The Official Joyce Update Blog

  These entries will be a bit odd as I (Jess) will be transcribing text messages from Dusty of the events as they happened and he had time to reach out to myself and the family. I will have him come back and edit/add more when he can.  8:49 a.m.  Dusty:   Dusty back on site at PRH, ICU staff busy in two different rooms with patients, update forthcoming once they realize Dusty has snuck in. 8:50 a.m.  Dusty:   Joyce awake and watching television,  stretched out in recliner. 8:55 a.m.  Dusty:   Dietician (also named Joyce, calling her Joy going forward  to differentiate) arrived to visit with Dusty. Joy have been tracking Joyce's food intake and noticed decline in food being consumed. Reviewed health log family has been keeping. 8:56 a.m.  Dusty:   Dusty informed Joy that mom eats slow and if she takes too long eating one meal it will throw off her appetite for other meals. Joy acknowledged that as she has time stamps for mo...

  These entries will be a bit odd as I (Jess) will be transcribing text messages from Dusty of the events as they happened and he had time to reach out to myself and the family. I will have him come back and edit/add more when he can.  8:33 a.m.  Dusty:  Dusty back on site at PRH. Checking with Sam (Nurse), BiPAP system worked and Joyce "back to normal" 8:49 a.m.  Dusty:  ICU is short staffed today. Sam is being assisted by LCSC nursing student intern. Alyssa today. Joyce is very responsive and back to what family would recognize as baseline normal. Joyce knows who Dusty is but cannot recall which of her sons is the oldest. 8:50 a.m.  Dusty:  Sam informed Dusty that the BiPAP was kept on Joyce until about the time she returned to cover morning ICU shift. 8:54 a.m.  Dusty:  BP 155/67     Pulse 82     Oxygen level 90%     CO2 saturation 19     Joyce responding to interrogatives and able to talk fairl...

8:14 a.m. - Craig arrived to farmhouse. Lights on, Joyce has been up and moving about already. Joyce says that it was quite a while ago that she got up. 8:28 a.m. - Dusty arrived to farmhouse. Joyce in recliner with oxygen line in place. Bathroom trip declined. Breakfast declined. No nightmares reported - Joyce could not recall if she had any. 8:30 a.m. - BP 149/78, pulse 72. BGL @ 130. 8:39 a.m. - Nutritional shake with morning medication. 8:42 a.m. - Breakfast (omelet, applesauce, toast with butter). Joyce finished breakfast by 9:27 a.m. Evidence found that Joyce had taken herself to the bathroom at least twice since Dusty left last night. Bathroom sanitized. 12:11 p.m. - Bathroom. Evidence discovered Joyce had previously soiled herself on one of the two trips she made prior to Dusty's return to the farm. Urinary incontinence. Remainder of urine passed. Flatus passed. Large amount of fecal matter in shoes - shoes sanitized. Joyce cleaned up and showered.  Weight 158.6 lbs. PT wal...

8:21 a.m. - Jess arrived to farmhouse. Joyce was awake and reading her newspaper. No oxygen line in place. Joyce in good mood, reports that her head is not hurting today. Joyce says she slept good even though she had a few nightmares. Joyce reported that her mouth is hurting worse today.  8:23 a.m. - BP 164/79, pulse 70. BGL 163. 8:40 a.m. - Morning medication with nutritional shake. 8:45 a.m. - Breakfast (2 scrambled eggs, whole banana, cup of peaches). Joyce ate very slowly and paused her eating often due to pain in her mouth. Jess kept encouraging Joyce to eat. Joyce finished her breakfast by 9:40 a.m. 9:43 a.m. - Bathroom trip. Urinary incontinence. Remainder of urine passed. Joyce very constipated. Jess gave Joyce Miralax at 9:55 a.m. Joyce tried multiple times to pull stool out of her anus by hand even though Jess instructed her not to do this. Jess had to constantly coach Joyce how to push and breathe to pass her stool. Jess had Joyce stand at one point and shift Joyce's hip...

