Thank you for your thoughtful reply. I agree that Mommy's getting out of the house
and into the car, and being driven around, would be very good for her. I accept your
assurances that you could protect her from being trapped in the hospital.

The first step, literally and figuratively is getting Mommy downstairs. Laura may or
may not have told you that  yesterday Mommy declined to try to descend the front stairs
at Laura's suggestion and in Laura's presence. I have been reluctant to make this attempt,
because if Mommy fell and I were behind her, I would not be strong enough to hold her.
If I were in front of here, we would both go down and there would be not one but two patients.
As of this moment (3:20 p.m.) Mommy hesitates to sit down even on the toilet from
concern she could not get up...  This morning I had top help her on the toilet and to get
dressed. I proceed as way opens.

I will print out this correspondence in large type, and give Mommy a chance to read
and to think about it; I will report to you her responses.

While I was at the grocery store between 1 and 2 p.m., a squirrel was caught in the
trap in the kitchen. (bait: peanut butter) I have just returned from deporting him or her
to the Audubon Wildlife Sanctuary.

Meyer, Klemens wrote:
> Here are my answers:
>
> 1. Since she is unable to negotiate stairs and get up out of a chair, is it feasible to take her to the hospital in an automobile? I am not convinced that with encouragement, she could not negotiate stairs. There is a large emotional component to her lack of function.
>
> 2. Ought a physical therapist initiate treatment without diagnosis?
> I will not pontificate on the problematic nature of the concept of diagnosis. There are many diagnoses here: there are a valgus knee deformity, a hip flexion contracture, osteoarthritis of many joints, including those of the spine; cerebrovascular disease, age-related sarcopenia and deconditioning contribute to poor balance. There is no reason to think that gentle, supervised exercise will make any of these worse. I do not think that any imaging studies would be helpful, although if Megan Whitmore, the physical therapist, asked me to order plain films of a certain joint or joints, I would take the request seriously.
>
> 3. If she entered hospital premises for any reason, isn't it likely that someone "responsible" would want to keep her at least "overnight"? Not as long as I'm physically present, in my white coat. Furthermore, in general, hospitals are no longer interested in dealing with debilitated people. They stay too long, and use up the DRG.
>
> 4. Isn't there a substantial possibility that removed from familiar surroundings she would become disoriented? I think that if accompanied by me, by Laura, or by you if you had the humor, she would probably be fine.
>
> 5. What is the probability that going to a hospital for any purpose today would make her happier 3 mos, 6 mos, 12 mos from now? I limit myself to 3 months; the others are all too uncertain. 50%. I think that the outing(s), the attention and the activity would be good for her. She should wash her hair, let Laura pluck her facial hair if that hair bothers her as much as Laura says it does, and make an effort.
>
> Megan Whitmore is available, and I am available, at the following times:
>
> Monday 3/3 3 pm or 4 pm
> Wednesday 3/5 3 pm
> Friday 3/14 any time from 8:30am
>
> It is my recommendation that Mommy accept an appointment on Monday 3/3, with the expectation that if the first visit goes well, she might have a second one on 3/5, and that subsequent appointments could be negotiated. It is possible that it will seem more practical to have someone come into the house for subsequent treatment, but I think that there is intrinsic value in making an effort to get out of the house, at least initially. Furthermore, I don’t know the people who would be invited in, and I would have none of the authority and none of the relationships which I can use to control the situation at the hospital. She (and you) would be treated particularly well because of the affection and respect the staff have for me. Finally, I happen to think that individuals matter, and I refer to individuals whom I know whenever possible.
>
> -----Original Message-----
> From: Ernst Meyer [mailto:ernstmeyer@earthlink.net]
> Sent: Wednesday, February 26, 2014 11:11 AM
> To: Meyer, Klemens
> Subject: Feb 26 update
>
> Mommy slept well. She is comfortable, but seems somewhat weaker than yesterday. Unable to get out of bed or out of a chair without much assistance.
>
> My questions: Since she is unable to negotiate stairs and get up out of a chair, is it feasible to take her to the hospital in an automobile?
>
> Ought a physical therapist initiate treatment without diagnosis?
> If she entered hospital premises for any reason, isn't it likely that someone "responsible" would want to keep her at least "overnight"?
>
> Isn't there a substantial possibility that removed from familiar surroundings she would become disoriented?
>
> What is the probability that going to a hospital for any purpose today would make her happier 3 mos, 6 mos, 12 mos from now?
>
> As for physical therapy at home, since treatments would be scheduled, it would be simple and straight forward to heat the bedroom to  75 degrees a) by adjusting the boiler, or
> b) by using one or more electric heaters.
>
> The squirrel is back.
>
> I hope you are feeling well.
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