What Happened To Karen

See pictures below of Karen's right lower leg to see the infected sores we went up to get antibiotics for. Karen's health insurance companies response "There was not evidence that Ms. Gotcher's leg was infected at the time (of the visit), and placing an Unnu boot was appropriate." This is fraud.

On December 30, 2024 (after explaining to them several times over one year what had happened to Karen on October 10, 2023 at the clinic, McCook, Nebraska, sending them pictures) I received a letter from Karen's health insurance company, Livanta stating "Even though the timing of Ms. Gotcher's developing sepsis was close to the office visit, there was no evidence during the office visit that she had sepsis or was developing sepsis. In the professional opinion of our peer reviewer, the services that were the subject of this concern met applicable professionally recognized standards of health care." Pictures below of Karen's right leg with an infected sore when we went up to the clinic and 4 1/2 hours after we left, after my telling the NP that we had come up for antibiotics for infection in her lower right leg, which she did not pick up and examine, putting a "boot" (Unnu) on it instead of giving her antibiotics, not recording what I had stated in her report, written long after we had left the office and I only saw days after Karen's death. The medical profession has become like Hitler's doctors skilled in "looking the other way." "We can do whatever we want. Shut up. Go away. But make sure you pay at the door for our services first." It is the common theme today. See the last letter I sent the insurance company (prior to their final statement) at the bottom of this issue.

What Happened To Karen.
(Just for the record.)

One cell of e-coli, under ideal conditions in seven and one half hours will result in one million e-coli cells. If we have two petri dishes with equal amounts of e-coli and one we treat with antibiotics right away and the other we give a rich supply of amino-acids (food), put it under pressure (which expedites reproduction), and heat it up to 104 degrees, then after eleven hours we give it antibiotics, is the outcome the same. I chose the first treatment. The Dr. (nurse practitioner) chose the latter. My wife died, not of cancer (lymphoma), which she had, nor of heart disease, which she had. She died of e-coli 29 hours after the nurse practitioner put an "Unnu," called a "boot" on her infected leg, after I had told her we came up for antibiotics to treat an infection on her lower right leg. Karen's health insurance company and Medicare see nothing wrong with what the nurse practitioner did, rejecting anything I have to say. Welcome to the medical profession today. Most lawyers agree that what the nurse practitioner did was wrong but since Karen had lymphoma, in the state of Nebraska no matter how much proof you have that what the NP did lead to Karen's death all the defense has to say is she had lymphoma, the infection could have come from anywhere (despite the fact Karen had no symptoms of e-coli since the source was not from her upper body but from her leg) and without any evidence, they win the case. It is therefore not worth the money or time for lawyers to defend you from medical malpractice and wrongful death, plus pain and anguish when it comes to cancer (lymphoma) in Nebraska, the "good life" state.

After eighteen Nebraska lawyers have said no to my request for action against a doctor who's actions lead directly to Karen's untimely and painful death (and since McCook, Nebraska is a "political subdivision" and I could only file charges for one year which now is past, which no lawyer told me about, saying I had two years) I have told my children, based upon what a lawyer determines your loved one's life is worth doctors can do whatever they want without being held accountable. I can't even wrap my head around how this can happen. You are taught that 2+2=4 and you accept it and you apply it and it works and then somebody comes along and makes it 5 which leads to the death of your loved one and everybody says that its OK, it can be any number you want to make it. Every one, including Karen's regular doctor is turning their head the other way, doing what the German Doctors did under Hitler. You might deny that fact but you can not refute it. It is not how far down that road you have gone. The moment you are on that road you are a mercenary, "What can I get out of this for me?" and "What will happen to me if I don't go along or get in the way?" and you can not say that is far enough or no we will not do this any more, the taking of life via the medical profession then becomes 'justified' (turning your head the other way to keep your job is where it starts). History has taught us it ends up bad. Nobody will listen because "What can I get out of this for me?" and "What will happen to me if . . .?" ("What about me?") is in control, replacing "That is wrong." and doing something about it, the Father's authority (authoring what is right and what is wrong when it comes to behavior and enforcing it) is gone (There is no right-wrong any more, just "Let's just get along, and look the other way when things are done wrong. We will just do 'better' next time.")

