CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 6 0000. ref SDS 4 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 010427 0830 meeting at Kaiser - Doctor Johnson notes Millie looks
040902 - so good nobody can believe she has such severe cancer, ref SDS 3
040903 - OJ6I; the doctor explained again Millie's cancer has mutated through
040904 - 11 relapses to resist chemotherapy. The doctor advised that Kaiser
040905 - has a new strategy prescribing therapy that is effective for treating
040906 - cancer as a chronic disease by "targeting" the genetic profile of
040907 - cancer that has mutated in patients, like Millie, to resist
040908 - chemotherapy. ref SDS 3 SJ6N
040910 - ..
040911 - On 100501 1037 Millie letter to medical team confirms understanding of
040912 - new strategy to treat Millie's cancer with targeted therapy.
040913 - ref SDS 4 F25O
040915 - ..
040916 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor
040917 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse
040918 - of cancer caused by UCSF medical mistakes. ref SDS 5 HH4I
040920 - ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 6 YX8L Kaiser contends that all of the
040923 - strategies for "targeted" therapies have been executed for Millie,
040924 - which seems conflicting with the record in this case. ref SDS 6 MZ4N
040926 - ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 7 TD5W
040930 - ..
040931 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments
040932 - with Abraxane chemotherapy that seems to be failing, and then after 3
040933 - more weeks without treatment, following a trip abroad, the doctor will
040934 - discuss "next steps." ref SDS 8 YL5N
040936 - ..
040937 - On 100503 2338 Millie reports to medical team that she will implement
040938 - Kaiser's guidance to delay changing treatments, and takes Kaiser's
040939 - letter on 010503, as assurance that recovery will be equal to changing
040940 - treatment immediately on 100505. ref SDS 9 6X7S
040942 - ..
040943 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast
040944 - Care Clinic, called and notified Millie that Doctor Rugo will soon
040945 - communicate with Doctor Johnson, or had already done so, to coordinate
040946 - with Kaiser on planning Millie's next treatment to recover from the
040947 - 11th relapse of cancer. ref SDS 10 NT5N
040949 - ..
040950 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd
040951 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.
040952 - ref SDS 11 KE4K
040954 - ..
040955 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,
040956 - seemingly on an accelerating rise, which threatens to cascade out of
040957 - control, because Abraxane chemotherapy is not effective. ref SDS 12
040958 - L54I
040960 - ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 13 KE4K
040964 - ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 14 PK9O
040967 - ..
040968 - On 100527 0217 Millie files claim with Kaiser Claims Resolution
040969 - Department for standard of care to recover from 11th relapse of cancer
040970 - caused by medical mistakes getting radiation treatments at UCSF on
040971 - referral from Kaiser. ref SDS 0 IZ7N
040973 - ..
040974 - On 100528 0322 Millie requests support from Medicare to separate
040975 - recovery for medical mistakes getting radiation from UCSF, from health
040976 - care benefits limited by Medicare insurance coverage. ref SDS 2 QQ6N
040978 - ..
040979 - On 100528 1031 called Medicare they have formed a team to review
040980 - Millie's case, and contacted Kaiser's Claims Resolution Department for
040981 - response to Millie's claim. ref SDS 3 4W5F
040983 - ..
040984 - 100601 0830 Doctor Johnson reported that Kaiser has not had time to
040985 - collaborate with UCSF on treatment for Millie to recover from UCSF
040986 - medical mistakes. He discussed treating Millie with MPA, but this was
040987 - not prescribed because Millie was treated with MPA in 2009, and UCSF
040988 - ended the treatment due to fears about blood clot side effects, which
040989 - were believed to cause breathing problems Millie had, though later
040990 - breathing problems were discovered to be caused by defective radiation
040991 - treatment. Since Doctor Johnson said Kaiser has no more treatments
040992 - for Millie, the only way Millie can get relief from pain caused by
040993 - cancer that is progressing without treatment is get treatment in
040994 - Hospice. Since Hospice is the only choice of care offered today,
040995 - Millie accepted this.
040997 - ..
040998 - On 100601 1531 Sharon called to schedule starting Hospice medical
040999 - services beginning tomorrow between 0900 - 1000. ref SDS 5 036C
041001 - ..
