The home care nurse spent the afternoon with us, learning about and understanding mother's condition, philosophy, determination and other factors that will affect her care from here on out. She was thorough, had reviewed mothers complete medical record, and was a real wonderful human being to boot. It was a great sharing, most of which took place on the deck in the sunshine with the hummingbirds flitting about. Nurse Trish arrived at 2:15 and departed after 4:30 so I won't be able to provide transcripts. However here are the findings and determinations in point form. I think they will draw the picture.   

- Mother's oxygen level was 98% after walking back and forth to the bathroom. Trish's was 97%  
- Mother's lungs were mostly clear today  
- The medical report prior to mother's last surgery indicated minimal fluid in the lungs  
- Still the X-Rays and MRIs showed multiple masses and areas of concern indicating a spread of cancerous activity in, around and behind the lungs.  
- Trish indicated that there are some good medical tools to remove the pain as well as the anxiety associated with restricted breathing capacity. She recommended that we get that worked out with Dr. Mahoney and get prepared so that these meds are here at the house and at the ready for when the time comes that they are required.  
- Although technically mother needs to be house bound in order to qualify for home care we agreed that if mother wanted to get active and walk or engage in other joyful activity outside the house she should do whatever truly makes her happy every step of the way. After all what does she have to loose?  
- There was direct inquiry of mother, a review and lots of good discussion about the Physicians Directive (POLST) and she recommended that it be updated after this last hospitalization and then posted at the entrance of the house.  
- Trish was impressed and more than a little pleased that mother and we had already done the work on the POLST and that had taken the time to prepare a questionnaire for mother and she had taken the time to fill it out to give us some guidance as to what is important to her at this time.  
- We talked about talking to Dr. Mahoney to officially lift the diet restrictions and the diabetes and cardiovascular treatment.  
- We talked about the flow rate of the oxygen and how that will be regulated over the course of events  
- We talked about the "Expected Death at Home" notification that Mahoney gives to the sheriff to save having to have a cornier come out when the time comes.  
- And finally, and probably most importantly, after some frank discussion about fitting this progression with physical therapy and rehabilitation mother was quite clear, in fact adamant, that she did not want to work that hard anymore and was ready to face the end as long as it could be as pain free as possible.   

I feel it will be a real blessing to have Trish as part of our team through this process. She is a wonderful human being and has personal experiences that bring her into the emotional and spiritual aspect of the process in addition to bringing the medical support for which she is paid.  

Now I'm off to see what we can fix for dinner...  

love you all  
me