Karen had CLL, Lymphoma, which is cancer of the bone and CHF, Congestive Heart Failure. Karen had three stents. Lymphoma made her lymph nodes large and tight. Congestive Heart Failure, due to the heart no longer being able to create enough pressure to force the water out of her body, gravity taking its course, made her legs large with sores sometimes developing due to cellulitis, water seeping out through the skin by the ankles. As far as knowing about medication and its effect on the patient from the young to the old I have reffered to the 1,300 page "The Nurses, Pharmacology, and Drug Therapy" book for years, starting in 1990 when my mother was ill. I understand their "excuses."

On October tenth, 2023, after she had cooked breakfast I took Karen up to see a doctor¹ regarding an infection in a sore on her lower right leg. Upon telling the doctor we had come up to get antibiotics for the infection, the doctor, instead of examining the leg and sending her to the hospital to get a blood test to find out what type of infection it was and get her on antibiotics, immediately reached for a wrap on her desk (called a "boot"; a "boot" or Unnu is three wraps, the last one a tight one to force water up the leg into the body where the kidneys can then recognize it and expel it, allowing a sore to heal from the inside out, as they do with burn victims - when properly done it works wonders) and immediately leaned down (without sanitizing around the sores, without cleaning the dead skin off the sores, which needs to be done in order for the new skin to heal properly, without placing a protective pad between the sores and the wrap, all of which if she had done she would have seen the infection—which was "red-ish," no puss, or above normal temperature present, see first picture of leg below) and put it on, repeating over and over again as she did, that the first wrap had zinc and calamine lotion on it. In 29 hours, Karen died from infection. The doctor pushed a localized infection, that could have been cured with antibiotics up Karen’s leg, incubating it. 4 1/2 hours after what was a leg at normal temperature, the leg was 104° (103.9°), with pussy sores and blisters now running from Karen's right ankle all the way up to her knee, where the "boot" stopped (see second picture of leg below). One cell of E-Coli, which was what Karen had, under the right conditions (which Karen had when the infection was pushed up her leg, thus well fed, under pressure, and under self generated heat as it rapidly multiplied) will in seven and one half hours produce one million cells (1 cell + 7 1/2 hours = 1,000,000 cells -- I wanted to kill the 1 cell, what the Dr. did required killing 1,000,000 + cells since it was 11 hours before Karen received any antibiotics times how many cells were there to begin with), yes that is one million cells from one cell in seven and one half hours. It was eleven hours before Karen received any antibiotics. Karen died in pain, she said it hurt worse than any sunburn she had ever had and no Doctor or nurse tended to it even though they mentioned she complained. All Karen needed was for the Dr. to send her to the hospital, given a test to find out what type of infection it was and given antibiotics. She was in the garden the day before getting some last vegetables of the season, in the kitchen cooking breakfast before we went up to see the Dr. She was still doing laundry, washing dishes, cooking. We were preparing to go to Sapulpa, OK in a few weeks to see our children, grandchildren, and great grandchildren who had not seen her, wanting them to know their grandmother and great grandmother personally (instead of only a name on a stone).

Source of infection: Karen had seen her cancer doctor a few weeks earlier. She had a sore that I had been successful in healing. When she took a shower before going up to see the doctor, we forgot to cover the scab and the sore reopened. It was a week or so after that, I noticed it appearing infected (reddish). At times she had not been making it to the bathroom on time and I perceive what happened was when she took the shower bacteria was able to enter the now re-opened sore.

On the third of October (2023), I was concerned enough to take a picture of the infected sore since Karen could not see her ankle. It was on the lower right side of her leg. During that time I was using pads to cover up the sore that had sticky stuff on them to hold them in place while I was putting the wrap on. I noticed when I was taking the pad off to put a new one on that the outer skin on her ankle was separating from the inner skin (due to the sticky stuff sticking to the outer skin) which led to more sores, resulting in three more sores (I quite doing that and no more appeared). It was on the sixth of October I took another picture, concerned about the infection. On the eighth (the picture I took shown here - how a Dr. could miss this I do not know, unless they did not examine the leg) I told Karen that we needed to go up to see her doctor because it wasn’t only reddish in the original sore, it was now pink in the other three (very faint).

Because we live 35 miles from the clinic and were on a tight budged Karen said she had an appointment with her heart doctor on the tenth and we should go up then. So I begrudgingly conceded to taking her then.

On the tenth, as I was driving her to the clinic, she admitted that she wasn’t taking all of her diuretics. She had cut back to taking half of it because she was going to the bathroom all the time and could not get any work done in the kitchen. We talked about her possibly having to spend a day or two in the hospital to get the infection under control as well as the diuretic right, which she did not want to do (spend time in the hospital), hoping we could get the antibiotic and simply go home. We had treated infections before at home, even sending a picture to her doctor² with him prescribing antibiotics for me to go up and get without having to see him, being able to stay home. Since it was not her regular doctor, we went up instead.