041002 - On 100602 0913 Liz provides orientation on Hospice care; she confirms
041003 - Sharon's report yesterday, that if Kaiser performs on the insurance
041004 - agreement to provide standard of care for Millie's patient profile,
041005 - than Millie can elect to recover from 11th relapse of cancer, rather
041006 - than continue with Hospice support for dying peacefully. ref SDS 6
041007 - 036C
041009 - ..
041010 - On 100602 1046 Diane received notice from Medicare to file claim for
041011 - Millie to get treatment for recovering from UCSF medical mistakes; she
041012 - is preparing a statement of claim. ref SDS 7 036C Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 7 MZ5H Eileen called later and reported that Kaiser denied
041015 - Millie's claim on the grounds that Medicare does not authorize payment
041016 - for treatment to recover from cancer, after a patient starts Hospice.
041017 - ref SDS 7 UN4M Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 7 I33H Eileen called back after
041019 - reading the claim and advised the denial of claim has been withdrawn,
041020 - and the matter is referred to Claims Resolution Department.
041021 - ref SDS 7 UN5P
041023 - ..
041024 - On 100603 1112 Linda called to schedule a visit for Hospice social
041025 - support. ref SDS 8 036C
041027 - ..
041028 - On 100604 1350 Linda visited to begin case management for Millie's
041029 - Hospice care. ref SDS 9 036C
041031 - ..
041032 - On 100606 1243 Judy visited Millie to begin Hospice social support,
041033 - covering from Linda. ref SDS 10 036C
041035 - ..
041036 - On 100611 0900 Linda visited again. She has not read the record to
041037 - verify understandings. ref SDS 0 036C Linda doubled Millie's pain
041038 - medication with morphine. ref SDS 0 QK5O
041040 - ..
041041 - On 100618 1451 Linda continued current pain medication; she ordered
041042 - medication for digestion to help Millie avoid coughing up food.
041043 - ref SDS 2 036C
041045 - ..
041046 - On 100623 1452 Linda visited a day ahead of schedule. Millie's pain
041047 - level is averaging 1 - 2. She reported current pain medication is
041048 - satisfactory. ref SDS 3 QK5O
041050 - ..
041051 - On 100706 1452 Linda visited, ref SDS 4 036C, and learned Millie's
041052 - pain level remains below 3 with current medication, including 60 mg
041053 - morphine and 2 oxycodone pills per day. Millie reported being
041054 - satisfied with pain control. ref SDS 4 QK5O Phlebitis has subsided in
041055 - both legs. ref SDS 4 2F9K Left arm and hand are visibly swelled.
041056 - ref SDS 4 ON9K Linda took vitals which are excellent for anybody, and
041057 - commented that "Millie looks wonderful." ref SDS 4 2F9F In a few
041058 - weeks Linda will perform re-certification analysis for Millie to
041059 - remain in Hospice. Millie advised that she intends to stay in Hospice
041060 - until Kaiser responds to her claim requesting treatment to recover
041061 - from UCSF medical mistakes that caused 11th relapse of cancer, and
041062 - with treatment that does not cause pain and suffering. ref SDS 4 2F5F
041063 - Linda is off-work next week, and so will see Millie again in 2 weeks.
041064 - ref SDS 4 QL56
041066 - ..
041067 - On 100723 1030 Linda here to provide pain medication; she met with
041068 - Millie and her children, Pam and Ron Jr. ref SDS 6 036C
041070 - ..
041071 - ON 100728 1016 Millie is declining in function, ref SDS 0 036C, called
041072 - her family, and they all arrived. ref SDS 0 MK4M Called Hospice,
041073 - ref SDS 0 XF4N, and Susan came and changed Mil's medication increasing
041074 - morphine, and adding Ativan, ref SDS 0 X54I, on 2nd visit later in the
041075 - evening, Susan showed how to use the emergency kit syrenge,
041076 - ref SDS 0 B69D Got help from Hospice by telephone, ref SDS 0 X84G
041077 -
041078 -
041079 -
041080 -
041082 - ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Yesterday, Millie suddenly began to fail.
041402 -
041403 - Proposed making an egg and toast for breakfast, which she likes.
