The end is near

On Saturday the decision was made between all of the doctors, Mira (my daughter and Elizabeth's step-daughter) and me that Elizabeth's condition is irreversible and that we should focus exclusively on palliative care to make her last time more comfortable and without pain. She had by then lost all cognitive function and was totally unresponsive to any stimuli except pain. Indeed, she seemed at times in terrible agony -- it was horrible for all of us to watch. We disconnected all of the curative IV's and started with periodic injections of morphine and ativan. These would work for a while but quickly wore off and left her again in pain as evaluated by her contorted face and arm motions.

Yesterday afternoon we started a continuous IV drip of morphine, at first at 2 ml/hr gradually increased to 2.7 ml/hr currently. On other advice, we stopped the ativan. During the day today this has been very successful; she has slept peacefully the entire day. Her respiration rate has slowed to 4-5 breaths/hour, which everyone agrees is not due to this relatively small dose of morphine but to a general slowing of bodily function as her body shuts down. We have consulted with the palliative care department and they are alerted if the need for stronger analgesics arises.

No one knows for certain, of course, but expert estimates are that she will die within a few days and possibly within hours. It is a very sad time for us all, but it has been inspiring to see the many of her friends and colleagues that have come to visit and often to stay for long periods. Of course, we are no longer concerned with visitors bringing infection.

According to her wishes (and mine as well) she will be cremated and there will be no funeral. There will probably be a memorial later in the fall that will have both a personal and a professional component, but there are no definite plans as yet.