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Sunday, November 20, 2005

Diary of a death

(The following account has been published, finally, by me, after long reflection. Since I have no idea what may happen in the future to my papers and manuscripts, and since the safest place is where nobody can change them, i.e. published, here they are! I feel also, that they may be of interest to Kate’s family. It has certainly been difficult to transcript pages dealing with an event one would prefer to forget, but can’t)

The reader is under no obligation whatsoever to read this diary, and does so having understood, or at least having read, my reasons for open publication on this site.

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Diary of a Death.

Forenote:

Mrs Kathleen Mitchell was born in March 1947,in Keighley, Yorkshire, and trained as a State Registered Nurse at Guys Hospital, London, in the 1960’s.
In 1968 she married Mr I.W. Mitchell, who is the author of this diary.
They lived, and worked, in various European countries, until her death in March of 1993, from cancer.
Mr Mitchell is still alive at the date of this publication (2005) and has been living in the South of France since the death of his wife.
During the year 1992 up until her death in March 1993 my wife suffered from intestinal cancer, and was operated no fewer than 8 times during the period February 1992 and January 1993, inside 10 months.
The failures of the surgeons, particularly at Lorrach, Germany, are only briefly mentioned, suffice to say that the very first operation was disastrous, spreading rather than destroying the cancer.
These notes or “diary entries” are a reminder to me and to others that modern medicine is still often in the hands of people, with all the faults appertaining – pride and belief of their infallibility . Not only Lorrach and the University Hospital Freiburg in Germany are responsable for the eventual death of my wife, but the whole system, corrupted often by over-zealous surgeons, jealous of their positions, and by drug companies – the modern day gangsters of the entire world.
These notes accompany my wife from her return from the University Hospital, Freiburg, Germany, up to her death in the Hospital at Lorrach, Germany.
It has long been my intention to publish these little notes, together with one or two articles from my wife, but for too long I have stared at the book, instead of writing in it!
If there are critical remarks, even scathing comments, that is because they are merited by those concerned, and I have never hid my opinions of things and people in this life.
All “medical” or “ semi-medical” references/opinions are those given by medical/surgical personnel, in my presence.

