Filed under: Alzheimer's, Daily Kos, Failure, Health, Hospice, Predictions, Sleep
“What’s wrong, MIL?”
She’d been restless most of the afternoon, but each time she called or squirmed enough to prompt me to investigate, the most she had been able to tell me was that she was “uncomfortable.” I tried to tweak her meds a bit, but I suspected that the duragesic patches which are supposed to be good for 72 hours were running dry half a day early.
She took a sip of water from the straw I held to her lips. She swallowed, then said: “I was just worried.”
“Worried? What are you worried about – maybe I can help?”
“Well, I think I need to go shopping.”
“Shopping?”
“For clothes. For when I take the train back to college this fall. I won’t have time to shop once I am there.”
* * * * * * * * * * * * *
My wife had been napping. These days, each of us does what we can to get enough sleep, whenever we can. Because while I write these entries about what I have been doing in caring for my mother-in-law, be assured that my wife does even more in caring for her mom. So we watch out for each other, try and leave time for napping.
When she came down, asked how her mom had been doing, I told her my suspicions about the patches. We’d seen evidence previously that they ran out a bit early for my MIL – everyone has a different speed at which they metabolize medicine, even something as supposedly stable as a transdermal patch. She agreed with my assessment, and we changed the patches 12 hours early. At worst, the hospice might complain that we had made a mistake, and not to do it again.
I didn’t care about that, and I wasn’t sure that it would matter – that the end would probably come before we had to worry about a new Rx for the patches.
* * * * * * * * * * * * *
It takes a while for the painkillers from the patches to saturate the system – there’s a ‘ramp up’ period, once they have gone dry. This is well understood, and we have additional painkillers on hand to help get past the initial stages – what are called “breakthrough” medicines. We’d given her what we hoped was enough of this when we got her to bed, along with something to help relieve her breathing difficulties. For a while, she slept fitfully.
Then at midnight she woke, tried to get out of bed. I heard her (I was on-call), got dressed and went down to see what she needed. As I got her disentangled from the bed rails and onto the commode, I asked her if she was OK.
She looked at me, her eyes watery and unfocused. I never did get much of an answer out of her, but it was clear from how much difficulty she was having breathing that I needed to do something. I did – increasing the dosage of the med she takes to control this kind of spasming. This is what we’ve been instructed to do by the hospice nurses.
It worked. After I got her back into bed and settled, her breathing relaxed, and she started snoring loudly. She snored like that for two and a half hours, during which time I actually got some sleep. You learn what sounds are good sounds when listening to a monitor at night.
And you learn what sounds are not. I woke about 3:00 to the sound of silence. Not even a hint of breathing from my MIL.
I went to check, found her still breathing, but so lightly and shallowly that you could barely tell it, even when standing right over her.
Two more times before I got up at 6:00 I went to check, see if she was still with us. She was.
* * * * * * * * * * * * *
She wanted to get up for breakfast, so we did that. But she was breathing and coughing so hard that when she’d finished we didn’t even suggest that we go ahead with her normal Sunday morning bath. Getting her dressed, she was barely able to hold herself upright in the wheelchair. When we got her into bed her breathing was again stressed, and again we gave her something to help, half a dose.
And then we called hospice.
Lisa, our usual nurse, had told me on her last visit Thursday: “Call. Anytime. We don’t like surprises.”
So I called. The office put us through to the nurse on call this weekend. It was Lisa. I told her how things had gone in the previous 24 hours.
“I’ll be right over.”
* * * * * * * * * * * * *
“There’s significantly diminished lung capacity,” said Lisa, setting aside her stethoscope. Kneeling there next to the bed, her hand gently brushing my MIL’s hair away from her face, she looked up at us, then back at my MIL. “Can you say goodbye to me? I just stopped by for a moment, and have to leave now.”
It took my MIL a few moments to understand. Then she smiled slightly, and with a weak voice said “Goodbye.”
Lisa gave us another patch, this one to help control secretions into my MIL’s airway. Some swabs for her mouth, when it needs moistening but she is unable to drink. Told us how to arrange the pillows under my MIL to help control aspiration problems. And that we should freely use the meds which help control breathing spasms, keep her comfortable. “It’ll probably make her even sleepier. But at this point, that is not a bad thing.”
I nodded.
And now we wait.
* * * * * * * * * * * * *
Jim Downey
(Cross posted to Daily Kos.)
