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MULTIDISCIPLINARY MEDICAL TEAM / FAMILY MEETING RE: DET. DAVID MICHAEL STARSKY

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THE POST GUNTHER SESSIONS

 

MULTIDISCIPLINARY MEDICAL TEAM / FAMILY MEETING
RE: DET. DAVID MICHAEL STARSKY 


June 7, 1979 – 1:15 PM, Memorial (transcript from recording)

Jacqueline©2019-11-08

 

HISTORY:
Patient: David Michael Starsky, white male, age 32
Date of admission: May 15, 1979 - 1:50 PM; time of incident: approx. 1:08 PM
Category: Multi-trauma and Injury; Penetrating injuries to trunk: 3 gunshot wounds (GSW); suspected trauma to spinal cord; severe (internal) bleeding/suspected arterial haemorrhage; weak / irregular pulse; respiratory distress; unconscious.
ER: trauma staff worked to stabilize the patient until finally at 2:45 PM he could be transferred to the OR for surgery.
OR: Trauma surgery team (OTT 4) – 9 hrs, 17 minutes; 3 bullets removed; 10 pints of blood; cardiac arrest after 4 hrs and 12 minutes; thoracotomy; resuscitation 7 minutes; cont. surgery.
Post-op status:
critical; comatose;
May 16, 1979 03:21 PM:  cardiac arrest  resuscitation 14 minutes.
May 17, 1979 08.30 PM:  Downgraded to serious/guarded
May 18, 1979 09:20 AM:  off ventilator; nasal cannula – status coma unchanged until 08:05 AM: patient conscious
May 19, 1979 07:56 AM:  patient awake – cognitive ability could not be tested yet
May 20, 1979 11:05 AM:  level 1 cognitive ability test; failed
May 21, 1979 08:45 AM:  level 1 cognitive ability test: successful
May 22, 1979 10:15 AM:  cognitive skills: adequate (non verbal);  short term memory: unsatisfactory
May 23, 1979 09:45 AM:  level 2 cognitive ability test: failed; respiratory infection
May 24, 1979 08:15 AM:  respiratory infection; intravenous antibiotics; decision pending on putting patient on ventilator again.
May 25, 1979 08.15 AM:  restless night; fever spiking at 104 degrees; upgrade intravenous antibiotics; patient sedated
May 26, 1979 08.15 AM:  situation unchanged
May 27, 1979 08.15 AM:  slight improvement; fever down to 100 degrees
May 28, 1979 08.15 AM:  patient’s temperature down to normal level; sedation level reduced
May 29, 1979 09:15 AM:  patient off sedation, temperature normal, first psychological assessment cancelled
May 30, 1979 10:05 AM:  situation unchanged; introduction gelatin; special attention swallowing
May 31, 1979 09:30 AM:  note nursing staff regarding development of bedsores; special attention/treatment plan
June 01, 1979 10:30 AM  wound care pressure ulcer started
June 02, 1979 08:15 AM  patient transferred to high care unit; special matress, wound care cont’d.
June 03, 1979 05:30 PM  introduction applesauce; nausea (admin. Prochlorperazine)
June 04, 1979 08:30 AM  breakfast gelatin first success after swallowing training; spontaneous breathing trial (STB) started to wean patient off
                                       cannula – 20% reduction oxygen level after 30 minute trial; SB moments will be increased by 10 minutes each day with
                                       2 hour breaks; monitoring (Sarge/Kramer alternating)
June 05, 1979 12:30 PM  pressure ulcer responding well to treatment; patient cognitive test level 3 successful; oatmeal/gelatin lunch, soft fruit:
                                       tolerated.
June 06, 1979 09:30 AM patient’s bed raised 15 degrees; monitoring Colley/Aaronson subsequent consultation Jamison (head of trauma 1,
                                       critical care, physiatrist)/Aaronson (physical therapist) re therapy plan;



June 7, 1979 – 1:15 PM, Memorial (transcript from recording)

Attending for Memorial: Dr Richard Jamison (head of trauma 1, critical care, physiatrist)
                                      Moses Aaronson, PT, MS, Cert. MDT (physical therapist)
                                      Dr Frank Foretti (neurologist)
                                      Dr Elizabeth Cavanaugh (pulmonologist)
                                      Myrna Johanson, Ph.D. (psychologist)
                                      Dr Daniel Bernard (cardiologist)

Attending for the family: Mrs. R. Starsky (patient’s mother) and per her request:
                                       Det.sgt. K. Hutchinson (BCPD, partner of patient)
                                       Capt. H. Dobey (BCPD, commander/supervisor of patient)

 

Jamison:
Thank you, Mrs. Starsky, gentlemen, for responding to our request for this update on our patient, your son, your partner and your detective, David --- David Michael Starsky.
We have spoken a few times, briefly, Mrs. Starsky – once on the phone and lately a bit more frequently, face to face. This was your first visit since your son’s hospitalization?