8:13 a.m. - Jess arrived to farmhouse, finding Joyce awake and happy to chat. Craig already on-site and using telephone. Craig informed Jess that he had only been on-site 10 minutes prior to her arrival - Joyce had been awake in her recliner with her oxygen line in place when he arrived. 8:15 a.m. - BP 153/76, pulse 73. BGL @ 146. 8:25 a.m. - Bathroom trip. Urinary incontinence, early bladder release. Remainder of urine passed. New diaper and pad. Toilet seat riser and bathroom floor sanitized. Returned to recliner by 8:38 a.m. 8:50 a.m. - Morning medication with nutritional shake. 9 a.m. - Breakfast (microwaved egg sandwich and banana). Breakfast finished by 9:55 a.m. Joyce had to force herself to finish eating all of her banana. 12:30 p.m. - Dusty attempted to pickup refilled Tramadol prescription he called in on Sunday. Refill was declined. Dusty called Moscow Medical when pharmacist informed him that they could not refill without doctor's consent due to classification of the dr...

8:55 a.m. - Dusty arrived, finding Joyce awake in her recliner and struggling with television remote. No oxygen line in place. Joyce claimed she had taken herself to the bathroom "much earlier" in the day. 9 a.m. - BP 153/75, pulse 76. BGL @ 122. 9:03 a.m. - Morning medication & nutritional shake. Breakfast (McDonald's sausage biscuit and whole banana). Ate slowly, kept falling asleep. Joyce extremely fatigued, slept throughout most of morning. Noon - Lunch refused, bathroom trip refused. 1 p.m. - Lunch refused, bathroom trip refused. 1:14 p.m. - BP 115/62, pulse 72. BGL @ 226.  2 p.m. - Lunch refused, bathroom trip refused. 3 p.m. - Joyce woke herself, asked Dusty if he would bring her dinner from town and buy groceries for the farmhouse. Dusty discussed with Joyce that the family was handling her groceries and that she didn't need to provide them with a list except for anything she might request special. Joyce expressed concern that she would be without "vi...

Dusty and Jess arrived to farmhouse ~9:40 p.m., found Joyce awake in her recliner without oxygen line in place, reading weekend newspaper. Evidence that Joyce had taken herself to the bathroom at least once (bowel movement) since Dusty left last night. Dusty cleaned up mess Joyce created with fecal matter in the bathroom. 9:50 a.m. - BP 151/80, pulse 71. BGL @ 136. 9:54 a.m. - Morning medication with nutritional shake. 9:57 a.m. - Breakfast (McDonald's sausage biscuit, hash brown, small orange juice). Breakfast finished by 10:45 a.m. 11 a.m. - Enrichment activity (laundry folding) started. Joyce talkative and responsive to interrogatives.  11:09 a.m.- Craig and Carol arrived to visit. Carol updated Dusty that Kindred contacted her on Friday and would have a nurse arrive to do a blood draw on Joyce "early on Monday." Concern over reported "black" stool Joyce passed is what prompted blood draw to be done.  11:26 a.m. - Joyce yelped suddenly, reported "ouchie ...

Craig covered morning care for Joyce while Jess was out at dental appointment and Dusty was being COVID-19 tested. 8 a.m. - Breakfast. Joyce ate very slowly. Dusty arrived to farmhouse ~12:25 p.m., found Joyce in bathroom with Courtney in attendance. Dusty assisted with cleanup of Joyce. Urine and small type 1/5 bowel movement passed. Joyce unable to rise up from toilet or remain standing independently under her own power. Preparation H applied. Dusty moved Joyce to sitting position on her walker and wheeled her out to kitchen, transitioning her to recliner with difficulty by ~1:45 p.m. Bathroom sanitized. Lunch negotiated. Courtney relayed that Craig provided morning medication to Joyce. Courtney remained onsite at farmhouse to monitor Joyce when Craig departed earlier in the morning. Courtney departed shortly after Joyce was returned to recliner, informed Joyce that she would most likely return this evening with Carol to provide evening care. 12:58 p.m. - BP 158/75, pulse 66. BGL @ 1...

8:19 a.m. - Jess arrived to farmhouse to provide morning care for Joyce. Joyce found awake with oxygen line in place. Joyce had taken herself to the bathroom recently. 8:20 a.m. - BP 156/101, pulse 81. BGL @ 152. 8:45 a.m. - Morning medication taken with nutritional shake. 8:50 a.m. - Breakfast (1 slice egg in toast with syrup). Breakfast finished by 9:05 a.m. Joyce reported to be "1000 yard staring" but enjoyed her breakfast. 10:12 a.m. - Joyce slept most of the time Jess was at farmhouse following breakfast, declined bathroom trips. ~Noon - Andrew (Kindred nurse) arrived to check Joyce, no family care provider present for visit. 1:18 p.m. - Dusty arrived to farmhouse, finding Joyce asleep in her recliner without oxygen line in place. Joyce had taken herself into bathroom and passed a Type 1 bowel movement - large mess left in bathroom (toilet seat riser, toilet handle, sink, floor) and in hallway where Joyce had tracked portions of fecal matter). Evidence that Joyce had ext...

