Hospice Nurse Dawn update

Hi to all...this is Kate.

Thanks Tish for the update on Baby Hugo. I love saying that. So glad that all is going well for Amber and John and family. Happy news is a good thing.

I just got a hold of Dawn A. from Harbor Lights. My messages were going into a voicemail black hole...but finally I got her cell phone number and was able to track her down.

Mama has qualified for hospice, and they received all paperwork...thanks to Tish for helping make that happen. So, hospice care will begin this week. Mama was extremely combative during the assessment and was screaming at Dawn to stop screaming. Dawn explained to Mama that she wasn't screaming and Mama began swatting at her. Dawn talked with the staff at length to get a better assessment of Mama. She said that Mama is still mobile (although I haven't seen much mobility when I visit) which means that Mama is not in End Stage Dementia yet...The staff also said that she is still able to feed herself...but that she forgets to eat so they have to encourage her. Dawn said hospice staff will help with that very much when they visit.

Dawn also said that the doctor has put Mama on Seraquil (sp?) to help with combativeness but that this takes 1-2 weeks before it gets in your system enough to really work. The staff told Dawn that Mama is extremely combative with them 90% of the time. I said that Mama was not as combative with us, although she was sometimes...that she did seem to respond to loving interactions in a much calmer way than she did with assertive interactions. Dawn said the hospice staff would definitely be able to be calmer and take more time with Mama just because it would be one on one time with her, while the Forum staff is trying to help all the other residents also. She acknowledged that it would take time for them to build a trust with Mama but she felt it would happen. I told her that we knew Mama could be a real pain in the ass (there's just no other way to say it)...but that she was also a wonderful mother who deserved to have moments of peace in all of this process. Dawn assured me they would help to give her that. Finally regarding Mama, Dawn did say that with her weight loss, and seeming lack of desire to eat, her decline would occur much more rapidly than it would otherwise.

Then I asked her about Papa. She said she had seen him on Friday, and that Denise would be the nurse out this week, and Dawn would see him again next week. She reviewed Dr. Harris' medicine changes and we discussed the Lasix change. She said that the Lasix was originally increased to get the edema under control, which she said they were all in agreement that it had. But increasing the Lasix also brings on kidney failure more rapidly...it is a diuretic. So more lasix...quicker kidneys shut down. Therefore the reason for decreasing lasix was to help the kidneys...and hopefully the edema will not come back immediately. If it does, it will be up to us and Dr. Harris if we increase Lasix again or say this is final kidney failure and stop.

I asked her about how she would manage his pain...because he would probably be on his deathbed saying he was "fine" or "okay". She said they watch for facial expressions, thrashing, gritting of teeth, and several other symptoms and will begin pain meds as they feel they are needed.

I told her about the fall and the gash in the arm...she did not know about that. Part of me really wants to do whatever we can to help Mama and Papa move on to heaven quicker. This process seems so horrible for them...and I just want them to find the peace that I know they will find in heaven. I think we all need to really assess how we feel about medical interventions for both Mama and Papa and be prepared to voice our thoughts to the doctors. I'm realizing that they won't necessarily come to us with the idea to stop any further medical interventions, we will probably need to go to them. Please share your thoughts.

Love,

Kate