on her face and could barely speak. She spent most of Thursday in bed, but early in the evening she wanted to set in her recliner. About 10:00 PM I was going to put her back in bed. When I started to lift her up she went limp and I almost dropped her. When I got her into her bed I noticed she was breathing rapidly but shallow. She seemed upset and a little agitated. When she got like this, it usually ment she had wet her lined paper under pants. I proceded to cut of the old paper garment and put a clean pair on her. When I turned her back over, I noticed her breathing had changed. She was now taking very short shallow breaths. I also heard a rattling noise in her chest. I raised the head of her bed so she could set up. The hospice nurse gave me two medications to give to her if her breathing got bad. The first was a small pill called Lorazapan (not sure about the spelling). The second was a liquid form of morphine. I was to try the Lorazapan first and if that did not work then I was to give her the morphine. She was clenching her jaw so tightly that I could not get it open to place the pill under her tongue. I was able to get the liquid morphine in her mouth. While I was waiting for her breathing to slow I called the hospice emergency nurse. While I was talking to the nurse I noticed that Mom's breathing had slowed but a change came over her. She looked like a fish out of water gasping for air. After a few minutes she got what I thought was a look of anger on her face and shortly after her breathing became very shallow and stopped. I could find no pulse either in her wrist or neck, then the was gone

I waited for over an hour for the hospice nurse to arrive and pronounce Mom dead. While waiting, I got Mon dressed. The nurse said that from the description I gave her it sounded like Mom had a massive pulmonary embolism. What I thought was a look of anger, the nurse said was probably pain. From the time I first noticed a problem until Mom died was no more then 20 to 30 minutes.

Since that night I have come to believe that my actions or my inaction caused the attack that took my mother's life. I am convinced that it started when I picked her up and put her in her hospital bed. If I had not tried to move her that night, she would not have slipped from my grasp. Instead of catching her, I should have let her slid down to the floor and put a pillow behind her. If I had done this she would not have had to under go the stress of being picked up and put into her bed. Had I called 911 instead of hospice when I noticed the her breathing was getting worse, she might not have died that night.

When I brought this up with Mom's PCP (primary care provider) he said that if it was an embolism, then it didn't matter if she were at home or in the emergency room. If the embolism was massive enough, then it was going to kill her. As for moving her. He said that all I did was make her last few minutes more comfortable. He told me that it was her time to die, and there was nothing I could have done to stop that. Mom's regular hospice nurse told me that I should take some comfort in the fact that Mom died at home where she felt safe and comfortable. She said that this was better then dying alone in a hospital hooked up to a machine.

Despite what I have been told. I am still convinced that I hastened the on set of my mother's death, and that is a terrible thing to realize.

[john]

I would talk to a grief specialist. It was probably diffcult since you happend to be there when she passed. It surely wasnt your fault and I am sure your mom was grateful you were there when she passed versus a cold hospital room without any family.

[Guest bean_si (Not Active)]

I most heartfully concur with John. Be kind to your soul - see a grief counselor. This isn't oncodoc's jurisdiction. Also, as much compassion as the people here have, we can not give you what your mind, heart and soul need.

TLC,

Cat

[Kel M]

I want to add my voice to what everyone else has said - do seek some assistance in talking about your feelings of grief.

I also want to add that my Mom recently suffered a pulmonary embolism. She deteriorated rapidly. She suddenly had a hard time breathing and a few days into it, she couldn't eat, she had no energy to get out of bed and she became violently ill.

She minimized her symptoms to the point where the situation became very critical before any action was taken. To be honest, none of us saw what was coming. She was almost done in by this thing and I never could have predicted how severe it really was.

My point after this long ramble is that, as caregivers and not doctors, we did the best we could and we happened to get lucky - she pulled through. Know that you did your best to help your Mom and to keep her comfortable. Be proud that you were able to be there for her - it was no doubt a great comfort to her.

You are in my thoughts and prayers. Keep the faith!

Kel

[kim]

I would like to say to you that as a hospital caregiver I feel that you did everything like you should of. Your mom was with you, and not in a hospital bed. She had someone who really loved her taking great care of her. I know you can't see this now, but you were very lucky to be there with her in her final moments. I see so many people in the hospital who die with no loved ones with them, and I just pray that I'll be there for my parents when it's their turns. You are dealing with some very hard emotions, and talking to someone might help a lot. My prayers are with you! It's never easy loosing a loved one. If it was then you never would have loved them at all. She suffers no more and you were there to see on to her next journey.

