If it does not bother them, why did my mom try so hard to get me to get rid of it?
I have used this site so much in the past four months while caring for my mom. I always found great info. Ironically, I have a question since she died a week ago, but I can’t find an answer to. My mom, who was 85, had managed COPD and a reoccurrence of breast cancer which caused a pleural effusion which is what set off her sickness. Everything seemed to happen after that, one problem after another. Up until late January she lived at home by herself and we visited often and she was able to go without using oxygen sometimes for several days and sometimes just to sleep. When she was hospitalized with her effusion she had no physical therapy, so began the four months of her not being able to get around and me staying with her. She ended up back in ER 2 more times for draining the effusion, and then again for dehydration (they gave her lasix with no fluids so she was back in 4 days!) we were talking to palliative care nurses from her insurance company who were guiding us because her own doctor was useless. We spoke about putting her on hospice care and were getting ready to make decisions that weekend. She did have bronchitis when she got home from the hospital 2 months ago but antibiotics and prednisone cleared that up. She had recently, in the past month or so started having excess saliva and reflux. Mylanta, seemed to help that a bit. However, she had a UTI and was on an antibiotic before she passed away. So I had not given her mylanta in a few weeks. She was very weak and did not like taking pills. (although she did have to take a couple a day) and she was able to eat and swallow solid food. She was getting weaker and weaker and could not even stand with help. The night before she died she had some phlegm in her throat that had been bothering her and was trying to cough it up but she was in a new hospital bed that made it hard for her to sit all the way up. So I had tried to help her. But she had a hard time. I gave her albuterol in a nebulizer, I gave her Vicks vapor rub, I gave her herbal tea that usually helps clear her passageways. But nothing was really helping she had a kind of restless night. She would fall asleep for a little while then wake up coughing. In the morning I went and bought her children’s Mucinex in a liquid form because the pills she had were so big that when she tried to take it the day before she coughed it up. Anyway after she took the Mucinex and a prednisone (which she did have a hard time swallowing but she did finally swallow it and drink plenty of water with it) we watched Sunday mass, and my sister came to the house and we all sat together in the living room. And my mom seemed to fall asleep. My sister and I sat a few minutes talking on the couch and we looked over and realized that she had stopped breathing. I know we are blessed that it was peaceful. I am haunted by the 4 months of her suffering. I am so sad she had to be aware of herself deteriorating. But mostly, now that I am aware of “death rattle” and the excess phlegm that starts about a day before death, I am guessing that’s what the “phlegm” was. But she was literally begging me for anything to get rid of it. She was sometimes able to cough a little, and I would say “anything good?” And she would look at her tissue and say, “good but not good enough”We were trying everything. Even though she seemed asleep when she passed, did the phlegm just choke her? Was it normal? My sister thinks prednisone pill called her down, but I can’t imagine it worked that fast. I can’t help but feel like I failed her because I didn’t know how to position her properly to cough? I had the bed all the way up, 3 pillows behind her, etc...I was literally thinking the past 2 weeks, “ can you die from not being able to cough up your phlegm?” Do I sound nuts to care at this point? I can’t get it out of my mind.
I'm sorry for your loss. I understand how that rattle could haunt you; it did for me a long time. The hospice nurse for my mom years ago explained it to me when I asked about it, as I heard it and thought I knew what it was but wasn’t certain how many days she had left. I was told when the rattle comes, it’s usually 2-3 days prior to death. It’s from aspiration of fluids, the body’s inability at end of life to properly swallow anything from food to medication. Everything builds up in the “windpipe” and the sound begins. There is literally nothing you could have done to help other than possibly suction, as was suggested in another answer, but as she was a COPD person, that could’ve traumatized her too, feeling the wind being pulled from her. I’m sure just like my father now (who has COPD not dying yet!) she just thought coughing up the crap would be better, make her feel better because it worked in the past. As far as the pills, the hospice nurse should have told you to crush all her meds or should have provided IV medication or even sublingual medication that she wouldn’t have to swallow. I did my best to clear her throat each day, tried to find the correct angle to help her swallow her crushed mix of meds (even massaging her throat to assist) but even in the end, matter came up after she passed.
When she started gasping for air, my dad tried to just boost her oxygen but I knew she was trying to leave and I gently moved him aside and turned it off. I told him, “She’s trying to go, Dad. You have to tell her it’s ok to leave us.” So he did, we both did and she flew away free from this mortal realm. My dad questioned the hospice nurse when she came, she was attending another end of life before ours, and she said that “your daughter did the right thing, she would have just continued to suffer.”
There are always dozens if not hundreds of ways we question what we could have done differently for the person we cared for; it’s survivor’s guilt and sometimes counseling helps and mostly it just takes time.