We were preparing to go to Sapulpa, OK to spend time with our grandchildren and great grandchildren. Several of them had not seen Karen, their grandmother and great grandmother, and she wanted to be a witness to them. Karen was cleaning up the kitchen, canning what few apples we had gathered that year and simply had cut back on the diuretic because she, going to the bathroom all the time wanting to get work done.

When we went up to the clinic Karen's body temperature was normal, including her legs. Having congestive heart failure, with water pushing down on her legs (gravity taking its course) the infection was kept local, there were no signs of if spreading anywhere else. Her blood pressure normal. All she needed was to get antibiotics and back on the full dose of diuretic. That’s all we had on our mind and talked about on the way to the clinic.

We saw Karen's heart doctor, actually an assistant, I wish we had seen her heart doctor instead since the assistant in her report wrote the legs looked normal, with seeping at the sores, when she did not physically examine them (that is pick them up and look at them, the reddish sore was on the right side of Karen's ankle) just looking down. I did not bother to tell her of the infection because we were making the trip to see a specialist and get antibiotics from them. In hindsight, I should have informed her and possibly gotten the antibiotics from Karen's heart doctor instead.

We then went to see the Doctor, who gave Karen a lecture on taking diuretics and then when I told her we came up for antibiotics because of the infection in her sores, immediately (before I finished making the statement) she reached for a wrap on her desk. She didn’t even open a drawer to get it or ask for someone to get it for her. She immediately leaned over and put it on, repeating over and over again that it had zinc and calamine lotion on it. I was sitting there, trying to figure out how that worked, and then became irritated because she didn’t sanitize the leg. Not wanting to be argumentative, having been put in my place, that she knew what she was doing, I just sat there. There was no discussion (as Karen's regular Dr. had with me whenever I made a comment, adding it to his report). She just did what she wanted to do. She did not pick the leg up and examine it. If she had she would have clearly seen the infection. She simply leaned over, while putting the wrap on saying over and over again that it had zinc and calamine lotion on it, telling us that her leg would feel good because of the calamine lotion. I sat there in silence, having been “put in my place,” that’s how I felt as she put the boot on, trying to figure out how that worked.

The Dr. did not have her report written out when we left which all doctors had done, so we went ahead and left, going out to a restaurant Karen loved to eat at, tequilas, which turned out to be her last meal. We went to Walmart to get groceries and while there Karen began to complain about her leg hurting. She had two boots prior to this one (which worked great) and had complained then so I was not overly concerned.

On the way home though I could tell Karen was under a lot of stress so I drove up as close to the deck as I could and helped her out. It was difficult to get her out of the car. Her right leg hurt so bad. I had to help her walk to the deck where she could not pick her right leg up because of the pain and she could not stand on it to pick the left leg up because of the pain. (Karen had two knee replacement so she knew what pain was.) I then went and got two 2 X 4's and laid them on the ground (that’s 3 inches) so she could step up on them and then reach the first step, with my help (in excruciating pain) and then with my help, get up the next step by grabbing the post of the sunscreen, pulling herself up to the deck. From the car to her chair, which was 60 feet it took us half an hour. I went and got a load of groceries and when I came back, she insisted that I take the wrap off. When I did what I saw was devastating (the picture taken to the right). From her ankle to her knee were sores and blisters and when I touched her leg to take the wrap off it was extremely hot, so I went and got a thermometer. Halfway up Karen's leg it read 104 degrees. We were both in shock knowing the seriousness of what had just happened. The boot had shoved the infection up Karen's leg through the water and blood, incubating it, pushing it up into her body, which was anemic (because of her congestive heart failure and lymphoma, E-coli thrives on amino-acid which she had plenty of in her leg). I finished putting the groceries away and cleaned the place up a little and got her back in the car and drove her up to emergency in McCook, Nebraska. She wanted to wait until morning, she hated being in the hospital but after some time I was able to convince her to go up (we left at 9:00 PM for the hospital—In hindsight we should have just stayed home, she comment when the Dr. in Kearny asked her what she wanted to do "I just want to be home"). I do not even remember driving her up. I was in shock.

From there on, it all continued downhill. After getting blood samples which took forever, the guy who worked on Karen (getting an IV in her) had a club hand and by the numbers which came back she was in serious trouble. I don't see how she could recover. From the time I saw Karen's leg at home I prayed the Lord would heal her. I saw no other way for her to recover.

