Friday 10/16/09

Also I wanted to add to the arrangements Salynn had outlined below that following the mass there will also be a gathering to celebrate Valerie’s life ,held at the Knights of Columbus Hall.

Love and Prayers for Val

Ryan

Thursday October 15, 09 2PM
The plans are made. Monday October 19, 09 there will be a burial service at 9 :00 AM for anyone who would like to attend to be held at Peasantview Cemetery in Morrisville, VT. A funeral mass will follow at 11:30 AM at St. Monica's church in Barre, VT.

For all those who would like to share a memory of Val with Dad, Rudy and Lea and all her family, please feel free to do so as a comment on the blog or on the on line newspaper for the Barre Times Argus will run her obituary as well as the local paper in Kennebunk.

Love and prayers to Val for eternal peace and rest....SAlynn

Thursday Oct. 15, 09
It is with peace and great sadness that I must say Val passed away at 2 AM this morning with Dad, Rudy and Lea, Alison, Fuller her dog and Diamond her cat at her bedside. In lieu of flowers, a donation in Memory of Valerie Trombley to either the Central Vermont Home Health and Hospice or The Humane Society of Central Vermont is preferred. The services are being planned as I write this. Tentatively, there will be a private, family burial of Val's ashes in Morrisville, VT followed by a funeral mass in Barre Vermont at St Monica's Church most likely on Monday Oct. 19, 09.

Love and Prayers of eternal rest to Val always...Salynn

The Humane Society of Central VT
Mekkelsen Hill Road
Barre, VT 05641
802-476-3811

Central Vermont
Home Health and Hospice
600 Granger Road
Barre, Vt 05661

802-223-1878

Wednesday Oct. 14, 09
At 8:30 this evening, my brother Baine called to report that Val's breathing changed has changed to raspy. Her oxygen dropped to 72% on the 6% oxygen. The VNA nurse came as requested by a phone call from one of my siblings or Dad. The nurse increased Val's oxygen to 7% and her oxygen saturation returned to 92%. The morphine drip was increased also and a patch of atropine was placed behind her ear. The nurse stated it would most likely be only hours. At her bedside is her parents Rudy and Lea, Dad, Alison my sister, and Baine with his wife Denise. Val looks peaceful with no visible signs of discomfort and is surrounded by those who love her. She is not alone as she leaves us to begin another journey.

Love and Prayers to Val always....Salynn

Tuesday Oct. 12, 09
Yesterday was an agitated day and today was a day of refusal. The morphine IV drip in in place and the end is nearing.....

According to Ryan, Val was so "fired up" yesterday trying to get out of the house, banging on her window, and trying to get out of bed by herself once ( she is too weak to do so, but she was trying) that today she was "spent" and a bit more peaceful.

At 3 am this morning, Val was awake talking about a white bag. Dad finally figured out she wanted to feel and touch Fuller's dog food. As she gets closer to going to her new home, the comfort of thinking of her animals has been a common thread in her attempts at conversation. During the day today, she told her mother Lea that she had a new puppy named Fluff. What joy that thought must be for Val to think she has a new puppy!! The animals which bring such joy to Val's life have been an active part of her mind.

This morning started by Val biting Dad's finger and refusing the Ativan pill. The VNA nurse Mary came twice today to switch Val to a morphine drip (IV) through her chemo port. Val is now taking the Ativan orally by syringe as she used to take the morphine. No more pills! Boy that has been Val's feeling since day one of her cancer battle, and she finally is getting her wish. Dad will supplement the IV drip by oral syringe tonight as needed if Val is uncomfortable.

Dad is the best he could be under these circumstances. He is exhausted emotionally, physically and psychologically. He knew he couldn't let hospice in his house more than they already were. But he has finally said "I can't do this alone" and has allowed his children and Val's four stepchildren to help him. Ryan will leave for TX tomorrow early Wednesday, Alison will be there Wednesday and Thursday and then Baine will be there Friday into the weekend until I can go back up.

