Since much of what I write here will reference our Hospice staff, I thought I'd start by introducing you to each: JR Paulson: Medical Director Patti: our RN Eden: our Aide Kim: Massage Therapy Randy: Social Worker Keith: Pastor and we will add volunteers as time goes on. Patti was here to trim Gene's toenails and I used the time to ask some questions and for Gene and I to talk with her. I began to talk to Patti about the pain Gene is having in his left shoulder: he screams when it triggers; there is no doubt his pain level is at 10; he said last night that it shoots pain down his arm, but it is so painful he can’t even tell how far; and it is one small area on lower right of his left scapula. I told Patti that last night Gene was in so much pain that I gave him one of my Hydrocodone/APAP and Gene told us he slept well. In this discussion, Gene brought up his fear of using any oral narcotics because of the potential kidney damage and that he did not want to end up in Iowa City (UofI Hospitals) again. I explained to Gene that he would not end up there---or any hospital—because of his ‘no hospitalization’ rule. Patti and I discussed with Gene the fact that given his health, it will most likely be an organ(s) failure that he dies from, and not the cancer itself. Talked with him about the stress the cancer is placing on his organs, and how easy it would be for his heart to stop, or him to get pneumonia, for example. Patti also discussed with us that if we wanted to avoid more load on Gene’s kidneys, there are several meds that he is currently taking that could be eliminated: aspirin, calcium, iron, magnesium, potassium, vitamin, and possibly some others. This was really a hard conversation for Gene. Gene seemed to understand what we were saying and asked questions when he needed more information. Gene and I told Patti that want her to be upfront and clear when a treatment move will detract from Gene’s quality of life. I asked Gene if he understood that there may come a point when he needs to chose between more pain control or living with some pain while being aware and active in his life. Gene now has a prescription for the same Hydrocodone/APAP that I take. Gene's anti-nausea medication has jumped from 4 mg every 6 hours up to 12 - 16 mg in the same time frame. Patti also gave me the official "Out-of-Hospital Do-Not-Resuscitate Order' today.