Mom Update 11/20/2008

On Thu, 20 Nov 2008 13:53:05 -0600, "MaryL"
-OUT-THE-LITTER wrote:

In Texas (and probably other states), a DNR order is different from a Living
Will. An elderly patient or someone facing catastrophic illness needs both.
When my mother signed her documents, I also updated my own living will. I
asked about DNR but was told that would not be appropriate for my age and
health, but it was for my mother. Incidentally, there are some specific
requirements in Texas law concerning both. Nevertheless, it is important to
make sure *in advance* that the doctor or institution you use will abide by
these documents because they are not required by law to do so. However, a
doctor who cannot or will not abide by a living will or DND *is* obligated
to release the care of that patient to someone who will. Unfortunately (in
my opinion), a family member can legally override the stipulations in these
documents.

When we were dealing with Mom, her living will, DNR, etc., it was
brought up that hospitals will not honor a DNR during surgery. I don't
know how reliable the source, and honestly, I don't even remember who
said it now. I could see where a hospital might want to take that
stance as letting people die during surgery doesn't do much for their
success rate. However, I had never heard of it being optional to honor a
DNR until then.

Right before Mom passed away, she was in the hospital. We had her taken
to the emergency room. I'm not sure now we did the right thing; I think
we just acted from a knee jerk reaction to the sudden change in her
condition. Looking back, I don't know why we didn't just make her
comfortable as best we could at home. We were all there with her that
day, and maybe it would have been a peaceful passing for her without
extra fuss. Hindsight, and all that. The few days that she rebounded
made it seem worthwhile at the time.

I remember that when they were going to move her from the ER to a room,
we had to wait for a nurse to escort us in case Mom coded. I remember
emphatically saying that she had a DNR order, and that she shouldn't be
resuscitated. I wonder if the orderly caught the irony of what I was
saying after we had just admitted her to the hospital. Maybe they're
used to it.

L.

MaryL wrote:
"jmcquown" wrote in message
...


Oh, and I had two copies of those executed documents can't find my
extra copies. I know they are around here someplace (I thought they
were in my suitcase). I've torn the place apart looking for them.

Jill

When did your mother have the DNR order drawn up? The reason I'm
asking is that my mother had hers done at the same time as she had
her will drawn up. As a result, an original of her living will, DNR,
power of attorney, etc. is attached to her will (although they are
not actually part of it). So, you might want to check her will and
see if a copy/original is clipped to the back of the will or in the
same envelope with it.
MaryL


It's not clipped to it (yes, she did them all at the same time). That was
one of the first places I looked when I couldn't locate them. Her will is
stapled to heavy vellum paper, tri-folded and inserted into a heavy envelope
that proclaims it's her Last Will and Testament. But I looked in the
envenlope anyway. No such luck.

Jill

MaryL wrote:
"jmcquown" wrote in message
...


Living Will/DNR with me per her lawyer's instructions. I saw the
documents when she was in the ER before she was admitted and also
after she was in a regular room. Then they lost them! This
information was never entered into her chart.

I spoke with her attorney about it. I can't be sure at this point
how much she comprehends. He can't prepare new documents unless he
knows she absolutely understands what she's signing (or making a
mark on, she can't sign her name anymore). So I'm between a rock
and a hard place. That hospital really ticks me off.

Jill

Can't her attorney provide a copy of her *old* documents, which
should still be valid?

He didn't keep a copies of the executed (signed and witnessed) documents, I
have no idea why. He has a copy of her will, and the durable power of
attorney is on record at the county courthouse.

I ran into the same type of situation as you
described. Fortunately, I had already made multiple copies because we
were warned when Mother signed her documents that they must accompany
her at *all times.* Even a trip to the dentist. I fought constantly
with the nursing home about that for the first couple of years. Their
practice was only to send the DNR orders when a patient went to
the hospital. I kept pointing out that something could happen at any
time, and I had been told that paramedics were required by law to
start resuscitation unless the documents were with the patient. At
my insistence, they finally attached a big note to the front of her
chart that a copy must accompany her at all times. I did not have a
problem with the nursing home after that, but I still took copies
with me anywhere I went. I kept copies in the car, in my house, and
in Mother's room at the nursing home. On several occasions, the ER
"couldn't find" the documents, so it's fortunate that I had my own. This
is just a tragedy waiting to happen for some patients. I really
felt terrible about constantly demanding to see the DNR orders
because it made me feel as if I somehow wanted my mother die. Nothing
could be further from the truth, but I also knew that she
absolutely did not want to be "maintained" on machines. I did have
very long and detailed discussions with her doctor as to exactly what
procedures were to be permitted because family decisions are
important even with a patient's signed DNR orders. He entered all of
that on his own records, and it was on file with the nursing home. It was
the hospital that seemed to need all information all over
again, even if it had only been a few days since I last gave them
information -- and sometimes simply by moving her from one room to
another.
MaryL