Mrs. Starsky:
Yes, yes, it was. I could only stay for a short while, but I intend to move here for as long as it will take for my son to heal. I will just need to make special arrangements to that end ---- I am so grateful to you and your staff and of course to Ken --- his partner Det. Hutchinson and Captain Dobey for being there for my son. He is so lucky to have them in his corner. I, I flew in the 31st; I’ll be flying back again tomorrow, which is why I really appreciate your effort to make it possible for me to be at this meeting.

Jamison:
No need to thank us, Mrs. Starsky; you are after all his immediate family. Now, there’s no need to beat around the bush and you yourself have made it clear that you prefer us to be as open and straightforward as possible regarding your son’s condition.
Det. Starsky was shot three times in his upper body on May 15th, some – three weeks ago now, 3 ½ weeks to be precise. It was automatic gunfire and his injuries as a result were massive and life threatening. I will spare you the minute details, but you will understand that the almost 9 ½ hours of trauma surgery during which he suffered his first cardiac arrest and the second cardiac arrest he suffered the day after, tell you just how seriously injured he was and of course, still is.
Nevertheless, we are beginning to see a turnaround in your son’s response to the treatment he has been receiving. He has had some setbacks, as was to be expected, but he has overcome them all with, I dare say, relative gusto, considering his condition.
In fact, I feel confident enough to tell you that we are guardedly optimistic about his progress. We think the fact that his overall excellent physical condition, his age and most likely also his character and spirit are big contributing factors to his ability to have come as far as he has.
However, this doesn’t change the fact that he is still in serious condition and it will take a long, probably very long, amount of time for him to not just heal, but to regain control over his body, his bodily functions and abilities and to mentally process not only what has happened to him, but how it most likely will affect him for the rest of his life. I will now ask my collegues to give you a brief status report on Det. Starsky’s condition and prognoses.

Foretti:
Mrs. Starsky, gentlemen. I was added to the medical team that is treating your son because he fell into a coma as a result of the cardiac arrest he experienced during trauma surgery. As you know his coma lasted 56 hours; during which he suffered a second cardiac arrest. However, continued neurological testing since the coma ended, have led me to conclude that Det. Starsky has suffered no damage to his brain; not to his intellect, his cognitive ability. I know you, Det. Hutchinson, especially were concerned that your partner might have suffered brain damage when he experienced memory lapses and some cognitive problems during the first two weeks since coming out of the coma.

Det. Hutchinson:
What had --- may I? (note: Jamison nods consent) Thank you, uh, what had me concerned was that it went up and down. I mean, the first few days after he woke up it was --- he was pretty much unresponsive. But some time after that, I had some relatively coherent conversations with him --- brief, but, but it seemed like he was very aware and alert. And then a day or two later it was almost back to how he was right after he woke up. That --- that really had me worried and, well, confused to say the least.

Foretti:
You must understand that the infections he sustained, as well as the medication that was used to fight off those infections, had their influence on his condition, too. But his results were still within the margin of expectation when taking into consideration all the trauma through injury, but also through treatment. You all will probably have noticed that especially the past 2 days, his cognitive skills have improved tremendously, which is another sign that he has now fully “woken up” so to speak. So, I am not at all concerned about his recuperation in that area. There is however still the matter of the connection between brain, central nervous system and muscles – the motoric side or physical side of the after effects of both the trauma and the coma. And his therapies will obviously focus on those issues as well as overall physical recuperation.

Cavanaugh:
Yes, thank you Dr Foretti. Mrs. Starsky, gentlemen. The impact of and damage done by the bullets that hit Det. Starsky caused massive internal damage to bones, ribs, tissue, bloodvessels, arteries and organs, such as his right lung. The trauma surgical team had to remove a third of his right lung and they deserve much credit for being able to limit further damage to the right lung and keeping the loss of lung tissue so minor, regarding the damage that was done. Your son is being weaned off the last supporting oxygen therapy as we speak, and we are very pleased by how his system is responding to this. He will – for the time being – keep a nasal cannula throughout the night, but we believe that within a week or two at most, he will be able to get by without any extra oxygen around the clock. His respiratory system will, however, remain a cause for caution in the future. How much caution we will only be able to tell after he will have finished all his therapies that will be started soon.