Rudy and Lea come daily 2-4. Rudy still reads to Val and Lea was given the job of swabbing her mouth and putting lip gloss on. Dad spoke to them to let them know if they need or want to come more now that it is near the end they should do whatever they need to do for Val and themselves as her parents.

Love and Prayers to Val always....Salynn

Monday Oct. 12, 09
The VNA nurse Mary came today. Dad asked Mary lots of questions about personality changes, mood swings, agitation, and hallucinations as Val's persona is no longer her own. Mary suggested giving the Ativan more frequently to keep Val from experiencing such periods of anger and agitation. For all who know Val, she is NOT an angry person. Perhaps, the cancer did metastize to her brain after the CAT scan of her head was done. Perhaps, this is a reaction to ALL her meds she is on (as it is alot). Mary the nurse did mention to Dad that some people become agitated and even violent or dangerous to hemselves. The Ativan can be changed to a different medication if Ativan can't handle these periods of agitation for Val. Val's request from the very beginning was not to suffer with pain; no one expected the suffering of the mind. Dad describes Val as "honery with abnormal behavior"; not violent yet.

As far as Val's day, well Dad and Ryan had her sitting in the chair twice today. She is awake a little during this, but continues to sleep 90% of the time. A new air mattress was placed on her bed to prevent bed sores. Val's water cup will be switched to a sippy cup as she is spilling her drink now ( last night at 3 in the morning all over herself). Rudy continues to read to Val every day while Dad lays in his bed to rest in the afternoon. Val ate two bites of soup and a few bites of pizza that she requested.

For all the days that Val never paid attention to her pets (at my last visit I had to take her hand to help her pet Fuller). They are on Val's mind in this hallucinatory state. Val is asking if there is enough cat food in the house for Diamond as she needs too take it with her to the next house. " I'm going" I've gotta get out of here" I'm taking Fuller" "Where is Fuller". It wasn't Val's agitated, unusual banging on the window beside her bed that bothered Dad today......it was Val's only lucid question...." Do you think I deserve this?" Somewhere in her mind Val is still able to think clearly about her cancer situation. Maybe the agitation is her way of expressing her anger about it...no one will ever know. I only pray the Angels and Saints have surrounded her from within to be with her in her mind at this time; I pray for peace within her mind.

Love and prayers to Val always....Salynn

Sunday Oct. 11, 09
My brother Ryan has been staying with Dad since last Wednesday and will stay until this Wednesday. This brings peace to us all as it is a very difficult time emotionally, psychologically and physically for Dad.

Val"s vital signs remain stable. Her oxygen is 6% , and Dad alternates 2-3 hours daily of the moisture added to the nasal cannula which doesn't seem to bring on her cough. A catheter was placed on Friday to allow Val to pee without getting out of bed and she continues to wear the diapers. The VNA nurse Mary and a home health aid gave Val a bath on Friday. Dad has signed up for this to occur every Friday. Val's morphine is now given every 6 hours (doubling the dose)instead of every three hours. Val was beginning to be bothered by the taste in her mouth. Val continues to eat only 3-4 bites at every meal and only when it is fed to her. She is drinking less now, not the three glasses of water a day any more.

Dad is still sleeping on the floor on his air mattress with an egg crate on top right next to her bed at night. Dad reports that since he changed the morphine to every 6 hours that she doesn't wake up in the middle of the night as much bright eyed and bushy tailed ready to talk.

Val continues to think that this (269 Windy wood Road) home is not her home. Val says to Ryan in multiple tries " I want to go find my home. Fuller is to go with us.". To Dad she says " I'm leaving soon and Fuller should come." I don't want to mislead anyone by writing that. Val cannot talk the phone, she still has a hard time speaking what she wants, or finishing a sentence and even getting her words out. Today, Val requested to go outside twice; once in the morning and once in the afternoon that Rudy and Lea witnessed. Dad and Ryan were able to get her in the wheelchair, bump it down the stairs and go outside in the driveway for 10 minutes each time with Fuller. Perhaps Val wants to see the outdoors again, perhaps Val is referring she is looking for her home in heaven or leaving to heaven soon. Everyone can interpret her words and actions as you may...we all must have faith and believe.