God Bless,

[Justakid]

You can not blame yourself! You were there for your Mom and did everything you could. I know it's hard not to 2nd guess yourself, but don't! You are a wonderful person and were there for your Mother! She was with you at home when she passed, everyone should be so lucky!

Your in my thoughts and prayers.

[paddy]

I suggest you read "Crossing the Creek" . If you put in a search you will find the website. (I would do it for you , but I am having to hurry tonight ) This site will not only will reassure you that your mother's dying process was natural and you did not in anyway speed her passing, but will also help you understand the stages of grief. Paddy

[Fay A.]

(((((Don))))))

Don, I KNOW that my brother and I did not hasten our Mother's death. But at the time she died, and for a long time afterward we would ask ourselves "Did we do the right things? Did we hasten her death?"

I made my Mom's food. Cooked it, pureed it. Put it in forms that made it easier for her to swallow and hold down.

The day before she slipped into a coma she aspirated some of what I had made for her lunch. I blamed myself for months. Intellectually I knew that my Mother aspirated because the cancer had spread from her lung into her throat. We all knew that this had happened,including her. It affected her ability to swallow. She choked on liquids and solids and semisolids. But I tortured myself for a long time....If only I hadn't served her the pureed food at that time.

I hope with all my heart that you are able to come to accept that you didn't kill your Mother. Lung Cancer did.

I'm not a physician, but I don't think that you can cause a blood clot to form by picking up someone, or grasping someone in the way you've decribed.

You did well by her, Don. I hope you can find peace soon. You deserve it.

[kimblanchard]

My condolensces on your mother's death and the pain you are feeling for her loss. I'm sure it meant a great deal that you could be with her at the end. As far as the ultimate cause of her death, no can can say for sure what the terminal event may have been. Cardiac arrythmias or airway occlusion could have caused similar symptoms. If it was an embolism, I very much doubt that you moving her would have dislodged the clot, very likely happened spontaneously. You have absolutely no reason to blame yourself for that.

I hope that your grief can eventually turn to peace and happy memories of your lost loved one. She was obviously blessed with a loving son.

[ellakc2]

Absolutely was not your fault. Your mother was so lucky to have such a

loving son. And believe it or not it is a blessing for you to be there when

she passed. My dad passed five yrs ago from cancer and went in a similar way. I was so glad to be there, now that I look back. Grief is soo

oo hard, but please don't blame yourself. Your mom would not of wanted

that for you. Take care.

[babesdaughter]

I had a very similar situation with my Mom. They suspected that she was experiencing superior vena cava syndrome. The day she died, I had the day all planned out. The CNA was coming to help me get her bathed and dressed. Then I had made arrangements with a hospice volunteer that is a massage therapist to come in and give her a good foot and hand massage. I'd sent the kids off to lunch with my credit card (okay, maybe the plan wasn't perfect).....and they we were ready to have a wonderful day.

The CNA had finished giving her a bed bath and we sat her up to change her pajamas....she slumped over and very rapidly deteriorated and died about six hours later.......I have played the scenario over and over in my head and wondered if us sitting her up is what caused the problem that eventually caused her death.....I've wondered if I would have put off the CNA visit a day if things would have been different.....if we would have just let her lay (basically, like she wanted to) then we may have had her with us longer......

I've finally come to understand that it doesn't matter.....if it did cause a problem, then the problem was inevitable. If it didn't happen that day, it would have happened the next or the next.....LUNG CANCER took my Mother's life....not my action, inaction, reaction or whatever action.

I know that I what I did for her that day and everyday, was done with love and respect......there is NO WAY that I would have knowingly done anything to compromise my Mom's health or provide care that was anything other than what I believed to be the best for her.

You know in your heart, Don, that you are the same way. You adored your Mom, as I did mine. We are heartbroken to be without them and would hit the rewind switch in a second if we could.....but we can't. And so here we are....the doubts and questions will linger for a long time, to some extent maybe forever....but the bottom line is that our Moms were very, very sick. We did the best we could and the rest was in God's hands. You will be blessed for the care you gave your Mom....I already have been.

I wish you peace.