I'm glad you kept so many copies, Mary. I surely wish I'd been given more
than two. I didn't have a printer/copier back in June but if I'd known I'd
need them I'd have made a million copies the moment I got the printer! I'm
sure that was tough insisting on knowing they had the DNR all the time, but
dammit these (hospital) people sure seem to screw up a lot! I'm sure it was
because they kept moving her around all the time. I saw it with her twice.
Then nothing. But honestly, it should have been entered into her chart
*immediately*. I pointed it out to the ER personnel. I pointed it out to
the nursing staff when she was assigned her first room.

But then (again), they managed to lose her lower dentures even though just a
couple of days before she came home I saw them sitting in a red cup on the
table by her bed. They sent the red cup home with her - the empty red cup.

Jill

MaryL wrote:
"MaryL" -OUT-THE-LITTER wrote in message
. ..

"jmcquown" wrote in message
...


Oh, and I had two copies of those executed documents can't find my
extra copies. I know they are around here someplace (I thought
they were in my suitcase). I've torn the place apart looking for
them. Jill

When did your mother have the DNR order drawn up? The reason I'm
asking is that my mother had hers done at the same time as she had
her will drawn up. As a result, an original of her living will, DNR,
power of attorney, etc. is attached to her will (although they are
not actually part of it). So, you might want to check her will and
see if a copy/original is clipped to the back of the will or in the
same envelope with it. MaryL

It's also possible that there is a copy in her "old" doctor's files. It's
fairly standard practice to file a copy with the family doctor
when documents like that are drafted.

MaryL


She hadn't seen her "old" doctor since April. She drew up her will and the
HPOA and Living Will/DNR in June.

Jill

CatNipped wrote:
"jmcquown" wrote in message
...
The biggest problem with that is when she went to the hospital I
took the executed copies of Healthcare Power of Attorney and her
Living Will/DNR with me per her lawyer's instructions. I saw the
documents when she was in the ER before she was admitted and also
after she was in a regular room. Then they lost them! This
information was never entered into her chart. So if she does wind
up back in the hospital they'll put her on all that medication again
despite my (and her) wishes. And if she codes, they'll revive her,
put her on a ventilator, whatever "heroic measures" it takes. This
is absolutely not what she wanted. That's why she had the documents
prepared in the first place! I spoke with her attorney about it. I can't
be sure at this point
how much she comprehends. He can't prepare new documents unless he
knows she absolutely understands what she's signing (or making a
mark on, she can't sign her name anymore). So I'm between a rock
and a hard place. That hospital really ticks me off.

Jill

The lawyer should be able to reproduce the original documents without
her have to re-sign anything!

An unexecuted (signed or with her mark) and unwitnessed Living Will/ DNR is
not legal in South Carolina. For that matter so is an unexecuted HealthCare
POA. Don't you think I asked him if his paralegal could simply print me a
copy off her computer?

I didn't run into these problems with my father. He didn't have *any* legal
documents (except for an old Will that didn't even have to be probated) yet
they let me make all the decisions. When one of the doctors wanted to
insert a feeding tube I said I didn't know, I'd have to think about it. I
mean, what did I know about gastric feeding tubes?! Well, another doctor
called me and said flat out he couldn't tell me what to do but if it was his
father he wouldn't do it. So I didn't. They just made him comfortable. He
rallied a few times, but in the end he died peacefully and without pain.

Good lord, Jill, they are making you jump through hoops and putting
you through the wringer!! I don't know that I could do what you're
doing, the frustration alone would kill me!

Hugs,

CatNipped

LOL I'm having a glass of wine now. I just got back from a very long
afternoon. I picked up refills of her two compounded liquid prescriptions
from the MediCap pharmacy. The on-call hospice nurse asked if I could pick
up the fenergan (sp) for nausea at Walgreen's since I'd be in town anyway
and she was on appointments attending to patients. I said sure. Got to
Walgreen's and they said "Oh, this isn't covered by hospice." I didn't blow
a gasket but I thought to myself oh come on, give me a break!