041404 - Lately she has been able to eat only half an egg and a few bites of
041405 - toast. She asked for Ensure, but took only a few sips.
041407 - ..
041408 - Later, she insisted I go hiking, and while I was gone, she got up from
041409 - bed, which must have been a huge struggle, and did some chores on the
041410 - computer paying bills, checking email, and struggled to get around for
041411 - personal care. By late evening, though, Mil could not support herself
041412 - getting out of bed.
041414 - ..
041415 - There has been decline of Millie's strength the past week or so, first
041416 - with difficulty getting upstairs. Lately, when we go to the store,
041417 - she has been pushing a shopping cart for assistance steadying her
041418 - walk. She went to the movies with Pam on Saturday, and barely could
041419 - walk from the car in the driveway into the house and get to the sofa.
041420 - She stayed there for several hours to gather strength for coming
041421 - upstairs.
041423 - ..
041424 - The past week she has needed help to avoid falling, although on
041425 - Saturday she climbed the stairs by herself, getting "thumbs up" for
041426 - courage and determnation to do this by herself, rather than call for
041427 - help. The past 2 days, she has needed help getting up from bed, but
041428 - could still walk and care for herself. On Monday, we discussed moving
041429 - a bed downstairs, so she would have a place to sleep both
041430 - up-and-downstairs without always having to climb the stairs. She had
041431 - resisted this for the past week, but on Monday we decided that would
041432 - be best. However, yesterday, Mil changed her mind. She set her
041433 - course to stay upstairs in her own bed.
041435 - ..
041436 - Early, this morning she could barely draw enough breath to sip Ensure
041437 - through a straw. Only able to take a few sips. She cannot eat
041438 - anything.
041440 - ..
041441 - Gave her morphine and oxycodone for pain. She can still communicate
041442 - enough to cooperate taking oral medication. Millie opened her mouth
041443 - so pills could be placed on her toung. With assistance, she lifted
041444 - her head slightly to improve swallowing, and then with water poured
041445 - into her mouth slowly, she swallowed the 60 mg morphine pill
041446 - prescribed by Linda last Friday, on 100723 1030. ref SDS 6 NC62 This
041447 - is fairly easy because the pills are very small. The oxycodone pill
041448 - is much bigger, and so causes problems swallowing. Fortunately, this
041449 - morning, Millie was able to swallow the oxycodone pill without a big
041450 - effort.
041452 - ..
041453 - Millie asked for more oxycodone than prescribed.
041455 - ..
041456 - Gave her additional oxycodone, because the doctor had indicated she
041457 - could take up to 2 tablets at a time, if needed, to control pain.
041459 - ..
041460 - Shingles recurrence - Cortisone
041461 -
041462 - Millie asked for cortisone treatment on her right forehead and
041463 - eye lid, the area where she had severe shingles, reported on
041464 - 100104. ref SDS 2 0P9S
041466 - ..
041467 - We have very little cortisone, so need to order refill.
041469 - ..
041470 - Itching IBC rash
041471 -
041472 - Gave Millie Atarax pill to control itching from advancing IBC,
041473 - and used the procedure, per above. ref SDS 0 3H5G
041474 -
041475 - Millie did not ask for cortisone treatment this morning, to
041476 - further relieve itching from IBC rash, which has been the
041477 - primary use of cortisone the past few months, since the meeting
041478 - with Doctor Johnson on 100601, when she asked for stronger
041479 - medication to control the IBC itching problem, and Atarax was
041480 - prescribed, reported on 100601 0830, ref SDS 4 5U5G
041481 -
041483 - ..
0415 -
0416 -
0417 - 0955
0418 -
041801 - Just now, Millie asked for assistance dying. She feels very badly but
041802 - indicates not being in pain. This is a deeply disturbing moment,
041803 - difficult to cope.
041804 -
041805 - [...below, Susan feels Millie may only about 5 days.
041806 - ref SDS 0 F16M
041808 - ..
041809 - [On 100729 0510 1700 Millie died. ref SDS 32 EK4I
041811 - ..
