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MULTIDISCIPLINARY MEDICAL TEAM MEETING RE: DET. DAVID MICHAEL STARSKY, June 17, 1979

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THE POST GUNTHER SESSIONS

 

MULTIDISCIPLINARY MEDICAL TEAM MEETING
RE: DET. DAVID MICHAEL STARSKY,


June 17, 1979 – 3:35 PM, Memorial

Jacqueline©2019-11-18

 

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 canula – 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 07, 1979 10:15 AM Pulmonary testing postponed in light of after effects of injury and surgery; STB continued: additional 15% reduction
                                      oxygen level (time intervals unchanged, Colley/Frantz alternating) pressure ulcer 80% healed; yoghurt: tolerated
June 08, 1979 10:05 AM Muscle strength/ROM testing (Aaronson, passive – assisted - mobilization protocol / muscle stretching protocol started);
                                      soft food / mash food diet started 3x/day; patient ready for first psychological assesment (Jamison / Johanson)
June 09, 1979 08:30 AM patient’s bed raised additional 15 degrees; monitoring Colley/Aaronson subsequent consultation P(a)MP;
June 10, 1979 10:05 AM Pulmonary testing successful (level 2), STB longer interfalls, oxygen reduction unchanged; P(a)MP
June 11, 1979 11:15 AM First psychologocal assessment (Johanson – advice for follow-up Jamison/Aaronson); additional 20% reduction oxygen
                                      level (time intervals unchanged, Sarge/Kramer alternating), patient’s bed raised additional 15 degrees (monitoring
                                      Colley)
June 12, 1979 08:30 PM Patient white blood count elevated: bladder infection, oral  anti-biotics started; 103 degrees; can’t keep food down;
                                      special attention; switch to intravenous antibiotics for night
June 13, 1979 10:15 AM Patient temperature unchanged; gelatin tolerated; extra fluids cont’d; 24 hr alert
June 14, 1979 09:15 AM Patient’s temperature normal; white blood count normal; mash food re-started (optional Prochlorperazine)
June 15, 1979 02:30 PM Last day intravenous antibiotics; breakfast: mashed bananas on ½ toast – tolerated; P(a)MP/ROM & muscle stretching
                                      cont’d.
June 16, 1979 03:45 PM Patient’s bed elevation 90 degrees total; exercise regimen expanded – standing up (20 sec each time – 5 min intervals);
                                      strengthening exercises extremities expanded; pulmonary testing level 4 succesful

Status updates:
Cavanaugh (pulmonologist):
Patient is on level 4 on the pulmonary test schedule. Recent setbacks (bladder infection; irritated digestive system) hindered further progress.
Coordination between breathing and swallowing has improved, yet is still somewhat off. Continue therapy.

Foretti (neurologist):
Patient’s physical responses are improving rapidly. Fine motor skills (hand-eye coordination): still off. Reflexes improving. Therapy developed
with Aaronson (PT) neuro-/physical. Cognitive skills normal – slightly impaired when fatigued.

Aaronson (physical therapist):
Patient’s system proves to be extraordinarily strong and resilient. Build-up to full physical therapy exercise schedule is promising. Temporary
setback due to bladder infection. Patient was shocked into reality as far as his lack of strength, flexibility and range were concerned. Combo
physical/psychological therapy works well with patient; drawing parallels with sports or the physical testing at the police academy is inspirational
to patient.

Johanson (psychologist):
I’ve set up an approach for further psychological assessment with Dr Aaronson that he now uses during his sessions with the patient. Patient’s
most notable characteristics are responsibility, loyalty, determination, inner strength. From his BCPD files we know patient lost his father, also
a police officer, at the age of 11. Patient feels responsible to his inner circle to not burden them; his determination will quite possibly propel
him to push himself too hard. I feel the entire medical team must remain alert that he will not strain beyond his abilities of the moment and
temper him in order to solidify the biggest chance of as much recuperation as possible.

Conclusion:
Jamison (head of trauma 1, critical care, physiatrist):
Patient’s overall improvement is certainly gaining momentum, however we should indeed take note of Dr Johansons caution and protect patient
from his own – sometimes too – optimistic nature. I personally find his sense of humor and ability to put things into perspective great assets
for his rehabilitation, but I concur that in his case, his body is still far from healed enough to be following his mind’s will. Yet, we cannot deny or
ignore that his recovery up to this point is absolutely incredible. I am very pleased and thankful that Det. Starsky and his mother have given the
go ahead to document his progress and all his therapies for further reference. We will continue all therapies as scheduled; if anything occurs that
might warrant revisting the current timeline, please report to my staff for a one on one consultation with me or team meeting if deemed necessary.