The pharmacy tech graciously called the hospice and left a message for the
nurse while I shopped for other stuff. When I was done she apologized for
the error and the prescription was covered - no charge. But *then* I had to
go to the grocery store... Oh lord am I tired! And I pulled into the
driveway not 3 minutes after the hospice nurse left the house. Shay (the
CNA) and I knew that would happen! LOL

Jill

The purrs certainly continue, for you, your mother, and the CNAs.

--

Joy

No amount of time can erase the memory of a good cat, and no amount of
masking tape can ever totally remove his fur from your couch. - Leo Dworken

"jmcquown" wrote in message
...
I managed to get some sleep last night. But the poor CNA who sat with her
had a time of it. The CNA (Shay) who was here during the day told the new
nighttime CNA (Joyce) oh, it's easy. You just have to reposition her from
time to time, make sure she's comfortable. Change her diaper and wash her
a two or three times. Give her ginger ale or juice. Piece of cake.

Not last night! Mom vomited about 5 times and developed diarrhea. Mom
barely ate anything yesterday so I don't know what that's all about. She
wasn't having these issues even when she was still in the hospital. Joyce
ran out of the wipes the hospice provided. (I just happened to have
another package of them, but I didn't know about all this until this
morning.)

I called and told the on-call hospice nurse. She told me to crush a
couple of Immodium in water and give it to her by oral syringe.
Fortunately I happened to have some Immodium tablets. She called in a
prescription. Mom is on a liquid diet for today until we see how things
go.

Her regular hospice nurse wasn't scheduled to visit again until tomorrow.
But she'd called yesterday and said she'd call me today to see if I needed
her to come out. I left a message saying yes, please come out today.

Mom says she's not in pain. She asked for more ginger ale this morning.
And I'm told she wanted to look at the newspaper during the night. But
right now she's just plain worn out from being moved around to be changed
all night. Joyce even changed the bottom sheet and did laundry! although
how she managed to get the sheet off the bed and a clean one on I don't
know.

Shay, the day-time CNA just arrived. I'll be able to go to the grocery
store today, at least.

Thank you all for your support, suggestions and continuing purrs. You
have no idea how much that helps me.

Jill

"jmcquown" wrote in message
...

LOL I'm having a glass of wine now. I just got back from a very long
afternoon. I picked up refills of her two compounded liquid prescriptions
from the MediCap pharmacy. The on-call hospice nurse asked if I could
pick up the fenergan (sp) for nausea at Walgreen's since I'd be in town
anyway and she was on appointments attending to patients. I said sure.
Got to Walgreen's and they said "Oh, this isn't covered by hospice." I
didn't blow a gasket but I thought to myself oh come on, give me a break!

The pharmacy tech graciously called the hospice and left a message for the
nurse while I shopped for other stuff. When I was done she apologized for
the error and the prescription was covered - no charge. But *then* I had
to go to the grocery store... Oh lord am I tired! And I pulled into the
driveway not 3 minutes after the hospice nurse left the house. Shay (the
CNA) and I knew that would happen! LOL


Hospice covers Phenagren, but not Zofran which is another of the nausea
medications Rob receives. We have to pay for it ourselves or get it through
the army hospital, now that it is back in their pharmacopeia. I don't know
how much it would have cost you, but it shouldn't have been more than $9
through tri-care. I'd check if you do have to pay for any out of your own
pocket.

Pam S

tanadashoes wrote:
"jmcquown" wrote in message
...

LOL I'm having a glass of wine now. I just got back from a very
long afternoon. I picked up refills of her two compounded liquid
prescriptions from the MediCap pharmacy. The on-call hospice nurse
asked if I could pick up the fenergan (sp) for nausea at Walgreen's
since I'd be in town anyway and she was on appointments attending to
patients. I said sure. Got to Walgreen's and they said "Oh, this
isn't covered by hospice." I didn't blow a gasket but I thought to
myself oh come on, give me a break! The pharmacy tech graciously called
the hospice and left a message
for the nurse while I shopped for other stuff. When I was done she
apologized for the error and the prescription was covered - no
charge. But *then* I had to go to the grocery store... Oh lord am I
tired! And I pulled into the driveway not 3 minutes after the
hospice nurse left the house. Shay (the CNA) and I knew that would
happen! LOL

Hospice covers Phenagren, but not Zofran which is another of the
nausea medications Rob receives. We have to pay for it ourselves or
get it through the army hospital, now that it is back in their
pharmacopeia. I don't know how much it would have cost you, but it
shouldn't have been more than $9 through tri-care. I'd check if you
do have to pay for any out of your own pocket.

