October 2020

Kathrine's letter 2020

Dear all

First of all, I am sorry for the loss of your mother and mother-in-law.

This is the account of the events leading up to Myrtle’s death and the practical things that need to be taken care of now.

Tuesday around midday I went by Tony and Myrtle before work and Myrtle seemed fine. During the evening Christian called me at work because Myrtle could not stand on her legs. We contacted a nurse from the local emergency network who went past Myrtle to check up on her. She decided that it would be best to get the on-call GP to come and take a look at Myrtle. When the on-call GP came Myrtle was feeling better and moving around the house. All her vitals where fine and the GP instructed Tony and Myrtle to call again if she began to feel unwell ones more. Myrtle could move around and got herself to bed.

Just as I got home from work at 1 o’clock Tony rang me to say Myrtle had fallen out of bed, had a seizure and was having a hard time breathing. He called the ambulance and Christian and I drove to them.

Myrtle was out of the seizure at the time we got to the house, but she still had a strained breathing. The ambulance with a doctor came shortly after. After a couple of minutes Myrtle started to wake up but was unable to recognize anybody. In the ambulance the doctor examined her and found nothing abnormal on her vitals so he decided that Myrtle should go to Odense hospital partly because of the seizure she had in February and Odense has a better neurological department then Svendborg hospital. We followed with Tony in our car.

At the hospital they took blood test, an EKG and a CT scan of Myrtles head. Myrtle was starting to talk but not making much sense which is quite normal after a seizure. I went with her to the CT room because she reacted better to my voice than that of the staff members.

After the scanning Myrtle began to recognize Tony and me. The plan became as follows, Myrtle would stay in the emergency department and the neurological department would the next day decide if it was necessary with an MR scan. Myrtle was still confused and uneasy but could answer short questions. Myrtle was in other words reacting in the same fashion as she did in February.

The CT scan showed no bleeding or clot and no change since the last scan from February. The blood tests showed no signs of infection and only a small increase in some lever enzymes which would not be the reason for the seizures.

Myrtle was asked if she wanted Tony or me to stay with her and she said that I should stay. Christian who was waiting in the car drove Tony home around 4.30 am so he could get some sleep. Sometime between 5 and 6 I helped Myrtle to the commode. At this point she was able to stand on her own legs holding on to me as she normally did if she did not have her rollator. When she got back in bed, she turned on her side with her back to me and fell asleep. I got a chair to sit and relax in.

Shortly after 7 am the lab technician came in to draw a new set of blood tests and EKG. I went to wake Myrtle and could see in her eyes that she was having absences, which is small seizures. I called the nurse who came quickly, and the absences seemed to stop, and the lab technician took the blood tests and the EKG. Not long time after that Myrtle had another big seizure that lasted about 1 minute. The nurse called the doctor. The doctor ordered a medicine called Stesolid which is Diazepam. Afterwards the doctor called the neurological doctor to say that he now was Myrtles’ primary doctor.

After the doctor left Myrtle had another seizure and the nurse administered the medicine and the seizure stopped. The nurse left the room. Shortly after I could see that the absences started again as small twitches in Myrtles eyes and right arm. I called the nurse and as she came in the room the seizure started. The nurse gave Myrtle some more medicine and called the neurological doctor to come immediately. The doctor came right away and after the Nurse and I had answered some questions about Myrtles health and what had happened he arranged to move Myrtle up to his department when Myrtles blood pressure and pulse suddenly dropped.

He called more staff in and they moved Myrtle to a trauma room and they also called the intensive care doctor down.

As Myrtle suddenly got bad, I called Christian and asked if he could leave work and drive Tony to the hospital as I did not want Tony to drive himself. I then called Tony to tell him what was going on and that Christian was on his way.

I was waiting in a room next to the trauma room when a doctor came in and asked if I had talked to Myrtle about being put in a respirator. While the doctor was there, I called Christian and Tony and put them on speaker so the doctor could listen in on our conversation. We both agreed that we knew Myrtle did not want to be connected to a respirator and the doctor went back into the trauma room.

