Movements of Mental Acuity

Reenie – look for call Thur from Lakshmi re PT and make sure to ask her about feedings (see below for both).

Alison was asleep when I got there at 11am. She did rouse herself but appeared with flat effect the whole visit. Alison’s roommate told me that yesterday the Dr Pat increased Alison’s meds given her outbursts (here we go again). I at some point asked and heard that they had stopped Ativan and moved to Chloripizan (?sp). Alison is neither mumbling nor sedated with her eyes shut, just not really as there as I am used to.

As Amy posted, they have upgraded Alison’s bed so it is now electronically controlled vs crank. It makes it easier for the repeated cycle of sitting her up to allow her to eat followed by laying her back down because of pain. Her bottom still hurts (? due to skin erosions – I asked them to change her at 11:30 so I could see but this had not been done by 2pm when I left).

I tried to find out what was going on with Alison’s feedings. I now have 6 conflicting data points. Alison and her roommate say that Alison was not given trays OR peg tubes for two days (may not be accurate). Alison later said she really liked the mashed hot dogs they gave her at lunch (when?). Per Lakshmi in PT, they do have periods during the day when patients do not received peg tube feedings, during which they schedule their other appointments like PT/OT/Speech. That means that interruptions in peg feeding are normal. When I got to the floor, Nursing told me Alison was not set up to eat regular tray feedings and that only Speech Therapy gave her food. Just afterwards, Dietary delivered Alison’s lunch… When Speech Therapy came in, Rachael said that she thought the previous Speech Therapist had put Alison on pleasure eating for 3 meals a day – that is what pleasure feeding is (vs some other term that restricts feeding to only Speech Therapy). Rachael said she would check. Lakshmi said she would review Alison case Thur during the weekly review with Nursing, to discuss if Alison is not being given either regular peg or pleasure feeding. My view, there is not sufficient staffing on the 4th floor to have time to feed Alison, given how long it takes (a 7th data point)... Alison says she is now 135 lbs (an 8th).

Regarding PT, Lakshmi is going to contact Reenie Thur about temporarily holding off on PT, until Alison’s ability to benefit from it improves.

I spent most of my time with Alison feeding her butternut squash soup and Aluette cheese (more supplies are still in refrig) and massaging her arms and legs. Next visitor, please bring more lobster bisque (Giant carries it prepackaged near their veggies for $6). Alison appears unwilling to try to do things for herself though I keep encouraging her to squeeze a tennis ball, move her fingers etc. She continues to say she wants to die. The room is noisy (TV on 24 hours a day) and hot. Oh my.

NOW the great info, which I saved for last. Alison is very together about certain things. I asked if she remembered when I was last there. Thursday she said – Correct! I then said that today was Wednesday. She said, "March 5. It is Peter’s bday. I would like to call him." I called his home phone and when the answering machine picked up, Alison waited for the beep and on cue left a complete and lovely message for Peter. When done, she asked to call his cell and remembered the last 7 digits perfectly. So we left another message. Ain’t the brain amazing!!!