Pam S


Phenagren... whatever the generic equivalent was (which was what was called
in) was covered by hospice. But the pharmacy got it wrong the first time.
It's not that I'd complain about a $9 TriCare for Life copay (it came in
pill and suppository form, so two Rx's actually). But come on, I know it's
covered. And when they checked sure enough, it was. Give me a break,
people. I am doing my best without you (the pharmacy, not hospice) nickle
and diming me to death. I'm paying for children's liquid Tylenol in case
she's in pain. I'm paying for low-dose 81mg chewable aspirin to prevent
post-surgery clots. It was just another notch in the belt that make me want
to scream.

Jill

On Fri, 21 Nov 2008 01:35:07 -0500, "jmcquown"
wrote:

snip
Phenagren... whatever the generic equivalent was (which was what was called
in) was covered by hospice.

I'm guessing we're talking promethazine(generic)/Phenergan(brand)? If
so, it's a drug which has been around a long time, and I'm still sort
of familiar with it from my time as an Army Pharmacy NCO. IIRC one of
the cautions is giving it to elderly patients, as they are more prone
some side effects - especially confusion and/or drowsiness. You might
want to watch and see if your Mom is confused after taking it. It
sounds like her Doctor is really working to cut back on her
medication, which is good since it's a real juggling act with the
elderly to get the right balance.
snip
--
Steve Touchstone
Little Bit, Sammy, Spotty, Princess, Furby
and Rocky (RB)
Pix at http://tinyurl.com/22pfn8
Vids at http://tinyurl.com/4yb6nj

Criminy Jill,

This whole thing just sounds like a nightmare. I can't believe the lawyer
didn't keep a copy of the POA papers. That is insane. At this point, I
really don't know what to even say to you because there is so much going on
that it is unreasonable for one person to really be handling it. I am so
glad you have a great hospice program there to support you because it sounds
like all the other institutions from the hospital to the lawyer to the
pharmacy exist only to see if they can make life a little tougher.

I hope your mother is feeling better today and I hope you got some rest. Out
of curiosity, where is LLL. You've posted often about your mother, but he is
one of your supports and I would hope that he is supporting you if by
nothing but phone. I will continue to have the cats purr for things to calm
down and get to some sort of normalcy.

I am also glad you have this group. I don't know about other people, but I
am always glad to see your daily update. As always, you are in my thoughts
and prayers.

Bridget

"jmcquown" wrote in message
...
I managed to get some sleep last night. But the poor CNA who sat with her
had a time of it. The CNA (Shay) who was here during the day told the new
nighttime CNA (Joyce) oh, it's easy. You just have to reposition her from
time to time, make sure she's comfortable. Change her diaper and wash her
a two or three times. Give her ginger ale or juice. Piece of cake.

Not last night! Mom vomited about 5 times and developed diarrhea. Mom
barely ate anything yesterday so I don't know what that's all about. She
wasn't having these issues even when she was still in the hospital. Joyce
ran out of the wipes the hospice provided. (I just happened to have
another package of them, but I didn't know about all this until this
morning.)

I called and told the on-call hospice nurse. She told me to crush a
couple of Immodium in water and give it to her by oral syringe.
Fortunately I happened to have some Immodium tablets. She called in a
prescription. Mom is on a liquid diet for today until we see how things
go.

Her regular hospice nurse wasn't scheduled to visit again until tomorrow.
But she'd called yesterday and said she'd call me today to see if I needed
her to come out. I left a message saying yes, please come out today.

Mom says she's not in pain. She asked for more ginger ale this morning.
And I'm told she wanted to look at the newspaper during the night. But
right now she's just plain worn out from being moved around to be changed
all night. Joyce even changed the bottom sheet and did laundry! although
how she managed to get the sheet off the bed and a clean one on I don't
know.

Shay, the day-time CNA just arrived. I'll be able to go to the grocery
store today, at least.

Thank you all for your support, suggestions and continuing purrs. You
have no idea how much that helps me.

Jill