041812 - Yesterday on Tuesday, Millie insisted I go hiking at Lafayette
041813 - Reservoir. She also asked that on the way back get the car washed,
041814 - saying I have to get used to doing things alone.
041816 - ..
041817 - Today, Millie said that while I was out yesterday hiking and getting
041818 - the car washed, she paid rent and utilities for August, she also
041819 - signed the registration on the car (pink slip) to transfer title.
041820 - Millie further explained having a life insurance policy, and that she
041821 - put the car registration and insurance policy documents in the case
041822 - for notebook computer c16. Millie said car insurance is paid for the
041823 - year, but the policy will have to be transferred, and that yesterday,
041824 - she called her friend at AAA, and told her to help with this. Millie
041825 - asked me to check and make sure this stuff is in the computer case,
041826 - because she wasn't sure.
041828 - ..
041829 - Explained there is a lot to do right now to work with Paula on getting
041830 - recovery back on track, referencing planning on 100722 1328,
041831 - ref SDS 30 036C, and so will check for documents in the computer case
041832 - later.
041834 - ..
041835 - Millie just smiled and said Doctor Johnson's letter sunk us. She
041836 - can't hold out any longer, because Kaiser and Medicare have "run out
041837 - the clock." Even if Paula "can move mountains" at Kaiser, Millie can
041838 - feel inside that it's now too late. She closed her eyes to rest.
041840 - ..
041841 - [On 100811 1512 called AAA and set meeting on car insurance
041842 - and updating ownership. ref SDS 8 X65H
041844 - ..
041845 - [On 100811 1601 found Mil's insurance policy in computer
041846 - case and called Unum on procedures. ref SDS 9 X65H
041848 - ..
041849 - [On 100812 1000 meeting at AAA with Daneen; changed name on
041850 - car insurance policy, and transferred ownership of car.
041851 - ref SDS 10 6S6N
041853 - ..
041854 - Millie getting up yesterday morning took great courage and tremendous
041855 - effort to overcome a steep decline in strength the past few days.
041856 - Today, just a day later, Millie is totally immobilized, and can barely
041857 - communicate now. She can barely bend an arm to jesture or point,
041858 - continuing sharp decline in fucntion since last night, when we
041859 - discovered she could not stand up from bed. This aligns with Doctor
041860 - Johnson's analysis on 090325, explaining rapid decline for cancer
041861 - patients after a few years having cancer, and in Millie's case, now in
041862 - her 9th year of care. ref SDS 1 P39M
041864 - ..
041865 - Millie's friend Peggy just called. Explained Millie is now starting
041866 - to fail rapidly since yesterday.
041868 - ..
041869 - Peggy was shocked, since she talked with Millie last night, and she
041870 - seemed her normal self. Peggy is coming over to help.
041872 - ..
041873 - Called Pam, Ron Jr, and Lilly. Explained sudden severe change in
041874 - Mil's condition. Tried to call Steve but his phone wasn't working.
041875 - Lilly said she was having difficulty calling Steve also, but she will
041876 - keep trying.
041878 - ..
041879 - Ron called Kim, and Kim later called Dorothy.
041880 -
041882 - ..
0419 -
0420 -
0421 - 1019
0422 -
042201 - Called for Linda at Hospice...
042202 -
042203 - 925 229 7800
042205 - ..
042206 - Talked to Chris; she transferred the call to Shelly.
042208 - ..
042209 - Talked to Shelly.
042211 - ..
042212 - Shelly said that Linda is off work today. Shelly will send another
042213 - nurse to the house today and "lay eyes on Millie," and help plan next
042214 - steps.
042216 - ..
042217 - Shelly said Linda is scheduled to visit Millie tomorrow, on Thursday.
042218 -
042220 - ..
0423 -
0424 -
0425 - 1032
0426 -
042601 - Millie asked to call Iris. Then we remembered that Iris is on
042602 - vacation in South Africa until the end of the month.
042604 - ..
042605 - [On 100804 1138 Iris returns and notified of memoriam for
042606 - Millie. ref SDS 33 KP8F
042608 - ..
042609 - Advised that Peggy is coming, and that Pam, Ron, and Steve are
042610 - coming.
042611 -
042612 -
042614 - ..