No, sadly, not the musical movement. Rather, the approach we now take to caring for my MIL. All our routines are slipping away, the carefully practiced choreography which has defined our lives for years no longer relevant.
I’ve been saying for a while that we were coming to a close of this chapter of my MIL’s life. I’ve been wrong before in my predictions that it would come on this day or that, before or after a particular holiday or birthday. And so I may well be wrong again when I say that we are now on the last few pages of the book.
There is something to this of that bittersweet moment, that sense of coming to conclusions you know are there, the resolution of conversations and plot lines that you get at the end of a cherished book. She no longer needs to wait for the usual markers of the day – when to get up, when to eat, when to nap. She got up this morning, and the rest of the day has followed as best we can to her wants and desires. Lunch an hour early, and including her favorite soup even though she just had it yesterday. (Campbell’s Tomato, if you want to know.) Supper about a half hour early. Bed more than an hour early. Because that is what she wanted.
Her worries we have answered as best we can, telling her that tomorrow we will see if we can help her find “the people she came here with.”
Unless she finds them on her own in her sleep.
I’ll keep you posted.
Jim Downey
Lisa, our regular hospice nurse, arrived while we were getting my MIL dressed this morning. She sat and watched, observing my MIL, seeing how she interacted with us, how she moved, how she looked. Then she went through her usual examination, checking vital signs, listening to heart, lungs, intestines, asking the usual questions about sleep, and appetite, and signs of pain. She sat back, looked at my MIL, and said pleasantly to her: “you always have such a beautiful smile.”
* * * * * * * * * * * * *
There is light snow falling, but the winter storm which had been predicted has missed us for the most part. The grey fits my mood.
In anticipation of the storm, and in response to the accelerated use of wood mentioned in this post, I spent most of yesterday afternoon out at our farm, cutting seasoned downfall and then hauling it back home. It felt good to be physically tired, rather than just emotionally exhausted. The soreness I feel today is a reminder of just how out of shape I am, but also holds a promise that I can once again get back into something resembling decent condition. Pain isn’t always bad.
* * * * * * * * * * * * *
The last few days have been oddly quiet. My MIL has slept most of the time, for all but 3 – 4 hours each day. My wife and I move through the house as silently as possible, even chastise the cats and the dog if they get noisy. We want her to have whatever peace and quiet she can.
When she is up, she is confused about where she is, who we are. We roll with it the best we can, though sometimes we’re caught off balance and react poorly. At least a couple of times we’ve played the “oh, here, let me call your mother” game again.
Today at lunch she was worried about where she had left her purse – she was concerned about how she was going to pay for her meal. I told her it was all taken care of, that she didn’t need to worry. She looked at me with such gratitude, the thanks not given a son-in-law of 20 years, but rather of someone offered unexpected shelter and food by a stranger on a long and difficult journey. Then we watched a squirrel play, and she laughed.
* * * * * * * * * * * * *
We were just getting her tucked into bed for the night. My wife leaned over the bed rails, down to kiss her mother on the cheek, as she usually does. “Sleep well. Have good dreams and pleasant journeys.”
My MIL looked away for a moment, rather than replying, “you too, dear,” as she usually does.
“Something wrong? Is there something you need, do you hurt?”
A glance, almost embarrassed. “Could you stay with me?”
It was my turn to be on-call. My wife looked at me, back to her mom. “You mean just for a little while?”
“No. Sleep here with me.”
“Of course. Let me go put some things away, and I’ll be back in a little while.”
* * * * * * * * * * * * *
“Any further signs of T.I.A.s?” asked Lisa, once she was done with her exam.
“No, but she’s been sleeping so much we likely wouldn’t have noticed.”
She nodded. “Her heartbeat is now much more irregular, and that can frequently cause a T.I.A. at this point.”
We nodded. The signs of hypoxia were very clear, and there was a mottling to my MIL’s skin in places we’d not seen previously.
“Her lungs are also very crackly, breathing labored just from sitting up. Pulse is weak, blood pressure low.” She looked calmly at my wife and I. “Is there anything you need? Do you want someone else from the team to come out and give you a break, so you can get away together?”
My wife and I exchanged glances. We have discussed this. As tired as we are, we don’t both want to be gone at this point. One of us is always here now, both of us most of the time. “I think we’re fine.”