Bernard:
Like my collegue Dr Foretti before me, I am pleased and amazed that your son's heart has not suffered any detectable damage from the cardiac arrests he has experienced. This is rather extraordinary, which is why I would like to ask your son and you for permission to document his case for medical purposes as Dr Jamison will explain to you. I seen no reason why your son would have a bigger chance for occurance of cardiac issues than the average person.

Aaronson:
Mrs. Starsky, Captain Dobey, Det. Hutchinson. My name is Moses Aaronson and I am assigned to your son’s rehabilitation as his physical therapist. Right now, his condition is still too fragile to be starting on a real therapy program. I will, however, either in the coming week or the week after that, begin with preparatory treatment, which will consist of loosening up his muscles, light exercises in bed to improve his lung capacity and I will also start practicing the more neurological exercises to benefit eye-hand coordination and fine motor skills through instructions from Dr Foretti. I have already met Det. Starsky briefly and if my first impressions are right, I think his character will be of great help to him in getting good results from all the therapies he will soon be receiving.

Johanson:
Ma’am, gentlemen. I am Myrna Johanson and I am a trauma psychologist. My task is to assess a patient’s response to whatever traumatic event that has happened to him and may change his or her life, sometimes for a short while, sometimes permanently and to help guide them through this process. I have not yet had the opportunity for an assessment briefing with Det. Starsky due to the aftermath of his coma. I would also like to have your input on how you feel would be the best way to approach him regarding the reality of the trauma he has endured.

Jamison:
Thank you all for this update. I am sure you must have some questions ---- Mrs. Starsky?

Mrs. Starsky:
Well, yes --- I think I do. It’s just --- it is a lot to take in --- What is most important to me, now, is how these injuries will affect my son --- I mean, the rest of his life. Will he be --- will he be --- disabled? ----- In any way?

Jamison:
I will be perfectly honest with you, Mrs. Starsky. At the moment – we really do not know. You see, your son is writing medical history as we speak. I’ve had my staff look it up in the records of this hospital. But no one, not one patient, with a trauma as serious as your son’s --- not the initial trauma, nor the trauma sustained during treatment – such as his cardiac arrests – has survived, let alone survived and improved like your son is doing right now. Which is why we would like to request his and your consent to document his entire case for future reference. We haven’t asked him yet, because of his early cognitive problems, but now that he has improved enough – and certainly after assessment from Dr Johanson, we would like to ask his permission to do so. So, again, to answer your question, we do not know at this moment how far your son will be able to improve; we are learning with him. But rest assured that our staff and team will put everything on the line to get your son back as close to how he was before the shooting as possible. He is a fighter and for that alone, we owe him as much.

Det. Hutchinson:
Uh, if I – if I may ----

Jamison:
Of course Detective.

Det. Hutchinson:
I would like to know how I --- if and how I can be of help in uh, with --- with my partner’s therapies. I, I would like to be involved – if that is at all possible. I, I think --- I think he would appreciate it and I think it might even help him ---- mentally, I mean --- Would that be possible?

Jamison:
Dr Aaronson?

Aaronson:
Everything that can be of benefit for a patient is welcome. But right now, it’s early days and he is too fragile to undergo anything but professional care. But as soon as his condition allows it, sure, I am all for it. Right now, I think you can certainly be of help to support and stimulate him mentally and psychologically. I think Dr Jamison had already arranged for special visiting rights around the clock for you, Mrs Starsky and Captain Dobey.

Jamison:
Well, around the clock is a bit much (laughter) but yes, special hours outside visiting hours.

Aaronson:
I’m sorry, I misunderstood (laughter). What I meant by that was that a patient usually benefits most from normal contact and treatment during his or her rehabilitation. Call it a diversion, I’m sure Dr Johanson will agree with me. It’s also a bit of a security blanket; something familiar in new, unfamiliar circumstances. So, yeah, as soon as it is sensible, I think it would be a great idea for Det. Hutchinson to get more involved.

Mrs. Starsky:
I know you have just told us that, well, that my son’s condition is – is new to you, for lack of a better way to describe it. But does that mean you don’t have any idea how long his recovery will take?

Jamison:
I’m afraid so, Mrs. Starsky. But you can believe us when we tell you that the team that is assigned to his recuperation is fully committed to his case. We are all in awe of what he has managed to overcome so far. It has even earned him a nickname by which he is known, not just by the team, but in all of Memorial. Your son goes by the moniker The Miracle Man.

(laughter)

Jamison:
If you have no further questions at this moment, I think we can close this meeting. Do feel free to contact our staff should any questions pop up at a later time, yes?

(meeting closed)