When we got to her room in the hospital, I sat her up in the chair because she could not lay flat. Karen had not laid flat for over one- and one-half years. Every time she laid flat, she could not breathe. Several times I tried to get her to lay in bed to get a night's rest and she could not (her tailbone hurt from having to sit all the time--we tried donuts but those did not work). She always slept in her chair at 60°. When we called for an ambulance, when she had Coved they would not transport her because she had to set up, she could not lay flat, when she tried she could not breath. I had to get her out of the ambulance. No one helped me. They just stood there talking. I scraped the back of her right leg on the bumper getting her out. Got her in my car which was not working, got it started and drove the 35 miles to the hospital, with her afterwards telling me she did not think she was going to come home, that is make it.

While there, just as it was when Karen had gone to the hospital the time before for her heart problem, she could not lay flat. We had to set the bed up as high as we could so she could breathe. When she had Coved, we had to stuff pillows behind her (three and four) with the bed all the way up. Two nights I had to sleep behind her on the couch with my arm hold her up at ninety degrees, so she could breathe, even with oxygen on (she called me her savior after that, knowing what would have happened to her if I had not been there). Both hospital stays they insisted upon Karen taking a CAT scan, which she could not because she could not lay flat. She complied and attempted to lay flat on the platform but could not proceed because she could not breathe. I consider it was the lymph nodes, which were throughout her body, as tight as they could be. We used message therapy for a while but had given up. She could get around the kitchen, do laundry, and garden, etc., do everything but she could not lay flat, and it may have been because when she did, they would press upon her lungs and prevent her from breathing. Already on oxygen, it made it impossible for her to lay flat. So when they³ demanded, and that’s the right word, demanded her take a CAT scan in the hospital we both said she could not. Because she could not. It was impossible for her to lay flat. But the doctor wouldn’t listen (blaming her for her death for not allowing him to take a CAT scan). Logic is, which we seem to have lost: If A equals B and B equals C then A equals C. If Karen (A) could not breath when she laid flat (B) and you have to lay flat (B) in order to take a CAT scan (C) then Karen (A) could not take a CAT scan (C). Is that hard to figure out. It seems to be because many of the Nebraska lawyers I've talked to say her death was her fault because she "refused" to take the CAT scan when told to. They also say they would not make enough money if they took the case, Karen's health being as it was. So if a drunk driver hits your car and kills you while you are driving yourself to the hospital with a serious health problem he is off the hook, you were going to die anyway.

While Karen was in the hospital with Coved, she lectured her doctor, like a mother her son stating, “You doctors are not paying attention to your patients. You’re not listening to us. We come in with special needs you are not attending to.” She knew what she was talking about. It was her not being able to breathe when she laid flat that no Dr. spent time to find out why. Assuming she didn’t like to take CAT scans and leave it at that.

The reason for the CAT scan was she was hemorrhaging inside (had internal bleeding) and they wanted to find out why. They took x-rays and demanded a CAT scan. The reason for the hemorrhaging was the result of Karen not being able to walk and their demanding that she walk from her chair to a bed to be weighed (despite our objecting we complied). With a walker, a nurse, and a belt around her, under her belly, with the nurse on her left side and me on her right she was forced to walk, in pain to the bed (she said her leg hurt worse than the worse sunburn she had ever had) just to weigh her. Do hospitals not have portable scales you can just step on like a weight-watchers scale. They weighed her with her sitting up on the bed. Then the nurse and I got her down off the bed. On her first step, with the walker in front, belt under her belly, me on her left side, and the nurse on her right, Karen went down. She was taking the nurse and the walker to the floor with her, so I grabbed the belt and pulled her up with all my might (she weighed 230 pounds) and dragged her, the walker, and the nurse to her chair and sat her down. That’s where the internal bleeding began. They would not listen to us, they would not listen to us about her not being able to walk, and they would not listen to us about her not being able to breath when laying flat, just like the Dr. in the clinic would not listen to me about the infection in her sore. All this was a result of Dr.'s not listening.