Love and prayers to Val always.......Salynn

Wednesday October 7, 09
When I left on Monday early evening I kept reinforcing to Dad that Val is peaceful, she is not suffering. Her pain is controlled. She gets brief periods of joy from seeing her animals, seeing a photo, or listening to us talk. She is beginning to look like an angel lying in her hospital bed.

Val's body has switched to the dying mode vs. the fighting mode according to her nurse Mary. Mary came on Monday and explained that the signs of her RAPID decrease in function, her need for increased oxygen, her lack of desire to eat or take her medicines are all signs. We all have to let Val know that this is OK. Mary explained to Val that if her blood levels are low it is her decision whether she gets a transfusion or not. Val's reply was " I don't see what good it would do me in these circumstances" Wow! Dad and I were both shocked, but in agreement with this. We all reinforced to Val she doesn't have to fight any more. How tremendously difficult it for all of us to say these things to her, but we do out of love for her. However, the time has come to allow her to go.

Mary explained that giving transfusions and giving her fluids are actually working against what the body is trying to do in the dying phase. We could actually cause her death to be more uncomfortable. An example of this: When the new oxygen machine was delivered on Monday, it is suggested to add a water humidifier for oxygen given at 5% and above. I said of course lets make the airway moist to avoid nose bleeds as Val is on coumadin and doesn't clot well. Val's body taught us a HARD lesson that is doesn't' want moisture. She was up with Dad on Tuesday morning from 5-7 AM sitting on the side of her bed coughing and spitting up phlem. That has has NEVER happened before. Needless to say, the humidifier is gone and we will allow her lungs to function without added fluid. Dad said it was heart wrenching to see her suffer and cough so much and so hard. Val's oxygen is being raised almost daily and now she is up to 6% by nasal cannula.The morphine is working really well t actually suppress her cough reflex and the three days I was there she had very little coughing and only with position changes.

Val's function has decreased even since I left on Monday evening. Nurse Mary will teach Dad how to change Val's diaper and pants in the bed, as standing without Dad holding her is now difficult. It was just a short week ago today that Val took her last walk upstairs and now she has difficulty just standing.

Rudy and Lea come every day from 2-4. Yesterday for the first time, Dad asked Val maybe she would like Rudy to read to her. Dad's plan is to lay down during these hours as the night are getting rougher with less sleep for Dad. Rudy began to read a Nicholas Sparks book to Val entitled The Nights in Rodanthe. I had just read it and returned it to Val commenting to her what great books she had in her library upstairs. This book in particular is a beautiful love story which takes place on the beach of New England. I know Val will like it. Rudy was THRILLED. For the first time he has a purpose and a way to connect to his daughter during her last days. I am sure it is comforting to Val to hear his voice.

Val continues to be confused and at times hallucinating. Dad tried cutting back the Ativan for the day time and saving that for the night time. After one day, he didn't see a difference. Now Val is frightened that she doesn't know it is her house. When I was giving her a pedicure on Sunday that was the day it began, "who's house is? this where am I?" Last night my brother Baine stayed with Dad. Tonight, Ryan will fly in from TX to stay (unfortunately he lost his job as of 9/30). Val has difficulty answering yes and no questions and rarely finishes a sentence she is trying to say. We have to be very patient at this time trying to figure out how to communicate with her.

Love and prayers to Val always.....Salynn

Saturday October 3, 09 ( My post last night mysteriously deleted so I will try again)

I flew to VT this morning to spend the weekend. I fly out late Monday night.
Val is tremendously weaker than 8 short weeks ago when we were in Maine
together. Now, she needs one person assistance for all these activities: getting up
from the bed, rolling in the bed, standing, walking to the bathroom is almost
a two person job, but I will call it one person for now. She walks to the bathroom
4 times a day, but that is as far and as much as she is able to do in her weakened
state. There are things she can't do any more that all of us take for granted: brush
her teeth, wash her hands standing at the sink (Dad and I have a basin for her to try
to use while she is seated on the toilet), even wipe herself she can't do.

