As of May 1, 2010...

...Blogger will no longer allow FTP publishing. Updates to this blog, which will probably be few to none, since this section of The Mom & Me Journals dot Net is, essentially, closed by time, can be found at http://dailies2008.blogspot.com. This section of the journal will also remain at in it's domain directory, so accessing links should not present a problem.

Closing out the Practical Aspects of this Journal

    As most, if not all, regular readers of The Mom & Me Journals dot Net know, my mother died at approximately 0709 on December 8, 2008. Although some of the other sub-journals will continue, this journal, if it continues, will not continue in the same form as previously, since it was a reportage of the technical aspects of my mother's life, including daily stats, what she ate, how much she slept, how often she evacuated her bowels and how her medication schedule was upheld or changed on any particular day. As I begin reviewing the more practical journals I may add posts mentioning me noticing peculiar aspects of her life that weren't clear to me while she was alive, but such a review is probably weeks to months in the future.
    Thus, this final practical post is a not to meticulous detailing of her last few days, linking to posts in the main journal that mention how her life wound down:

1. December 7, 2008 @ 00:56:  A review of her condition as and her evening before she slept Saturday night.
2. December 7, 2008 @ 1756:  Includes her arising in the morning, what she ate, what she drank, what meds I gave her when she ate, and more review on how much she slept that day.
3. December 8, 2008 @ 05:18  Includes a review of some of the last meds given to her and what her condition was when I awoke to give her these meds...and stay with her, from then to the end of her life.
4. December 8, 2008 @ 10:00:  Includes a detailed description of her "active dying phase" up to her death.

    I think that should do it. There is a "morphine log" and an "acetaminophen log" that I kept from the time she began taking morphine to her death. Hospice asked me to keep the first log as a reference for them so that they could determine if and when she'd more and how much more she might need. The acetaminophen log was for my own reference, in an attempt to avoid overdosing with acetaminophen. Since my mother died a little over three days after this new phase of her life began, Hospice didn't ask for the logs. I can't see any particular reason to publish them, although I retain them and, if it seems, in the future, that it might help elaborate some point connected to caring for Dying Ones, I may publish them.
    As well, please be assured, I'm continuing to post over at the main site. If you're curious to know what I could possibly have to say now that my mother is dead and our adventure would seem to have come to a firm end, click over there and see.

Non-Stat Day:

Medication Changes:

• 0810: .125 mL morphine sulfate; her breaths per minute were at 24, I needed to run backed up errands and I wanted to make sure that we did not have a repeat of yesterday morning, when she was so breathless that she awakened and began experiencing the middle back pain that goes along with her lungs working too hard. When I returned from errand running at 10:50 she was breathing easily, her breaths per minute were 23, and she was sleeping comfortably.
• None of her regular medications were given. Her morhpine and acetaminophen doses are being recorded in hard copy morphine and tylenol logs.

Sleep:

• She slept most of the day. She was in bed all day. My guess is that she was awake for maybe five hours in all, between pain episodes, recovering from them and awakening for a regular morphine/tylenol cocktail that she received every 2-5 or so hours throughout the day from noon on

Full Stat Day:

AM Blood Glucose:     Time:  0840     Reading:  200	AM Axillary Dig Temp:     Time:  1120     Reading:  96.0
Blood Oxygen:     Time:  1115     Level:  93%     Pulse:  95	Breaths Per Minute:     Time:  1445     Reading:  20
Breaths Per Minute:     Time:  0115     Reading:  28	Breaths Per Minute:     Time:  0135     Reading:  32

PM Blood Glucose:     Time:  2210     Reading:  184

PM Blood Pressure:     Time:  2220     BP:  142/70     Pulse:  79

Medication Changes:

• 0850: 500 mg acetaminophen for middle back pain from labored breathing
• 0945: .125 mL morphine sulfate for air hunger
• between 0945 and 1015, all regular medications except iron
• 1015: per Hospice RN, .125 mL morphine sulfate for continued air hunger and 10 mg furosemide for feet swelling
• 1145: 300 mg iron
• 1700: .25 mL morphine for air hunger
• 1715: 1 Ducosate Sodium pill in order to attempt to head off morphine constipation
• 2220: Probably about .20 mL morphine sulfate (some drops of it squirted out of her mouth when I gave it to her)
• 2245: 325 mg acetaminophen, general purposes, she asked for it, saying she thought it would help get rid of her "coldish" feeling
• 0140: .25 mL morphine sulfate per Hospice RN on call