Dusty arrived to farmhouse ~8:25 a.m., finding Joyce asleep in her recliner without oxygen line in place. Joyce had turned off all lights in the farmhouse at some point after Dusty departed last night. Evidence Joyce had taken herself to the bathroom at least once since Dusty departed farmhouse last night, early bladder release issue discovered. Dusty cleaned up mess in bathroom and sanitized floor and toilet seat riser. 8:29 a.m. - BP 168/77, pulse 69. BGL @ 128. 8:35 a.m. - Bathroom trip. Urinary incontinence, diaper pad insert replaced. Remainder of urine passed. Preparation H applied. PT walk to living room with difficulty, frequent stops made. 8:52 a.m. - Breakfast (1 slice of whole wheat toast with butter and apricot jam, peaches, nutritional shake). Morning medication administered. Breakfast finished by 9:09 a.m. Joyce began napping. Joyce woke herself ~10 a.m. and wished Dusty a "good morning," then resumed sleeping. 10:30 a.m. - Bathroom trip declined. Joyce resumed ...

Dusty arrived to farmhouse ~8:40 a.m., found Joyce awake in her recliner without oxygen line in place. 8:50 a.m. - BP 151/78, pulse 68. BGL @ 116. 9:14 a.m. - Breakfast (6 small cinnamon vanilla pancakes with banana slices and syrup, 1/2 banana, nutritional shake). Morning medication. Breakfast finished by 9:38 a.m. 9:40 a.m. - Bathroom trip declined. 10 a.m. - Bathroom trip declined. 10:30 a.m. - Bathroom trip declined.  11 a.m. - Bathroom trip declined. 11:30 a.m. - Bathroom trip declined. 11:39 a.m. - Bathroom. Urinary incontinence. Early bladder release in recliner and in seating herself onto toilet, mess cleaned up - incorrect diaper pad inserts utilized previously which led to failure of diaper sealing correctly. Correct diaper pad inserts restocked to bathroom and incorrect ones removed. Remainder of urine passed. Shoes sanitized. Joyce showered and changed into fresh clothes. Joyce reported difficulty in standing/walking throughout toileting and cleaning process.  Weig...

Dusty and Jess arrived to farmhouse ~8:35 a.m., finding Joyce asleep in her recliner without her oxygen line in place.  Evidence Joyce had taken herself to the bathroom at least twice since Dusty departed farmhouse last night. Joyce reported that she did not sleep well - she was "unable to fall asleep." 8:36 a.m. - Lancet cartridge replaced. BP 183/96, pulse 83. BGL @151. 8:39 a.m. - Bathroom trip. Urinary incontinence, diaper pad replaced. Remainder of urine passed. Preparation H applied. PT walk to living room - Joyce had difficulty walking to/from bathroom, reporting pain in both legs. Returned to recliner by 8:50 a.m. 8:55 a.m. - Morning medication with nutritional shake. 9 a.m. - Breakfast (McDonald's hash brown and sausage biscuit). Joyce began napping after breakfast.  11:06 a.m. - Bathroom. Urinary incontinence. Diaper pad replaced. Remainder of urine passed. Preparation H applied. PT walk to living room. Joyce's calves swollen, ankles fine. Joyce returned to ...

Dusty arrived to farmhouse ~9:30 a.m. after picking up Christmas Eve dinner supplies and remaining Christmas morning meal components from Moscow. Found Joyce awake and sitting in her recliner without oxygen line in place. Dusty asked Joyce if she had eaten anything and she said she did not. Evidence that Joyce had taken herself to the bathroom and had a bowel movement. Joyce declined shower, Dusty informed her it would happen later today as she had refused so strongly yesterday. Joyce reported that she "had been cleaning and putting things away" around the house to prepare for Christmas. Joyce reported that she had slept in her bedroom last night, moving herself there after Carol departed for the night. Joyce given newspaper to read while Dusty prepared breakfast. 9:55 a.m. - BP 141/75, pulse 76. BGL @ 204. Dusty asked if Joyce she had eaten anything again, citing it is important to know for her health log because they have to explain the high blood sugar level spike if she h...