“OK. But this is exhausting. I know it is.” Lisa brushed my MIL’s hair again with her hand, smiled at her. And repeated what she had said moments earlier: “you always have such a beautiful smile.”
* * * * * * * * * * * * *
Jim Downey
(Cross posted to UTI.)
Filed under: Alzheimer's, Climate Change, Global Warming, Health, Hospice, Predictions, Science, Society
Humans have altered Earth so much that scientists say a new epoch in the planet’s geologic history has begun.
Say goodbye to the 10,000-year-old Holocene Epoch and hello to the Anthropocene. Among the major changes heralding this two-century-old man-made epoch:
- Vastly altered sediment erosion and deposition patterns.
- Major disturbances to the carbon cycle and global temperature.
- Wholesale changes in biology, from altered flowering times to new migration patterns.
- Acidification of the ocean, which threatens tiny marine life that forms the bottom of the food chain.
The idea, first suggested in 2000 by Nobel Prize-winning chemist Paul Crutzen, has gained steam with two new scientific papers that call for official recognition of the shift.
There’s more, basically explaining how the shift from the Holocene can be established. Worth reading.
I may post more later, but am fighting a bit of a sore throat thing that has my energy reduced. Brief update on my MIL: hospice nurse was in this morning to bring us meds and do a check up, and it is clear that my MIL is losing ground. We’ve stepped up her duragesic dosage again, to make sure that she stays comfortable, and Lisa (the nurse) went over some other things we can do if she gets into difficulty. We’re just taking things on an hour-to-hour basis.
Jim Downey
Filed under: Alzheimer's, General Musings, Health, Hospice, N. Am. Welsh Choir, Patagonia, Predictions, Preparedness, Sleep, Travel
I came downstairs yesterday morning a little after 6:00 to discover from the home health aide that my MIL had not been up all night. This has happened a couple of times recently, and usually she calls or rustles around enough to indicate that she wants to get up and use the potty sometime shortly thereafter.
But not yesterday. She was quiet, sleeping until my wife and I went in to check on her. And she didn’t want to get up at her usual time of 8:00, sleeping until 9:30. Then she had a light breakfast and went back to bed, sleeping until noon, when she had some lunch and then again back to bed. Then she slept until 4:30. When I got her up then, her cyanosis was the worst it has yet been, her entire fingers a disturbing deep blue, as were her feet. This indicates a level of generalized hypoxia that shows just how poorly she is doing.
At no point whenever she was awake did she know just where she was. She kept thinking that she was on a train, or wondering where her car was, asking about when she was going to go home. We played along as best we could.
* * * * * * * * * * * * *
I sent this to a good friend last night:
Anyway, then dishes, got my MIL to bed, et cetera. Now, catch up on some email, do a bit of surfing. I need to start doing some research, find a good online source for learning a bit of survival Spanish.
Why? Well . . .
You probably already know about the North American Welsh Choir tour to Patagonia next October. And you may know that in return for my wife coordinating all the reservations and money and whatnot on the Choir’s end, she is getting her cost of the trip offset (in full, it looks like). Just in the last few days I’ve decided that I am going to go along.
Yeah, surprises me a bit, as well. I have no desire to go to South America. I have never had any desire to go to South America.
But my MIL is going to die soon. And late this year I should have decompressed from that, and been working hard for months being a good little book conservator, maybe an author. It will be a good time to challenge myself in a new way, get out of my comfort zone. This tour will be a good opportunity to do that. Plus my wife and I haven’t had anything approaching a real vacation in a couple of years, and we didn’t do anything to celebrate our 20th anniversary last October. So, this will serve that purpose as well.
So, I guess I should learn some survival Spanish. It is only courteous. And doing that won’t hurt me, either. Neither will pushing myself to get in better physical condition for the trip – something I am planning on for all the other good reasons I know, but this will provide additional incentive.
It’s odd to be thinking ahead this way, to a time when my MIL will no longer be with us, no longer our hour-to-hour responsibility.
But if you know of a good online tutorial for Spanish, let me know.
* * * * * * * * * * * * *
She seems somewhat better this morning. She slept well last night, but wanted to get up to use the potty at 4:30 this morning (I was on-call). I checked her temperature then, and it was almost three degrees above normal. But her hands were their normal color, with just a trace of blue under her fingernails.
And she was anxious to get up and have breakfast at her usual time, though a bit reluctant to get her weekly bath after. During her bath, my wife reported a return of the more noticeable cyanosis. After, she was limp and sleepy, barely able to stay awake while we got her dressed and back into bed.