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30th January 1993: Lorrach,Germany.
Returned from Freiburg this morning. Ambulance trip not the most comfortable, but supportable. On arrival, the urine catheter was taken out immediately, due to a bladder infection caused by the same, and because of the pains associated. Pains increased due to a distended bowel not due to the cancer.
To try to distract a little, I took in TV,radio, musical discs,magazines, newspapers, writing paper etc., as well as some food and drink articles, allowed by the doctors, but not available in the hospital. The fact that they allow all these things, and have moved Kate to single room (normally occupied by 3 people) are not encouraging signs.
The Doctors finally advised against her coming home at this particular stage, because they preferred to try and “stabilise” her condition first.
The morphine dosage is up to 200mg. I don’t really know what this all means, but I accept the obvious fact that the higher the dose, the more pain Kate must be suffering, but equally the more dependence on the drug. I know that she, as a highly qualified nurse is equally aware of all these facts, but she doesn’t talk of it, and I don’t feel it will help if I bring up the subjects.
For the moment, breathing is OK, just the occasional use of oxygen.She sleeps badly, nonetheless, and is extremely tired and “used”.
Sunday 31st January1993
Temperature has risen overnight to 39c and then redescended to 38.2c- otherwise no change. Kate talked about having a “jolt”(?)
1st February 93
Kate slept a little. Took some drops in the night against her fever.They made her feel sick, and there was quite a bit of vomitingand nausea. A “down” day. Started taking daily newspaper in, to try to renew interest. The biggest problem is still eating.Nothing goes down permanently.
Today was declared “final solution” day by the German Doctors here, a request for instructions regarding sedation was made. Who should take this decision – I can’t, and I’m not sure that Kate can. I suggested that the only thing to do was to follow her (Kate’s) instructions, so long as we could understand them, and that the minimum of sedation would be that to stop any physical suffering.
A bad day.
2 Feb 93
Slept a little, but I see that Kate is suffering physically and mentally. We finally got a longish period of time with Doktor Berger, and the decision was taken that from today, Vallium will be given, and the high calory drip food is to be stopped, in an attempt to get Kate to nourish herself from the diat in liquids (and milk puddings like semolina etc).
Immediately after the first administration of Vallium, I noticed a decided improvement, but this is the nature of the drug, which kills the pain, and puts the patient in a sort of “high”. She is certainly more peaceful and rested, but still so very tired and used.
The medical and nursing care is better, due to the fact that they are doing something for their ex-colleague.
3 Feb 93
Kate in very good form. A good night’s sleep, only problem today are that the slight pressure pains on the stomach are getting worse. Vallium and Morphine doses at the same level.Kate broached the subject of “funeral” and so we talked about that and other similar things.We watched a TV film together and Kate slept in.
4 Feb 1993
Kate in good form again, her bag or “beutel” which is there to catch the excrement, is working in fine form (which means the healthy intestine left inside her is working, and isn’t blocked by any cancerous growth) and like two kids, we watch this bag filling up, and congratulate each other! The drug dosage is still at the same level, as I understand it, Morphine at 240 (whatever that means) plus Vallium. Kate is eating a little, and expressed a desire for some water “Perrier zest” which I went out to get.
5 Feb 93
No change – still in good form. The stomach shows strange “coloured wrinkles”-this may be the first signs of further problems.
6 Feb 93
Moral dropped. “Eye wandering” and almost depressive tears. She has every right to react so, having been so incredibly brave. A diat expert is due to come on Monday.
On leaving the hospital, I found that some friendly person had stolen my bicycle.
Sunday 7th February 1993
No change, except that she asked for the morphine to be raised from 240 to 260. Vallium stays the same. These figures mean nothing to me, but as the professional nurse that she is, Kate is aware of their significance, and I asked the Doctor privately, if he thought it was a good thing that she was informed of the doses given. As he said, it was Kate herself who suggested what dose should be given!
Same day – evening – Morphine dosage up to 300! Otherwise – no change, in fact quite cheerful.
8th Feb 93
Kate slept long, and very soundly. On awaking, she was a little confused, as though a good sleep had let her forget everything. She was sick only once, possibly due to adapting to her new diat. This worried her slightly, and when I left to do the shopping , she had a slight fever, and was very warm, but then so was I!
PM – same day – Fever gone temperature down to 36.6c. All these little triumphs we have to hold on to. She is very sleepy, due to possibly too high morphine dose, when the pains go down, the morphine makes you sleepy.Kate described her state of health as “quite well!”Frankly, such courage is remarkable.
9 Feb 93
No change – still quite sleepy. Temperature is normal, but she has “cold sweats” from time to time.The doctors say these are due to the medicaments, and that blood counts and other tests are excellent. I try to get this information over to Kate, and she seems pleased.
