"She had a typed up list of meds she was taking and knew that she needed her asthma meds at all times. They knew, they said. It was written and stated verbally more than once. None of her asthma meds were to ever be withheld. Not one time. Everyone eveywhere knew it." A list of a patient's home medicines is taken as part of a history and customarily attached to the chart. But, what I am asking is are you sure they were on her chart as an order to be given? If they were, and she hadn't had them for days, SOMEBODY made the decision not to administer them. One issue is who and why? Since you say she didn't have them since Saturday, did she or you ask that question before her episode? It doesn't feel right that everyone who had given patient care to her would have missed it, and not questioned why that was the case. This is exactly where I was coming from when I addressed the flow of information. If she had been getting her meds right along, was there a possibility this would not have happened? I have to make the assumption the breathing treatment was given as a new stat order. Did I understand correctly that order had issued for a matter of hours and not acted upon? Did any one of the floor staff catch that fact well before she called you? Did any of them try to expedite the treatment by communication to the physician or pharmacy directly or did they leave it up to another department to follow through on it? At the facilites where I worked all the floor staff who were caring for a patient or administering meds would have looked that drug up in the a reference and educated ourselves to it's generic name and likely been in contact with the pharmacy about it quickly if there were an issue. We were required by our own policy to do this with every medication. Good, good policy. Is that a policy in that institution as well? Your description of the actions of the resp tech and LPN still leaves a question in my mind whether they had access to the drug to be administered. If that were the case, how could they give it? Were they trying to calm the patient to decrease her respiratory demand until they could get and administer the drug? Could they have been just as anxious as you or your mother, but doing the best they could under the situation? I guess what I am saying is that I still would question this a communications issue and also wonder if it could also be an accountability issue. Checks and balances likely exist in the system to prevent those things from happening. You might be surprised who "could" be considered accountable. Your doc did the right thing for initiating a complaint, and I'm not in any way saying your anger is inappropriate. You should be upset.......but I'm wondering at this point.......at whom. I'm not implying any particular member of the staff is at fault nor guiltless. I'm saying that an internal look-see is appropriate to address those issues not apparent from the outside. Been there and done that myself as an advocate. I'm very glad it turned out OK.

drtomato, Yah, same thing here across the water (Wisconsin) We get 2 inches of rain which then freezes solid and then we get 6 inches of snow on top of it. I still have around 3 feet of snow/ice over the top of my garden. I don't start my seeds until April, but it would be nice if I got some sign that summer was actually coming before starting them. It's interesting you mentioned Tiny Tim. I started some about a month ago because I was bored and I'd heard they can be grown as indoor plants, since they only get to 12-18 inches high. They're about 3-4 inches high now. Are you going to plant them outside, or are they for hanging pots or something like that? Mike

I grew up in a 1-story earth home (so no basement) and we currently live in a slab townhome (1500 sq ft). If you don't need the storage/rec space and if the lot you choose is flat, I don't see the need for a basement. Our lot is angled for a side walk-out basement so we're going to have a basement (unfinished for now, possibly forever.) I'm going to try posting my floorplans directly here. Looking at my floorplans and comparing them to your requirements, I think you could make 2500 sq ft work for a 4BR. We have that formal study (I work from home full time) AND the sun room (this will be our piano room)--two spaces it sounds like you wouldn't need. It's basically a modified version of this model home.

Glad you all liked it. I started reading it before she moved to her present location so I've 'seen' her place grow over the years. The hours she must spend taking care of it is mind boggling.