0427 -
0428 -
0429 - 1038
0430 -
043001 - Stephanie arrived, Millies granddaughter.
043003 - ..
043004 - Patty and Pablito called, on their way to Oregon for Katie's (Rebecca)
043005 - wedding on Saturday. Explained situation of Millie suddenly in
043006 - distress, per above. ref SDS 0 036C They arrived about 1300, and
043007 - visited for 6 hours or so. Glad that everyone introduced themselves,
043008 - because there was a lot to do for Millie.
043010 - ..
043011 - Robin called about visiting this weekend, as planned 2 weeks ago.
043012 - Explained situation of Millie in grave distress, per above.
043013 - ref SDS 0 036C Robin will call on Friday to discuss visiting this
043014 - weekend.
043015 -
043017 - ..
0431 -
0432 -
0433 - 1119
0434 -
043401 - Ron Jr arrived, later Pam, Peggy, Kim came, and in the late
043402 - afternoon, Steve and Lilly arrived with Emily. Amanda and Mathhew
043403 - also arrived.
043405 - ..
043406 - Millie still communicating fairly well. She recognized and talked
043407 - with everyone, thanking her family for helping out today. However,
043408 - ability to speak declined throughout the day.
043410 - ..
043411 - Pam called Marilyn, and Marilyn then talked briefly with Millie by
043412 - phone. Millie having a hard time speaking now.
043414 - ..
043415 - Trying to get Millie to eat some of Kim's brownies, which have a
043416 - medicinal additive.
043418 - ..
043419 - Broke off a few bits of a brownie, and placed it in Millie's mouth.
043420 - She was able to chew this and swallow, but only a few small bits, then
043421 - shook her head that was enough.
043422 -
043423 -
043425 - ..
0435 -
0436 -
0437 - 1217
0438 -
043801 - Called Janna and explained that Millie is not doing well, and that her
043802 - children are here. Janna is home on Wednesdays, so she is coming over
043803 - from her apartment around the corner in the complex.
043805 - ..
043806 - Janna arrived about 20 mintues later, and after seeing Millie, and
043807 - offering suggestions for her care, Janna stayed and visited with the
043808 - family downstairs.
043809 -
043810 -
043811 -
043813 - ..
0439 -
0440 -
0441 - 1448
0442 -
044201 - Susan arrives...
044202 -
044203 - Susan Coppa, RN
044204 - Martinez Hospice
044205 - Kaiser Foundation Hospitals
044206 - 200 Muir Road
044207 - Martinez, CA 94553
044208 -
044209 - 926 229 7845
044218 - ..
044219 - Shingles symptoms.
044220 -
044221 - Early this morning, Millie was still able to communicate fairly
044222 - well. She asked for cortizone treatment on her right forehead
044223 - and eye lid, so this was applied, per above. ref SDS 0 QK4L
044225 - ..
044226 - Susan prepared a work plan for treating Millie's sudden declining
044227 - condition.
044229 - ..
044230 - Susan called Doctor Johnson to place orders for additional medication.
044231 - She got a message saying the doctor is still on vacation, which is the
044232 - message Linda got last Friday on 100723, when she needed approval for
044233 - increasing Millie's Morphine, and increasing decadron.
044234 -
044235 - [On 100729 0510 next day, Millie declined, so Susan made
044236 - another new work plan. ref SDS 32 LG3L
044238 - ..
044239 - Susan called the Hospice doctor and/or pharmacist.
044241 - ..
044242 - Cortisone
044243 -
044244 - Susan ordered more for Millie which has been used to control
044245 - itching from IBC getting worse, but this has been replaced
044246 - today with Atarax.
044247 -
044248 - Cortisone was ordered to control symptoms of shingles
044249 - recurrence, per above. ref SDS 0 QK4L
044251 - ..
044252 - Susan went through the Hospice Emergency Kit, and advised that using
044253 - medications from the kit should be preceded by calling Hospice for
044254 - notification and guidance...
044255 -
044256 - Morphine in liquid form is given with a syrenge Millie begins
044257 - having difficulty swallowing, which may begin today, or anytime
044258 - in the next few days.
044259 -
044260 - Amount of morphine to give will be designated by Hospice
044261 - telephone support, per below. ref SDS 0 UN5O
044263 - ..
