Subject: September 30, 2015 at 10:00 p.m.
From: Ernst Meyer <ernstmeyer@earthlink.net>
Date: Wed, 30 Sep 2015 22:30:17 -0400
To: Anne_Bingham <annebinghamlaw@gmail.com>, "McPhedran, Peter" <peter.mcphedran@yale.edu>, townsendfarm <townsendfarm@roadrunner.com> , Marion Namenwirth <namenwir@umn.edu>

September 30, 2015 10:00 p.m. Since early afternoon yesterday September 29, Margaret had been mildly agitated. Last night she slept much less soundly and moaned intermittently. Her fluid intake today was much increased to perhaps 750 ml. She has not wanted anything to eat. Klemens performed appropriate physical examination and concluded that Margaret's agitation is not caused by pain. We have considered lorazepam sedation, but concluded that it would be better to try to restore her serenity by non-pharmacologic means. The ulcers on the buttocks have healed.  The ulcer over the sacrum has been reduced to a 1.5 mm epithelial defect. As of today the flexion deformities of both elbows and of the right knee can still be reduced with gentle passive extension, but Margaret is so adamant about keeping these limbs flexed that absent splinting, which would be very uncomfortable, the development of flexion contractures seems inevitable.