1. While Mom sat in her wheelchair until about 2:30 this afternoon and while she looked refreshed from taking a shower, she was groggy throughout the time I spent with her from about 11:30 until 3:00. Mom talked occasionally, without continuity. She ate some applesauce, enjoyed her protein milkshake, and ate a tiny bit of cottage cheese and zucchini and rice from her lunch plate.
Mom got weighed when the aide showered her and she's down to 128.2 pounds.
Early in the afternoon, Andrea, her hospice nurse visited and examined Mom. Andrea is animated, personable, and knowledgable. In appearance, she thought Mom looked a little better than a week ago when Andrea last saw her. When I asked her if I heard this observation correctly, she said I did, but was quick to add, "Your mother is very frail." I agreed and never thought otherwise.
Andrea explained to me the five signs approach to determining and evaluating pain in a patient. She explained that it is best to evaluate Mom's pain after she has lay down and been at rest for about five minutes or so. Andrea looks at five areas and assigns a 0, 1, or 2 to each category. The five areas are these:
1. Breathing: Is Mom breathing smoothly and easily or is there some degree of labor to her breathing?
2. Vocalization: Is Mom verbally expressing that she feels pain? Is she moaning, groaning, or vocalizing pain in some other way?
3. Facial expression: Is Mom's face relaxed or is she grimacing? Is her face wrinkled from discomfort?
4. Body Movement: Is Mom's body still? Or is she fidgeting? Jerking? Twitching? Writhing? Mom tends to draw her knees up and then let her legs down again -- a sign of pain.
5. Can she be calmed down? If we talk to Mom while she is lying down and showing signs of pain, does she respond, say, with a smile? Does she seem comforted if we hold her hand or stroke her arm? Do any of these efforts relax her? By the way, last Friday, Andrea assigned a "1" to Mom in this category because when Andrea spoke to Mom, Mom did smile and seemed glad to hear Andrea's voice, but she didn't completely relax. Had Mom not responded in any positive way to Andrea, she would have assigned her a "2" in this category.
Last Friday, Andrea determined that Mom was at level of "1" in each category. When Carol had reported that Andrea scored her at five out of ten, I thought that meant that on a scale of 1-10, Mom's pain was at 5. I thought this because when Mom used to go to the pain clinic, the doctor always asked her to rate her pain on a scale of 1-10.
Now I know that the number five represented a pain level of one in each of the five categories.
Andrea also talked with me about the medicinal powers of morphine beyond it being a pain reliever and, on another subject, helped me understand how Mom's complexion shows signs of oxygen depletion even though her oxygen levels are very good thanks to the oxygen she has going into her system all day and night. A consequence of heart failure is that oxygen doesn't get transported well to all tissues -- so Mom's nose continues to be blue and she continues to experience the mental difficulties that come with vascular dementia. The heart failure also helps explain the fluid buildup Andrea could feel in Mom's upper arms and in her legs, and hear near her heart.
2. Debbie and I have a lot on our minds and are in the midst of making some important decisions. We drove to Coeur d'Alene this afternoon and talked. I'm not 100% sure that we have arrived at absolute decisions yet, but we sure worked at it and think there are some good possibilities for our life together as move ahead.
3. We went downtown to Crafted for a glass of rye IPA and split an order of chicken wings. Then we went to Slate Creek for a half a pint of their IPA. We love Slate Creek and would have stayed longer, but there's no air conditioning in their tasting room, only a fan blowing hot air. We look forward to returning to Slate Creek when the weather is cooler. We ended our little tour of beer joints at Daft Badger where I loved my Badger's Bounty IPA and Debbie thoroughly enjoyed drinking Peach Perfect, a lightly fruited peach wheat beer.