Val 's mental status is declining. There are more periods of confusion and hallucinations.
She has difficulty finishing her train of thought (sadly, she has little spontaneous
conversation), she even has difficulty answering questions ( like would you like this pasta
with sugo or chicken broth?) Actually, the mental status seems unchanged
or no different than when she was on Vicoden. The morphine 1ml = 20mg of morphine which is given every three hours for the break through pain. The fentanyl patch of 125mg on her back is the long lasting pain control. It is sad to she her change positions and tell us she feels
abdominal pain. The fine line will be not to give her too much pain meds so she can't communicate to us, yet control her pain. We trust our nurses to help us with that. Val has moments when she is asking me " who are you? and where am I?". She is not oriented to time or day or year either.

Val's desire to eat is leaving her. She takes less than 5 bites when many small
foods are offered. Her desire to take her medications is leaving her. Her
desire to close her eyes and sleep or rest is #1. She still gets moments of enjoyment when I show her some photos of things she likes, read her a card or letter, or show her photos from the trip to ME. She smiles when I speak her animals. Diamond her male cat continues to find her legs on her bed to sleep which is his favorite spot. Before she was sick, Val would sit for hours in a chair if Diamond had come to sleep on her legs/lap so as not to disturb his sleep. Fuller, her dog, comes to sleep under her bed, in front of the bed or on the love seat which faces her. When Val is up walking the dog is under her feet and as close to her as possible giving her love an affection. She almost trips on him every time, but he is there.

Love and prayers to Val always......Salynn

October 1, 09 Thursday
I must first say thank you to all who continue to send "snail mail" letters to Val. She gets a card or letter almost every day. She no longer reads them herself, but Dad reads them to her. She wonders what is wrong on the day she might not get one. The letters and cards bring her more joy than anyone can imagine.

There have been a lot of changes this week for Val. Last night Wednesday, was the first night ever that Val slept the night in her hospital bed downstairs and Dad upstairs. Dad listened for her with the baby monitor, plus he gets up almost every two hours to go to the bathroom or feed the cat ( The cat had Val trained to do this so now Dad does this.) All went well, except Val complained of pain,which she never does, in the middle of the night so Dad gave her a double dose at that time which seemed to help her.

The morphine is suppose to help with the cough which occurs when Val changes positions. Tuesday night after climbing the stairs (to Val it is like climbing Mt. Everest), she sat in the chair at the top like she always does coughing so hard she vomited. That was scary for both of them.

It was Tuesday of this week that Val's pain medicine was changed from vicoden to morphine orally via syringe in her mouth. I think 1mg every 4 hours is the dose. After two days, Val's pain seems to be controlled on a very low dose, and she is NOT so out of it that she can't verbalize her needs. There is a fine line. Val doesn't want to be in any pain, yet Dad wants her to not be knocked out by it either. Val continues to sleep 90% of the time. The morphine has a high constipation effect. The nurse Mary used a suppository to help Val today. Val remains on the 125 fentanyl patches on her back for pain also.

Val continues to take a few bites at every meal; usually less than 6. That is joke as when we were in Maine I asked her to take as many bites as her age. (as that is how my young children do it 4 bites if you are 4 years old). Val compromised and took 6 to represent the years of her life by tens. She also drinks only when you put the glass in her hand. Her desire to eat is dwindling away. Dad has IV fluids for Val on heand in case she needs them, but for now she is OK.

Hospice trained personnel has been coming twice this week. Tuesday and Friday. Tina Ruth is her name. Dad describes her as a small woman in her 60's. Kate the other hospice trained personnel will come when Dad needs her too also. Dad is getting used to the help and realizes he needs it as much as Val does.

Love and prayers to Val always....Salynn