I just checked on her, helped her get settled in a new position in bed. She is getting weak enough that she has difficulty just rolling over sometimes. This time she was also worried about whether she was going to disturb the person who was sleeping next to her. I told her it was OK – they would understand.
* * * * * * * * * * * * *
It’s odd – making plans to be gone traveling this fall, yet being very tentative about what I am going to be doing this afternoon. Like so much of my life these days, it is the exact inverse of what anyone would consider ‘normal’. But so it goes.
Jim Downey
Filed under: Alzheimer's, Government, Health, Hospice, movies, Sleep, Society
I sat, my back to the fireplace, feeling the heat from the fire, listening to the pop and crackle of the fresh log I had just placed there. Across the room, the hospice nurse and my wife were sitting at my MIL’s feet, the nurse doing her routine examination for the second time in a week.
This is new. Previously, we’d only been on weekly visits. But as it is clear that we’re in the final days of my MIL’s life, we decided to schedule an additional time. And, thanks to how hospice works, we’ve the option of calling for additional visits as needed, or adding in more regular scheduled visits each week. Just knowing this resource is available is comforting.
Lisa, our regular nurse, listens, touches, looks. I am struck by just how much good medicine is still based on these simple techniques, when it all comes down to it.
As it does when you are dying.
* * * * * * * * * * * * *
“What do you need, MIL?”
“I need to call my mother.”
I go get her cordless phone, dial the number and hand it to her while the phone is still ringing. Someone answers on the other end.
It is a brief conversation. She just wants to let her mom know that she is all right, not to worry. The voice on the other end reassures her, tells her to wait until she comes for her. She hands the phone back to me, and I disconnect. She is happy.
My wife and I had set this up weeks ago, in the event that the occasion would come that we needed it. Simple, really – an incoming call to my wife’s cell phone from my MIL’s number would be the cue that her mom needed this kind of reassurance. No need for me to say anything, contributing to the illusion.
* * * * * * * * * * * * *
We watched Waking Ned Devine the other night. A quirky, offbeat little movie that I love. The central theme is about love/friendship, played out in the story of a small village in Ireland where a local lottery winner has died before he can claim his winnings, leaving no heir. The villagers band together to claim and share the money, but as much out of memory and fondness for the departed Ned Devine as their own greed. It’s the sort of movie that always leaves me with bittersweet tears.
And after, surprisingly, my wife got to talking with her mom about MIL’s own situation. From an email my wife sent her sister following this:
When the movie was over Mom was obviously tired but also looked like she wanted to talk. I’m not sure what made me do it, but I started talking to her about her own death much more directly than I have before. I did so as carefully as I could, but I really felt like I needed to be very direct and clear (probably also influenced by the conversation with you). I told her that the nurse that comes every week does so because we think she may be dying, that we are caring for her the best we can and will continue to do so for as long as necessary. I mentioned that she often talks about people who have passed on, and told her that it would be OK for her to do so as well. That we love her very much but we want her to be happy, and if her parents come for her it is OK for her to go with them. She actually seemed to understand what I was talking about, though now and then, she seemed a little unsure, so hopefully the permission part (at least) will sink in.
Permission? To go. That it is OK to die. Often people who are in hospice need to hear this, one way or the other.
* * * * * * * * * * * * *
Lisa is surprised at just how cold my MIL’s legs are. “They’re like ice!”
You don’t usually get that kind of reaction from a seasoned hospice nurse. And, perhaps a bit out of embarrassment, she shifted over into more clinical terminology. Blood pressure. Indications of reduced lung capacity, congestion, observation of ancillary breathing mechanisms. Compromised circulation. She asks about appetite, kidney and bowel function, signs of pain or distress, coughing. Clinical terminology or not, her voice is always concerned, compassionate. “I detect a number of changes.”
We nod. My MIL is worried with whether her lap shawl is straight.
“When she is showing signs of breathing difficulty, or coughing, use X or Y medicine as necessary.”
She looks at my MIL for a long moment. “We want to make sure she is comfortable.”
Indeed we do.
* * * * * * * * * * * * *
They usually won’t tell you this beforehand, but there comes a point in hospice care where the usual restrictions about medicine dosage and usage becomes, let us say, somewhat more casual. The rules are in place to control the abuse of very dangerous and addicting drugs, after all. But when the end comes, no one in their right mind is going to be worrying about addiction, when there is comfort to be given.