Food:

• Between 0850 and 1100 ate two pieces of multigrain toast with Fleischmann's margarine and cinnamon and a drained can of Mandarin orange slices
• At about 1715 ate a piece of ham, a boiled egg and 14 oz of 40% OJ and 60% water (this is mostly her normal breakfast; the toast was served earlier in the day)
•  
• At about 2300 ate a piece of Costco Double Chocolate Cream Pie

Sleep:

• Up at 0830
• Back down at 1145
• Up again at 1630
• Down for nap at 1930
• Up from nap at 2200
• Down for night at 0145
• Awake 10 hours

BM Full Stat Day:

AM Blood Glucose:     Time:  1348     Reading:  154

AM 60" Dig Temp:     Time:  1359     Reading:  97.5

PM Blood Glucose:     Time:  2133     Reading:  189

Medication Changes:

• 325 mg acetaminophen for breakfast
• .125 mL morphine sulfate at 2340 for air hunger at 6/lpm
• .125 mL morphone sulfate at 0045 as a maintenance dose for air hunger
• Skipped prune juice because of high BG number in evening

    Bowel Movement:  Occurred during bathing. Excellent volume; good consistency; very easy elimination; somewhat challenging clean-up.
    Dinner:  Grilled cheese and pepperoni sandwich on cracked wheat sourdough bread, 3 garlic stuffed olives, 3 pimiento stuffed olives, 3 sweet peppers
Sleep:

• Awake at 1330
• Down for nap at 1815
• Up from nap at 2100
• Down for night at 0115
• Awake 9 hours

Full But Switched Stat Day:

AM Blood Glucose:     Time:  1457     Reading:  211	AM 60" Dig Temp:     Not taken

PM Blood Glucose:     Time:  2136     Reading:  214

Other Temp:     Time:  0100     Reading:  98.4

Medication Changes:

• 325 mg acetaminophen at breakfast; general purposes and "I don't feel good all over"; I asked her if she wanted it with breakfast and she said "yes"; she, however, refused my offer of acetaminophen or ibuprofen before her nap or with dinner
• Skipped the prune juice again tonight to see if this impacts her high BGs

    About 2 cups sauerkraut and polish sausage; about 3/4 cup loaded (with sauteed veggies) stuffing
Sleep:

• Awake at 1400
• Down for nap at 1915
• Up from nap at 2100; this was a short nap for her but a bout of dry hacking awoke her
• Down for night at 0130
• Awake 9.75 hours

Contents of Hospice Comfort Pack

    At my request, the Hospice RN who visited yesterday went through the contents of our refrigerated Comfort Pack and explained the Hospice purposes of all the meds therein contained. Following is what I learned:

• Morphine Sulfate:  See Morphine Manual
• Acetaminophen Suppository 650 mg:  For difficulty swallowing and/or end-of-life fever
• Haloperidol 2mg/ml:  For nausea or severe agitation
• Ativan (loracepam) 1 mg:  For anxiety, usually, in the case of respiratory patients, due to difficulty breathing; often used with morphine
• Prochlorper 10 mg tablets and 20 mg suppositories:  For nausea
• ABHR:  Suppository for nausea
• Hyoscyam 0.125 mg/ml:  To quiet death rattle at end-of-life; when the RN told me this I immediately asked, "Is this for the patient's comfort or for the family's comfort?"
  "You're on the button," she replied. "It's for the family."
  "Ah," I said. "Then I probably won't be using it. Over the years I've gotten used to a variety of noises coming from my mother. If she's comfortable and peaceful, I can't see any reason to quiet her death rattle."

    Please note, these explanations, above, are not extensive and there is a lot of information they don't include. I wasn't looking for a PDA explanation...merely a thumbnail sketch of why we have them and how we might use them. The RN underlined that before using any of them, at least for the first time, I should always contact Hospice for approval and direction, and, of course, I will.