Subject: October 12, 2015 at 5:40 p.m. From: Ernst Meyer Date: Mon, 12 Oct 2015 17:42:29 -0400 To: townsendfarm BCC: ernstmeyer@earthlink.net, "McPhedran, Peter" , Anne_Bingham Dear Alex, Thank you for your empathy and understanding. Margaret herself had stipulated in writing, before she became ill, that there was to be neither nasogastric intubation nor i.v. fluids. Klemens and I agreed; and I'm under the impression so did Janet, Peter and yourself. At 5:35 p.m., Margaret has still not awaked; she may be lapsing into a coma. Such predictions are hazardous. I don't try to awaken her, and I will keep you informed. Thank you for everything. Love, Jochen townsendfarm wrote: > Dear Jochen, > > From what you describe it sounds as though the only way to provide fluid intake would be by intravenous injection and I don't imagine you would want to do that. > > Nor would I if I were in your place. Surely, no one is counseling you to give " iv s". I understand what you say about giving medicine. I think there are s.c. nior i.m. preparations like lorazepam but one would use it only to relieve perceived suffering - I think. Am I reflecting your thinking rightly? Love, Alex > > > -------- Original message -------- > From: Ernst Meyer > Date: 10/12/2015 11:02 AM (GMT-05:00) > To: Anne_Bingham , "McPhedran, Peter" , townsendfarm > Subject: October 12, 2015 at 11:00 a.m. > > October 12, 2015 10:00 a.m. > > Margaret's illness appears to have entered a new phase. > Yesterday at 1:45 p.m., as I wrote you, because of her otherwise > uncontrollable anxiety, I gave her, for the first time, one > 0.5 mg. tablet of lorazepam after which her moaning subsided > and she slept very soundly until about 6:30 p.m. After changing > her I put the straw to the cup of whole milk into her mouth, > but she would not drink, and gradually fell into a sleep in which > she started to moan, very loudly, in fact to shout so loudly that > had the window been open, a School Street passerby might well > have called the police. > > This very loud moaning continued through the night and continues > into the morning: Just now Margaret is repeating, over and over > again, shouting, in a very loud voice "no, no, no". I thought I > heard her say also "Laura". - "Jochen", in any event, has at least > for the time being, been forgotten. Remarkably, the clear articulation > of words, which had been prominent and remarkable, is now absent. > The inchoate moaning and shouting is cyclical and coincides with > the period of Cheyne-Stokes respiration. Her pulse, as I felt it > during the course of the night, varied, at times it was rapid, > (+/- 100 per minute) irregular in rhythm, and fluctuating in > intensity, suggestive of atrial fibrillation, at other times, > like a ventricular pulse, forceful and rhythmic, with every > 3rd beat dropped. > > Rightly or wrongly, I'm confident that Margaret is not in physical > pain. I imagine her experiencing, if anything at all, a nightmare, > with nebulous, transient, perhaps frightening apparitions, which > are almost immediately forgotten. Unless and until she wakes up, > Margaret is obviously unable to swallow either solids or liquids. > I don't believe her shouting and moaning should be treated with > medication. But I may be wrong, and I'm open to being corrected. >