We’ve reached this point. My wife and I had realized it last week, but were reluctant to act too much on this knowledge without confirmation from our nurse. No, she didn’t tell us to exceed any prescriptions, but was willing to answer our questions about what medicines were suitable for what problems. So, in response to anxiety, or breathing difficulty, or coughing spasms, we add in a few drops of this solution, another one of those pills, maybe a small shot of whiskey.
* * * * * * * * * * * * *
My wife smiles slightly, amused, as I add another log to the fire. I know what she is thinking – she is remembering my protestations earlier in the season that we didn’t want to be too profligate with the wood I had stockpiled.
Yet it is very cold out, and my MIL does so love a fire.
* * * * * * * * * * * * *
Jim Downey
(Cross posted to Daily Kos.)
With all the dignity and presence of a southern lady, my MIL held her self erect, looked at me and said “I’ve had a very nice time this evening. And dinner was lovely. And your performance, though I’m a little ashamed to admit that I can’t remember exactly what you did.”
“Well, thank you!” I answered. Then I helped her finish up on the commode next to her bed, and carefully laid her down for a nap.
It was 12:45 in the afternoon. She had just finished lunch consisting of a peanut butter & jelly sandwich, Pringles, and some chopped pears. Needless to say, there had been no ‘performance’ by me or anyone else.
* * * * * * * * * * * * * *
“I don’t know how you guys manage it,” said Lisa, the hospice nurse. She had just finished her examination of my MIL, and had been going over what she saw as we talked after. She’d mentioned the option to have an aide come over to sit with my MIL while we got out for a bit.
After my wife and I exchanged glances, I (or maybe it was my wife – these details start to slip away) said that we preferred to not both be gone at the same time at this point. Why? Well, because it feels like the end. We want to make sure one of us at least is here with her.
And it’s not just us. Lisa commented that my MIL had never before looked so ashen, so grey. We agreed that she would come again on Monday, unless we called her sooner.
* * * * * * * * * * * * * *
Her fever spiked about 4 degrees higher than normal last night, just as my wife and the overnight aide we have in three nights a week were getting her to bed. I was washing the dishes when my wife came into the kitchen and told me, on her way to getting a Tylenol tablet for my MIL. I dried my hands and followed her back to the bedroom. We got the extra pill into her, I checked her pulse and the color of her fingernails, had her look at me to see whether she could focus or not.
She couldn’t.
I wondered whether she’d make it through the night.
She could.
* * * * * * * * * * * * * *
“My mother has passed on, but Auntie has taken over for her.”
“Auntie?” asked my wife.
“Yes, Auntie. She has taken over for my mom. I was waiting for my mom to come for me, but she’s passed on, so Auntie has taken over . . .” a pause, uncertain look around the room. “. . . everything.”
“Well, OK.” My wife looked at me. We’d been waiting for this. Together, almost simultaneously we said, “MIL, if she comes for you, you can go with her. It’s OK.”
“It’s OK?”
“Yes, when Auntie, or your mom, or your dad – when they come for you, you can leave with them.”
“I can?”
“You can indeed. Until then, we’re taking care of you here.”
“But if they come, I can go?”
“Yes, you can.”
* * * * * * * * * * * * * *
We met with the social worker for an hour or so yesterday afternoon. She is kind, intelligent, insightful. She offered a lot of suggestions for us to consider, from a respite break (which would take my MIL to a skilled nursing floor at the local hospital for five days), to advice on how to better manage the stresses we’re under.
None of it was useful.
Oh, it was, in the sense that had we not considered those things, it would have been very beneficial to bring it up. And neither my wife nor I were aware of the option for the five-day respite break.
But we’ve managed through these things long enough that I think, honestly, we’re doing about all that can reasonably be done to handle the stresses, to give ourselves (and one another) what breaks we can.
And right now we’re not willing to see my MIL off to the five-day break. Not right now. If she rallies again, and seems stable, then we’ll consider it. But not when things are so shaky with her health. After all we have been through, after all we have done, to let her slip away now in the care of someone else in a strange environment would be just too painful, would feel very much like we had failed to see the thing through to the end.
Neither of us wants that.
* * * * * * * * * * * * * *
As I got the safety rails and straps on the bed in place, my MIL looked up at me, concerned.