044264 - Ativan is for anxiety, but also supplements morphine to control
044265 - pain and discomfort. Susan described Ativan as a "wonderful"
044266 - drug that does many things. Kim later said her parents used
044267 - Ativan to improving breathing, because they had asma.
044269 - ..
044270 - Atarax pills can be given by mouth as long as Millie can
044271 - cooperate and is able to swallow, and for the purpose of
044272 - reducing itching. This should replace Cortizone for itching,
044273 - but cortisone will be used to relieve new symptoms of shingles,
044274 - per above. ref SDS 0 4G77
044276 - ..
044277 - Atropine 1% small bottle given to the patient as 2 drops in the
044278 - mouth. Susan said that syliva forms a blockage in the throat
044279 - when patients are not eating, and makes a crackling during
044280 - breathing. She emphasized that breathing is not reduced, but
044281 - the condition brings discomfort to the patient. The 2 drops of
044282 - Antropine 1% usually clears the problem.
044283 -
044284 - [...below, called John at Hospice and he gave instructions
044285 - on using Atropine 1%. ref SDS 0 L47T
044287 - ..
044288 - [...below Millie suffered crackling breathing, so gave
044289 - Atropine and this seemed to relieve Millie's discomfort.
044290 - ref SDS 0 B69F
044292 - ..
044293 - Susan seemed to explain that with increased morphine from 60 to 90 mg,
044294 - every 12 hours, Millie will no longer need oxycodone. Ativan replaces
044295 - decadron, and Atarax replaces cortisone to conrol itching.
044297 - ..
044298 - Susan discussed getting a hospital bed for Millie. We left Mil's
044299 - room for a moment and walked into the other room to discuss the need
044300 - for a hosptial bed. Explained that Millie wanted to end her life in
044301 - her own bed.
044303 - ..
044304 - We went back to Millie's room, and Susan asked Millie if she wanted a
044305 - hospital bed. Susan explained briefly, this might make Millie more
044306 - comfortable and would be easier to care for her needs. Millie shook
044307 - her head no, and was able to barely say "no."
044309 - ..
044310 - Susan said that a hospital bed is required for Millie to get certain
044311 - types of Hospice care, including assistance bathing. She decided not
044312 - to order a hospital bed tonight, and said that when Linda, Millie's
044313 - Hospice Case Manager, comes tomorrow, she will further assessment.
044315 - ..
044316 - Susan indicated that since Millie is having trouble eating, per
044317 - brownie test above, ref SDS 0 3I4N, Millie should end decadron,
044318 - because decadron medication requires having food in the stomach before
044319 - taking it, and Millie cannot eat now.
044320 -
044321 - [On 100729 0510 Linda called and discussed replacing
044322 - decadron with something else that does not require eating
044323 - prior to taking medication. ref SDS 7 J174
044325 - ..
044326 - [On 100729 0510 Linda agreed to end decadron, and placed an
044327 - order for a substitute to care for Millie going forward.
044328 - ref SDS 7 6S5H
044330 - ..
044331 - [On 100729 0510 1222 Linda arrives, and makes updated
044332 - assessment, ref SDS 7 6Q4K, that Millie needs another
044333 - updated medication and care program. followed up,
044334 - ref SDS 7 ZS6O
044335 -
044336 -
044338 - ..
0444 -
0445 -
0446 - 1505
0447 -
044701 - Pam and Kim have gone through the Hospice book. They called Alta
044702 - Vista Funeral Home to make arrangements for Millie, per Millie's
044703 - instructions on 100715 0935. ref SDS 5 XS5H
044704 -
044706 - ..
0448 -
0449 -
0450 - 1538
0451 -
045101 - House is now full of family and friends to support Millie.
045102 -
045103 - Kim is going out for pizza to feed everybody.
045104 -
045105 -
045106 -
045108 - ..
0452 -
0453 -
0454 - 1804
0455 -
045501 - John called back.
045502 -
045503 - He advised that his management team decided not to send a nurse for
045504 - Millie tonight, in order to achieve Kaiser cost containment goals.