PM – same day – Very bad. Back onto oxygen, due to a vein canal tube falling out and the morphine running onto the bed, and not into the vein. Kate was asleep at the time, and must have turned awkwardly or something.At the moment she is in extreme pain, and a new tube has been installed, and the morphine is flowing. This will subdue the pain, but is a bad setback – to reality maybe – for Kate and myself, for now we know what happens when the drugs are stopped. She is drowsy but restless, with cold sweats, still on oxygen and still uneasy.The vein drip is ok now, but a new artery drip is being put in today.
Weds 10 Feb 93
Arterial drip has been done, and Kate is in a much better condition.Vallium doses stays the same, but we know how depend she is on the drugs now.She is still tired, but cheerful, and less oxygen is needed.
Thursday 11 February 1993: This is a big day. A new summit meeting is set up with the Doctors. Vallium and Morphine doses are to be raised to 20ml and 360ml respectively.Kate was very depressed after this visit, and cried a little, but said that her body and mind were not yet ready to die. I wish I could take her place, but I can’t, and all I can hope is that when my time comes, that I am as cheerful and brave as my wife, Kate.
She has decided to try the higher drug doses, and let them increase them as necessary, instead of the alternative – a spinal nerve closure, which would effectively take all sensation (pain or otherwise) from her, from the waist downwards. In the afternoon, she had obviously chewed it all over in her mind, and seemed to be back to normal cheerfulness.
12 Feb 93
Kate slept heavily, there is no change, but she is in good spirits. She feels sick quite often, and when she vomits, the odour and colour is the same as diahorrea (indicating not very good things) on top of which, her bag is not filling anymore, and her stomach is very swollen.Cortison and anti-nausea treatment is being given.She complains of pains in the upper thorax, and pressure, Temperature 37.4c
13 Feb 93
Slept very solidly and seemed to be in good cheer.Slightly different attitude, as though she is coming to terms with destiny.Her stomach is becoming very problematic, and the bag is still not filling, for a second day.The result is that she is still feeling and being sick.
PM: No change apparent.The stomach appears to be empty, because although still nauseaus feelings, no passage of vomit has been made.
Kate shed a few tears, because she was unable to eat anything, and she wanted so hard to please me. We had a little laugh about it afterwards, and we ordered ourselves cups of tea! (Coffee is not allowed, of course, and quite frankly the tea is so weak, it is hardly recognizable, but with the cheerful atmosphere it brought, it seemed to be champagne.
Her strength is going rapidly, but her willforce is unbelievable.
14 February 1993: St Valentine’s Day.
Kate hadn’t slept too well, but was quite cheerful. I hope my little gift and Valentines card helped a little. No chocolates of course, this year, but I promised them double in the next year, and we both had a giggle about it. Don’t know how or why, but the situation and the nearing departure of Kate, seems to have now been assumed by both of us, and it simply isn’t a subject. We both know what implications are involved when we breach any particular subject, particularly of the future, but we still do so. No future kills quicker.
Not really an event for Valentine’s Day, but an event of note – the “bag” suddenly started working and filling again, after 3 days. This cheered her (and me) up a lot. She still feels sick now and then, but according to the Doctors this is probably due to the morphine.
PM: Took in some lemon sorbet, and an Orchidee, the sorbet melts and passes nicely, soothing the throat with the coolness.Kate was cheerful, but at the same time talked in a sad voice.
15 Feb 93
No change. The bag is now going like mad, filling over and over again. Kate jokes that I may have found the solution, and a great medicine, for bowel cancer – Lemon Sorbet! She was able to eat a little more at breakfast time and at lunch. She was quite cheered by this fact.
16th Feb 93
Slight rectal and stomach pains have appeared. Morphine dose is up to 400
Eating seems to be better or “easier” for her, but otherwise little or indeed no change. This afternoon the morphine dose is to be increased against the pain. Vallium has stayed at 20mg’s. I’m told by the Doctors this is “normal” because the Valium is given basically to “buck-up” psychologically, and this didn’t seem to be necessary. Higher doses would result in a quicker and more permanent and deeper state of “drowsiness/sleep”.
17 Feb 93
No change – no treatment – day passed calmly.
18 Feb 93
She didn’t sleep too well, and looks drawn and tired and weary. I get the feeling she has made her decisions.
PM: Pains returned. Morphine up from 400 to 500, Valium increased, and coming through very quickly. She is extremely tired, and things are looking very bad.
At this time, this publication will be stopped. The remainder will be published at a later time.
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(I would like to recall to the reader that they are NOT obliged to read this diary, that they do so having understood that I publish it only after a long period of reflection, and only because I have no idea what may happen to my papers and documents in the future. I feel that these notes may be of interest to Kate’s family, or friends – and maybe even to people suffering in a similar manner, to let them know that there are many others out there in the same situation).

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