Subject: October 12, 2015 at 11:00 a.m. From: Ernst Meyer Date: Mon, 12 Oct 2015 11:02:58 -0400 To: Anne_Bingham , "McPhedran, Peter" , townsendfarm BCC: ernstmeyer@earthlink.net, Benjamin , Cyndy Behrman , Marion Namenwirth , "Meyer, Klemens" , Nathaniel , Niels Holger Nielsen 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.