Service will indeed be at 2 p.m. on Saturday, September 6 at Providence Presbyterian Church, 9019 Little River Turnpike, Fairfax, Virginia 22031.
If you would like to make a contribution in memory of my mother, consider Shalem Institute, another organization of peace or spiritual life, or a group of your choosing.
Some people have asked if they could send their condolences by mail to us, which would be very kind – although hardly necessary.  But if so, Karen’s address is

Karen Grumbles
1816 N Kenmore St
Arlington VA 22207

A quick follow up note that we’re not certain of the time of day of the service, yet.  We jumped the gun.  But still September 6 at Providence.

Ann Kulp died at 2:30 this afternoon. We will post information about her memorial service as soon as we can. It will be held at Providence Presbyterian Church.
Thank you all for your care and support.
Karen and David
 

That seems to be the sort of contradictory news this week.  I (David) arrived Thursday morning and she said to me from bed, “I’m not doing well.  I’m just not myself.”  She got up to have some breakfast with me.  As everyone says, she looks great: her skin tone is good, she’s quick with her thoughts, moves well and quickly.  I noticed her penmanship was excellent — so very good motor control and good vision. But she had a small bowl of cereal and complained that she had no appetite.  As she sat at the table, she paused, breathed intentionally and complained about feeling short of breath.  “This sucks,” she said.  Mom climbed into the recliner and slept until after noon.
We met Karen at the oncologist’s office to discuss Mom’s decline, which Karen and Mom agree started last weekend.  But ironically Mom’s vitals are great.  Good blood pressure and resting oxygen levels are 96%!  Pain is sporadic, most recently in her neck and shoulder, but usually two tylenol is sufficient.  Mom’s MRI of her neck region from Wednesday showed additional metastasis in her bones, but no  fractures or compressions threatening her spine.  Mom hops up on the exam table without a thought.  She’s still quite strong.
However, Mom’s left lung isn’t working well at all — that’s the one with the tumors.  Monday’s test showed her lung capacity was way down.  And Mom will struggle with mini coughing fits throughout the day struggling to expectorate.
Dr Heyer understood that breathing discomfort is the primary concern and suggested that she try oxygen.  He didn’t recommend further chemotherapy because the remaining drug option had only a 5-10% chance of being effective, can cause lung complications and would be weakening.  And he didn’t recommend radiation because pain was mostly manageable.
Mom again repeated that she just didn’t feel like herself and suggested that it might be time to call hospice, which the doctor agreed was a good step.  There’s really no downside considering she doesn’t have any plans for curative treatments.  We don’t want to call hospice at the 11th hour and it makes sense to focus on comprehensive palliative care at this point — even if Mom is mostly self-sufficient and in relatively good shape.  If she improves substantially then she can drop hospice.  Regardless, she’ll still meet regularly with Dr Heyer and her pulmonologist, Dr Williams.
So the order was placed for hospice, which is a big milestone and feels premature if you read it as a death sentence.  Instead, I think the three of us all agree that it feels like the right next step to be prepared for the future and to best address Mom’s comfort today.
I drove Mom back to her apartment and after some visiting Mom said reluctantly that she should probably get some dinner.  She repeated that she had no appetite. We walked to the dining room with her new walker for the first time.  It’s not a long walk, but Mom stopped twice to sit for a few minutes and catch her breath.  Once we arrived, she stopped to greet and chat with numerous friends and introduce me to many residents.  And then she sat down and had a big meal of salad, fruit, a “delicious” omelet, pumpkin pie, ice cream and coffee!  Oh, I forgot that she had squash soup in her apartment two hours earlier.
So she has no appetite, but when she’s with others and the food is right in front of her, she seems to have little trouble.  I suspect that she eats much less when alone because she doesn’t have the energy or inclination to get food.
Anyway, as is typical, evenings mean a resurgence of energy and she was up until midnight still trying to catch up on emails.  I finally kicked her out of the guest room where her computer sits so I could sleep!

My mom’s surgery this afternoon was successful.  She had a pleurodesis, which is essentially the destruction of the sack around the lungs to keep it from accumulating too much fluid.  That fluid accumulation (effusion) had recently become much worse causing pain and breathing problems for my mom.
My mom was waiting in recovery with my sister this evening when I spoke with her on the phone and is in a lot of pain.  The post-operation pain was much worse than she expected.  She is afraid to cough and feels awful, but Karen says she looks great.
Before my mom was even fully awake the nurse had her on her feet and walking — which didn’t make her happy, but we know that early walking has been shown to be closely linked to quick recoveries.
The surgeon reported draining a liter of fluid and my mom currently has a tube that continues to drain fluids, but the hope is that that will be removed and she’ll be stitched up to go home by Friday.  The surgeon also reported that, unfortunately, he could visually spot plenty of cancerous lung tissue during the surgery.
Mom was talkative and sounded like her usual self.  We chuckled at a few jokes.  She’s bracing for more serious pain and a longer recovery than she hoped.  This was not a “walk in the park”, she emphasized.
I’m so grateful to Karen for all the time she’s spending with Mom.  I think all three of us have a similar attitude that it just stinks that Mom has to go through this.  But at least she has Karen nearby and all of you!