045505 -
045506 - [...below Susan, Hospice nurse, arrived to assist with
045507 - Millie's care onsite. ref SDS 0 B69D
045509 - ..
045510 - John further said Kaiser will not deliver Fentanyl patch to improve
045511 - pain control, which Lilly earlier explained was helpful for her mother
045512 - when she was treated by Hospice, and later her father. John advised
045513 - that Kaiser management feels patients need to exercise cost
045514 - containment by using the Emergency Kit delivered by Linda on her first
045515 - visit.
045517 - ..
045518 - [...below Susan, Hospice nurse arrives and advises that
045519 - Fentanyl patch has been ordered for Millie and Linda will
045520 - deliver it tomorrow when she arrives to care for Millie.
045521 - ref SDS 0 B658
045523 - ..
045524 - John explained using contents of Emergency Kit...
045526 - ..
045527 - Liquid morphine.
045528 -
045529 - .25 ml every 2 hours
045531 - ..
045532 - Moderate pain...
045533 -
045534 - 0.5 ml every 2 hours
045536 - ..
045537 - Extreme pain...
045538 -
045539 - 1.0 ml every 2 hours
045541 - ..
045542 - Atarax
045543 -
045544 - Reduce itching from IBC, in place or to supplement Cortizone.
045546 - ..
045547 - Atavan
045548 -
045549 - Anxiety and supplemental pain relief.
045551 - ..
045552 - Atropine 1%
045553 -
045554 - Wet resperation, when Millie's throat is crackling during
045555 - breathing, because of saliva build up when swallowing declines.
045556 -
045557 - 2 drops every 4 hours and 2 more after 30 minutes with no evident
045558 - improvement.
045559 -
045560 - [...below Millie suffered crackling breathing, so gave
045561 - Atropine. ref SDS 0 B69F
045563 - ..
045564 - Hospice after 1700...
045565 -
045566 - 877 829 8613
045567 -
045568 -
045569 -
045570 -
045572 - ..
0456 -
0457 -
0458 - 1822
0459 -
045901 - Susan arrived during the call with John, and for her 2nd visit helping
045902 - Millie today, per above. ref SDS 0 X54I
045904 - ..
045905 - This seems conflicting with John's report earlier that Kaiser refused
045906 - to send a nurse to the house, per above. ref SDS 0 X84G
045908 - ..
045909 - This was a big help having Susan return.
045911 - ..
045912 - Susan initially advised that she has ordered the Fentanyl patch for
045913 - pain control, which John said earlier Kaiser would not provide, per
045914 - above. ref SDS 0 L45G Susan advised that Linda will bring the
045915 - Fentanyl patch for her visit tomorrow morning.
045916 -
045917 - [On 100729 0510 Linda did not bring Fentanyl patch to
045918 - increas Millie's pain control, but placed an order after
045919 - arriving on the job. ref SDS 7 6R4K
045921 - ..
045922 - Thanked John for calling back and providing additional help, and
045923 - arranging for Susan to return.
045925 - ..
045926 - After talking with John, Susan provided care for Millie.
045928 - ..
045929 - Susan said she called and told Linda, who is off work today, about
045930 - Millie's change for the worse, and Linda was very surprised, because
045931 - just last Friday, Millie seemed in very good shape. ref SDS 6 QK5O
045932 -
045933 - [On 100729 0510 Linda cried when she saw how much Millie
045934 - declinded since last Friday. ref SDS 7 6Q6O
045935 -
045936 -
045937 -
045938 -
045939 -
045941 - ..
0460 -
0461 -
0462 - 1828
0463 -
046301 - Susan demonstrated how to use the syrenge to apply morphine liquid,
046302 - and Atavan, if this becomes necessary, according to treatment levels
046303 - reported by John, per above. ref SDS 0 UN5O
046305 - ..
046306 - Susan showed how to crush Atavin pills between two teaspoons, mix with
046307 - a small amount of water in the spoon, and draw the solution into a
046308 - syrenge already loaded with morphine liquid, saying these medications
046309 - can be mixed and given together in the syrenge with a single
046310 - application.
046312 - ..
046313 - She showed how to slide the syrenge beneath Millie's tounge and press
046314 - the syrenge slowly to empty contents into Millie's mouth, for
046315 - immediate effect to relieve and avoid pain and suffering.