So their solution to the internal bleeding was to give her medicine to close up the small veins in her legs and arms to get her blood pressure up, which at the time was in the 80s over the 40s. During that time all the nurses on the floor came into the room and lined up along the wall like they were watching a rat die. In fact, prior to that the doctor came in and called her a dog, "What we have here is a very sick puppy." The whole attitude was we were in a lab. My question is, what was going to be her condition if she would even survive? Losing arms and legs. And what effect does that medicine have on a person already struggling with a heart condition. It was shortly after that that they called for intensive care, first in North Platte, who could not take her and then Kearney, Good Samaritan Hospital who sent a helicopter that flew her there. I had to drive the two hours there not knowing if I would see her alive or even to able to talk to her.

When I arrived and open the door I heard her clear, cheerful, excited voice coming from across the room. "There he is." I went over and asked her where she wanted me. She said “By my side." There I sat for seven hours until she died. The report she gave to the doctors^{3, 4} in Kearny was we came up to the clinic because her leg was "swollen and red." The doctor there came in and told us she was not going to make it through the night. In both hospitals, no one tended to the pain of her leg, she complained over and over again it hurt worse than the worst sunburn she had ever had, yet no ice, no salve, nothing. It was like it did not exist. Karen refused to take Morphine as her mother had and could not talk to her minister and her husband as she was dying. On the evening of the eleventh of October, at 7:16 PM Karen went to be with the Lord.

I have contacted 18 lawyers now, most saying I have a case find some reason not to take it. They, like the doctors do not listen to what I say. It as if no one cares, that doctors can do whatever they want. We pay heavy health bills and insurance for the hospitals to pay lawyers to protect them from the errors they make. I called the clinic on the sixteenth of October to complain. I called them two times after with no response. Karen’s health insurance company asked for the doctor's records, which the clinic refused to send, the first request refusing to admit it even existed. Karen's health insurance company says that is illegal and have complained but after a year received the records and decided the Dr. had done nothing wrong. Knowing Medicare, seeing its bureaucratic (politburo) structure of investigation I do not expect it to say anything different.

Now the report of the doctor, which was written long after we had left (I did not see it until after Karen's death), was damming. First, she did not record anything I said. Which every doctor that we had seen recorded. And then she slandered Karen with a generalized phrase used in Communist countries to silence. anyone who might criticize what they have done (I lectured in the University on the subject). She put in quotes the words “too busy” in regard to Karen not taking her medicine. That would be like . . . Let me just say first of all the doctors in Kearney wrote out what Karen said with honesty and with no bias. When a patient's advocate says something, you need to record it and secondly, you need to record what the patient says without bias. For example, if a judge ordered you to jury duty and you told him you had a relative who was dying and could not make it, a compassionate judge would simply say "catch you next time." But if that judge wanted to silence you for some reason (as they do in Communist China), he would send the sheriff to arrest you, put you in jail, with fingerprints, mug shot, name in the paper following, and then you would read “too busy" to do jury duty, to serve the citizens. Communist countries use this method, the practice of generalizing to silence any legal response to the crimes they do. Do we have it actually practiced in clinics and hospital in America. It appears we do. This is incomprehensible in a free society. You do not slander your patient. You record what "they" say without bias. Another example regarding a phrase people hear in a dialoguing of opinions to consensus, facilitated meeting, "Not a team player" voiced in response to anyone not working with the "team." Lets take that all the way down the road. Once you step on that road this is where it always goes. I will hand you a gun and tell you to put it to the head of a Jew and pull the trigger (something I would not do) and if you don't' your not a "team player." You can not stop it from going there. History has shown us that is where it always goes.

Regarding the Dr.'s disregarding my telling her of the infection in the clinic, if you were a pilot, you have a checklist you have to review before each flight, if you ignore that checklist and somebody is harmed or dies you lose your license and you can even serve prison time and be heavily fine. It is as though the clinic really doesn’t care, even Karen’s doctor is mad at me (accuses me of attacking him) because I pointed out that another doctor led to his patient's death and his is not reporting it. This is a Dr. who Karen thought the world of, who chided him, as a mother would her son, regarding doctors not listening to their patients, who grabbed his hand one day in his office and prayed over him, that the Lord Jesus Christ would bless him and his wife, and even asked for him to advise her on her death bed. He has ignored what happened to her (saying "I was not there"), which everyone in the clinic and the hospital has done. In fact, the doctor in the hospital used the very same verbiage the doctor in the clinic used “too busy." In the 56 years I knew Karen she never used those words--"too busy." She did not use those words in the clinic, and she did not use those words in the hospital. So doctors can pretty much do and say what they want and it’s your duty to sit there and shut up (silence is consent). We pay heavy health insurance costs which is then used to pay lawyers to "protect" Doctors who do medical malpractice, even those institutions which are responsible for medical oversite do the same.