“Something wrong? Something bothering you?”
“Well, like I said, I have had a very nice time tonight.”
“Yes, thank you. It is kind of you to say so.”
“But I think I should be going soon. My mother and father have been on a trip, and they are looking for me.”
“And when they come, you can go with them.”
“But if I am sleeping,” she said, that worried look on her face again, “how will I know?”
“If they come looking for you, I will be sure to tell them where you are. I promise.”
And I keep my promises.
* * * * * * * * * * * * * *
Jim Downey
(Cross posted to dKos.)
Filed under: Alzheimer's, Book Conservation, Health, Hospice, Predictions, Preparedness, Sleep
(This is something of a follow-up to yesterday’s post.)
My MIL made it through the night. And seems to be holding her own today. But her fingernails are still blue, breathing noticeably labored. To be perfectly honest, I hope the end comes quickly and with ease for her. If that sounds horrid, or cold, or heartless – well, I’d say you haven’t been paying attention. I am none of those things.
We’re trying to keep things as ‘normal’ as we can, to maintain our usual schedule, get my MIL up at her usual time, have meals as planned, all the normal routines. This might be a bit absurd – it feels like it to me – but consistency really does give comfort to someone with Alzheimer’s. And while other health factors are now in action which will likely end her life soon, she is still very much an Alzheimer’s patient.
But I am changing my schedule a bit, canceling meetings with clients, postponing this or that activity to make sure either my wife or myself are always here. We had our usual ‘respite’ break scheduled for this Thursday afternoon, but I worry about leaving the respite sitter here alone with my MIL. My clients have all been understanding about this, which is good. As I told a friend this morning, there are advantages to being a skilled craftsman in an unusual profession.
So, we wait, pretending that things are normal. Until they’re not.
Jim Downey
It’s hard to say when the end will come. But we must be getting close.
How close? Days. Perhaps just hours.
Why do I say this?
Instinct. Well, that and lots and lots of small clues, details that add up to one probability, details that probably most wouldn’t notice.
But among the little things are some big mile-markers. The last few days, my MIL has slept between 18 and 20 hours per day. When awake, she breathes with some labor, and she regularly shows signs of cyanosis. Her confusion is noticeably worse.
Couple that with what Lisa, the Hospice nurse, noted on her last visit, and I’ve been mentally reviewing what we need to do, what we need to look out for, what I will need to tell the family. I worry that I have cried “wolf” too many times, in my effort to keep everyone informed. Well, better that than a misguided attempt at secrecy, I suppose.
So, I re-read all my posts on this subject. And went through, once again, Dying at Home.
I’m about as ready as I can be.
I hope.
Jim Downey
Filed under: Alzheimer's, Astronomy, Bad Astronomy, Carl Sagan, Health, Hospice, NASA, Phil Plait, Science, Space, Titan
Phil Plait, the Bad Astronomer, has been at the American Astronomical Society meeting in Austen most of this week, and has had a wonderful series of posts about the meeting. He just posted the final one this morning (though there will undoubtedly be follow-up posts once he is home as sorted things out). You can find the whole series on his blog.
* * * * * * *
Jacob sent me this note:
http://www.itwire.com/content/view/16012/1066/
Not exactly related to Communion aside from “tholins”, but I thought you’d be interested.
It is interesting to see that these complex organic molecules have been found in such abundance. The term tholin was coined by Carl Sagan in his early writings about Titan, and I discuss the material extensively in Communion of Dreams (if you haven’t read it -and if not, why not?).
~~~ Thanks, Jacob!
* * * * * * *
Speaking of notes, I got this nice one from Carl:
I just wanted to say that I’ve truly enjoyed your posts since you’ve joined UTI and your novel is top-notch. I’m not a big sci-fi fan, but your characters and description held me all the way through.
* * * * * * *
A brief update on my MIL’s condition: the visit from the hospice nurse on Thursday confirmed what we’d seen this week – continued deterioration. Her BP is very low, pulse weak, and heart rate very high (all worse than they were the previous week), and her lungs have diminished capacity and evidence of fluid. Once again we have tweaked her meds and treatment procedures, but this is mostly just an effort to keep her as comfortable as possible. I think part of the exhaustion my wife and I feel is just ongoing anticipation.
I’ll keep you posted.
* * * * * * *
Jim Downey
Communion Of Dreams 