046317 - ..
046318 - Since Millie was given the prescribed dose of morphine, 90 mg at
046319 - approximately 1830, per above, the additional .5 mg and Atavin
046320 - somewhat overmedicated Millie. Susan feels Millie should sleep
046321 - peacefully this evening with extra medication.
046323 - ..
046324 - Susan showed how to use swabs to wet the inside of Millie's mouth.
046325 - Millie seemed to like this.
046326 -
046327 -
046329 - ..
0464 -
0465 -
0466 - 2034
0467 -
046701 - Susan was wonderful givng Millie full attention, time, and expertise
046702 - to make her comfortable in every way, and with decorum and dignity of
046703 - appearance which Millie appreciated in her life
046705 - ..
046706 - At this time, Millie is sleeping peacefully. She has been less and
046707 - less able to communicate, perhaps due to increased morphine, per
046708 - above. ref SDS 0 B751 She now looks comfortable, and without
046709 - suffering or pain.
046711 - ..
046712 - Walking Susan to the car; Susan feels Millie may have 5 days before
046713 - she dies.
046715 - ..
046716 - Hugged and thanked Susan on behalf of the family for coming out a
046717 - second time today, "going the extra mile" for Millie.
046719 - ..
046720 - Susan will call Linda this evening or first thing in the morning, and
046721 - let her know how Millie is doing, and explain what has been planned
046722 - for Millie's care tomorrow.
046723 -
046724 - [On 100729 0510 1700 Millie died. ref SDS 32 EK4I
046726 - ..
046727 - In the house, the family gathered at the dining room table. Kim
046728 - brought in extra chairs from the patio, so everybody could sit. We
046729 - talked about the day, and how wonderful it was that so much of the
046730 - family - all of her children, and grandchildren, except Amy who is
046731 - sick at home in San Diego, and so could not come up - and of course
046732 - Millie's friend Peggy, who could all be with Millie at this time.
046734 - ..
046735 - Pam said she called Iris in New York, and left a message.
046737 - ..
046738 - Advised that Millie wanted to call Iris this moring, then remembered
046739 - that Iris is in South Africa on vacation until the end of July, per
046740 - above. ref SDS 0 NP5F
046742 - ..
046743 - Lilly suggested making a list of others who should be called, and told
046744 - that Millie is nearing the end of her journey. Pam used Millie's cell
046745 - phone to get the list for Millie's "Contacts," and everyone
046746 - contributed other names.
046747 -
046749 - ..
0468 -
0469 -
0470 - 2218
0471 -
047101 - Rob just called and said that Patty called Sally about Millie being in
047102 - grave condition, and Sally called Rob.
047104 - ..
047105 - Advised that Millie is not doing well. She failed suddenly beginning
047106 - Tuesday night.
047108 - ..
047109 - Rob is attending Katie's wedding in Portland on Saturday. He will
047110 - keep in touch on Millie.
047111 -
047112 -
047114 - ..
0472 -
0473 -
0474 - 2242
0475 -
047501 - Millie having symptoms crackling breathing that seems to require
047502 - Atropine 1%, per above. ref SDS 0 L47T
047504 - ..
047505 - Gave Mil the 2 drops. Was not sure how these very small drops can
047506 - work their way to the saliva buble in the throat, since it seems they
047507 - would adhere to the tough. These 2 drops however did seem to quiet
047508 - the crackling in Millie's breathing.
047509 -
047511 - ..
0476 -
0477 -
0478 - 2303
0479 -
047901 - Some minor crackling seemed to continue, so gave Millie another 2
047902 - drops. Seems again to resolve crackling problem.
047904 - ..
047905 - Millie has been letting out an abrupt noise of some kind, sort of like
047906 - a moan, but not sure. Checking she seems okay.
047908 - ..
047909 - Changed the cold compress on her forehead.
047910 -
047912 - ..
0480 -
0481 -
0482 - 0028
0483 -
048301 - Millie seems to be sleeping peacefully.
048302 -
048303 - Went to bed.
048304 -
048305 -
048306 -
048307 -
048308 -
048309 -
048310 -
048311 -
048312 -