It is now eighteen lawyers I have contacted. All turning the case down because it did not "meet their criteria." When the Dr. put the "boot" on Karen's right leg she moved a local infection up a leg full of water and blood, incubating it, guaranteeing Karen's death. No one seems to care, not even Karen's Christian Dr. "friends," who only say it is "concerning."

It is now legal for doctors in Nebraska to put a "boot" on an infected foot and if the patient dies not be held accountable. It is now medical protocol. Even the lawyers agree. Their silence give consent.

Karen Gotcher, a loving wife who is now before the Lord; 6/10/1950 - 10/11/2023

No one knows what it is like to loose a spouse except those who have lost a spouse. I miss Karen beyond words. She knew she was dying, they gave her two years, but not this way, at a Dr.'s hands. With her dying in excruciating pain we sang hymns, prayed, share the Word of God together until she could no longer talk, with me beseeching the Lord all the time to heal her. Despite the pain her mind was totally on meeting the Lord. I witnessed a child of God going home. That does not excuse what the Dr. did.

"Precious in the sight of the LORD is the death of his saints." Psalms 116:15

Dean Gotcher

Karen had infected sores in the past before getting antibiotics so I was simply trying to get ahead of this one. The picture here is of infected sores she had in the past (picked up in the hospital) that were treated with antibiotics and healed. Sent this picture up to Karen's regular Dr. who sent me up to the pharmacy to pick up antibiotics without having to bring her in. Problem solved.

1. Naomi Olson, DNP-C (10/10/2023 3:46 PM) McCook Specialty Clinic. placed Unna "boot" on Karen's infected LRE which led to Karen's death. Her only concern: "Patient has not been taking Torsemide as prescribed - states she is "too busy'" (words Karen never used)

2. Mathew Nielson MD, McCook Community Clinic. Karen's Dr. looks the other way. "I was not there."

3. Lorinda L. Reece MD, McCook Community Hospital.

4. Deborah Sheldon, APRN's. Domingo L. Maynes III, MD agreed with Deborah Sheldon's findings (Good Samaritan Hospital, Kearny, Nebraska).

Their Report: "When arrived at CHI Health, Kearney Nebraska: Chief Complaint: Shortness of breath, edema and RLE pain. Karen S. Gotcher is a 73 y.o. female, admitted to CHI Health Good Samaritan on 10/11/2023 with Septic shock. She has a past medical history of CLI diagnosed over a year ago and has declined treatment, coronary artery disease status post stents x3 on aspirin and Plavix, diastolic chronic heart failure was taking half dose of her diuretic, hypertension and obesity. She presented to McCook hospital with weakness and was admitted with concern for pneumonia and septic shock (We never mention pneumonia to anyone since that was not the problem, Dean), she was admitted overnight and treated with IV antibiotics. Patient's hemoglobin was noted to be 6.1, initially she refused blood transfusion but did agree to 2 units which were given prior to transfer. She reports seeing her cardiologist about 2 weeks ago and being told to take her full dose of diuretics but admits she hadn't done so yet, she was also following with outpatient would care to swelling and redness in her RLE. Lab work here reveals a white count of 379,000, Hgb 7.9 and creat 1.9. She is currently requiring high flow 2 at 50L 50% and levophed. She is alert and oriented. She complains of burning pain in her RLE, it is red, warm and weeping. She complains of shortness of breath and heaviness in her chest. Denies nausea, vomiting, diarrhea or constipation. She has a foley in place. Her husband is present. She says she just wants to be home. ... She is oriented to person, place, and time, Behavior is cooperative.

Refuse CT scans. Met with patient and her husband, she pulled off her high flow O2 and says she doesn't want to wear it but does eventually agree to leave it on. Patient says that she wants to talk with Dr. Neilson, her primary doctor and ask him what to do. She says that says she is not afraid to die. I talked with patient and her husband about obtaining CT scans, reasoning behind needing further workup and patient says she will not bee doing any CT scans. She says that she is not opposed to comfort cares but does not want to stop current treatments. 'I'm ready to die if my time comes.' Husband is supportive of patient and her decisions. 11:15 AM Patient drowsy but awake and conversational on arrival, asked for husband, do not DNR/DNI, 12 PM husband arrived, 4 PM patient became lethargic, one word answers, 5PM patient unresponsive. Husband continued at bedside. Death 7:16 PM"

The last letter I sent (this is the rough draft) Karen's health insurance company.