After a little while the doctor came back and said that Myrtle was more stable. They had started a new antiseizure medicine but there was still no contact.

They moved Myrtle up to the neurological department in a room with a nurse present at all times. Christian came with Tony and we all went up to the department. Due to the COVID-19 restriction only two of us was allowed to stay so Tony and I stayed with Myrtle.

Myrtle was still seizing but only in a few muscles; they were now on the third type of medicine and if that did not work, they had a fourth option they could try.

The doctor who came down to the emergency department along with a senior female doctor came to talk with us. They had a fine English which Tony could understand. Both the doctors and the nurse also knew I am a nurse and therefore used more technical terms when talking to me and I then translated them to Tony to the best of my abilities.

The seizures stopped after the treatment with the fourth antiseizure medicine had been administered. Myrtle had at this point been having seizure for about four hours. The doctor’s plan was to see if Myrtle would wake up the next day (Thursday) She did not expect Myrtle to wake up for the rest of the day because of all the medicine that they had given her. If Myrtle did not wake up Thursday, the doctor would order an EEG which is a test that registers brain activity.

As Myrtle had been having seizures for so long (which is called Status epilepticus), the doctors concern was that Myrtle might still be having seizures but of a non-convulsive kind. This means that the body stops seizing but not the brain.

The nurse offered Tony something to eat and I left to get something to eat with Christian who was waiting in the lobby. I had been down to talk to him a couple of times since he and Tony came to the hospital. The nurse said she would call me if something changed while I was gone and keep an eye on Tony while Christian and I got something to eat.

When I got back from lunch the doctor came and talked to us about the possibility of applying a feeding tube. I had earlier talked with the nurse and said to her that I was not in favor of that course of treatment without Myrtles own consent, as it could prolong Myrtle’s life unnecessarily if she did not wake up. Both the doctor and Tony agreed on a plan where they would give Myrtle IV-fluids with energy supplement and then take the feeding tube idea up for consideration if Myrtle woke up.

We stayed a bit longer with Myrtle and then went home at around 2.30 pm. The nurse would keep a close eye on Myrtle and telephone Tony and me as soon as there were any changes.

Christian drove us home and Tony promised to call if he needed anything. Before I went to bed, I called Tony and we planned what time I would pick him up later to go to the hospital.

(Thursday) at 5.15 am the hospital called me to say that Myrtle had died 10 minutes ago. She had started to seize again, and her blood pressure dropped. They got the seizure to stop and the blood pressure up but her breathing kept being irregular. She died shortly after 5.05 am. The whole event took under 30 minutes. I called Tony and we agreed to go to the hospital at 10 o’clock. It was the nurse from the day before who helped us. She was very helpful.

When I was waiting to talk to the nurse in the hall a new doctor went into the room where Tony was sitting with Myrtle and started to examine Myrtle (a second post-mortem examination). The doctor started to talk to Tony in Danish and as Tony replied in English the doctor suddenly disappeared again. This was very unpleasant for Tony and after telling the nurse and saying a last goodbye to Myrtle we went home. The head nurse apologized later.

So that was the events of 2 very hard days.

Tony has picked out one of Myrtles favorite dresses for her to wear. We have started all the practical and legal stuff that follows when someone dies. Both my mother and I have some time back talked to Myrtle about what she wanted when she died. Myrtle’s wish was to be cremated and have her ashes scattered in the sea so she could float up the Themes and the East River to her boys.

We will have to apply for a permit for that with the Danish authorities. If any family members disagree, they will not give the permission so please let us know if you do not agree. Tony does not wish for a funeral so we are going to tell friends and family to donate the amount of money they would have spend on flowers to the local animal shelter for cats.

If all agree to the ash scattering, we have the option to wait until spring or summer to do it if any of you would like to attend. If not, we have the possibility of filming it so you can see it that way.

I will send a new mail when there is more of the practical stuff been arranged. You can always call me if you have any questions

My love and thoughts go to you all.

Kathrine.
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