Update: 03/31/06

Medications:

330 mg. Oral Morphine (11 doses).

12 drops Atropine (4 doses).

5 mg. Oral Lorazepam in 7 doses (for sleeping/anxiety).

Morning SAT: Oxygen Saturation = 94/Heart rate = 101 (sitting).

How Joann’s Day Went:

Having thought about it for several hours, I still haven’t come up with a good way to describe Joann’s day. So, I’ll just spit it out. Early this morning, sometime between midnight and 5:00 AM, Joann had a stroke. A big one too, apparently. Notice the medication changes above, and you’ll see that she is on a liquid medication regimen. She can’t swallow pills anymore, eat, drink, and all the other things that define the divide between functional and nonfunctional. This too is a natural progression of her disease, although she went from relatively sufficient to completely dependent much quicker than I would have suspected. Or, anyone else either, for that matter. Her nurses were genuinely shocked at the rapidity of Joann’s decline. Meanwhile, I’m learning new ways to take care of her at home.

Update: 03/30/06

Medications:

165 mg. Oral Morphine (6 doses).

180 mg. Extended Release Morphine.

6 drops Atropine (2 doses).

2 mg. Lorazepam in 2 doses (for sleeping/anxiety).

20 mg. Compazine in 2 doses (nausea)

Morning SAT: Oxygen Saturation = 92/Heart rate = 102 (sitting).

Evening SAT: Oxygen Saturation = 88/Heart rate = 103 (lying down).

How Joann’s Day Went:

This morning I found Joann still in her lounger. She indicated that she couldn’t breathe, so I gave her the first dose of Atropine, and 30-mg of morphine. (New feature.) This was all before her morning tablet set. My guess—hypoxia. From that point on, she had another bad day. She still wanted to sleep in her lounger, so I let her, at 11:00 PM bedtime.

Update: 03/29/06

Medications:

145 mg. Oral Morphine in 5 doses.

180 mg. Extended Release Morphine.

5 mg. Lorazepam in 5 dose (for sleeping/anxiety).

50 mg. Compazine in 5 doses (nausea)

Morning SAT: Oxygen Saturation = 90/Heart rate = 112 (sitting).

Evening SAT: Oxygen Saturation = 92/Heart rate = 126 (lying down).

How Joann’s Day Went:

Joann had another rough day today. She is slowing down and sleeping more, usually sitting in her lounger-chair. In the evening, she did fix her hair in time to play a short hand of cards with Bill and I. After her evening tablet set she stayed up until 1:00 AM. When I tried to get her to go to bed, she wouldn’t move farther then her lounger. I’m guessing that’s because she breathes better sitting up. So, I left her in her chair thinking she would come to bed later.

Update: 03/28/06

Medications:

200 mg. Oral Morphine in 8 doses.

180 mg. Extended Release Morphine.

1 mg. Lorazepam in 1 dose (for sleeping/anxiety).

20 mg. Compazine in 2 doses (nausea)

Morning SAT: Oxygen Saturation = 89/Heart rate = 130 (sitting).

Evening SAT: Oxygen Saturation = 93/Heart rate = 101 (lying down).

How Joann’s Day Went:

SSDD (Same Shit, Different Day). Joann had a very rough day today. I keep worrying about giving her too much morphine, but her pain is such that she just gobbles it up. And, I can tell its her pain too, she starts violent spasms when she needs more medication. However, she was a little better by evening, so she, Bill and I played a short game of cards. She ate well of Bill’s magnificent ground-beef-sausage meatloaf. We were in bed by 11:00 PM. I was really exhausted as I hadn’t slept the night before due to keeping Joann’s oxygen on all night so she didn’t bleed.

Update: 03/27/06

Medications:

80 mg. Oral Morphine in 4 doses.

180 mg. Extended Release Morphine.

2 mg. Lorazepam in 2 doses (for sleeping/anxiety).

30 mg. Compazine in 3 doses (nausea)

Morning SAT: Oxygen Saturation = 89/Heart rate = 110 (sitting).

Evening SAT: Oxygen Saturation = 93/Heart rate = 95 (lying down).

How Joann’s Day Went:

My apologies for the lateness of this post. I had been up all night keeping Joann’s oxygen on her face so she didn’t bleed. Tiredness overcame me in the evening.

VNA nurse Wes stopped by today and he finally got a chance to see Joann as we all know and love her. She even took a shower, did up her hair and put on fresh clothes. She hadn’t done her hair in ten days or more. I could tell that she was doing better on the higher doses of extended release morphine. By even, however, she started slipping down that slippery rope of reality to about where she had been the night before. No cards tonight, bedtime by 10:00 PM.

Update: 03/26/06

Medications:

100 mg. Oral Morphine in 5 doses.

180 mg. Extended Release Morphine.

2 mg. Lorazepam in 2 doses (for sleeping/anxiety).

10 mg. Compazine in 1 dose (nausea)

Morning SAT: Oxygen Saturation = 90/Heart rate = 130 (sitting).

Evening SAT: Oxygen Saturation = 94/Heart rate = 125 (lying down).

How Joann’s Day Went:

Joann had a better day, at least in the morning. The new 90-mg. morphine capsules appear to be doing the trick. In the afternoon though, she started slipping again. I guess that’s just the normal progression of her disease. Her heart rate keeps climbing, on average, and her oxygen saturation is slipping. Other than that, nothing new to report.

Update: 03/25/06

Medications:

180 mg. Oral Morphine in 6 doses.

180 mg. Extended Release Morphine (increased from 60-60-mg to 90-90-mg.).

1 mg. Lorazepam in 1 dose (for sleeping/anxiety).

20 mg. Compazine in 2 doses (nausea)

Morning SAT: Oxygen Saturation = 90/Heart rate = 129 (sitting, awake 1 hr.).

Evening SAT: Oxygen Saturation = 97/Heart rate = 101 (lying down).

How Joann’s Day Went:

Joann had a really bad day. This seems to be an extension of yesterday evening where she was having hard-to-control pain. I called the VNA and nurse Gail increased her extended release morphine (ERM) to 90-mg., up from 60-mg twice daily. In the meantime, Joann was frequently taking 30-mg doses of breakthrough morphine to control her pain. When Gail called in the order for the ERM to Ordway Drug, they formulated a special capsule of 90-mg. morphine for Joann. I assume they don’t carry the exact dosage in a tablet form. I don’t think Joann’s coming back from this level. I called her son David and he talked to her for a while, that seemed to do Joann some good. God knows I love Joann, but it was the first time I had to feed her. Having gotten past that, I guess I’m initiated.