Actions

Work Header

CONSULTATION MULTIDISCIPLINARY MEDICAL TEAM (MEMORIAL) / DET. DAVID MICHAEL STARSKY

Work Text:

 

 

 

 

 

The most used disclaimer:
The TV show "Starsky and Hutch", and the characters from it
are the property of the persons who hold the copyrights
and other legal rights to them.
This story is a work of fiction, written for pleasure only
and not for profit. It is not intended, in any way,
to infringe on these preexisting copyrights.

THE POST GUNTHER SESSIONS

 

CONSULTATION
MULTIDISCIPLINARY MEDICAL TEAM (MEMORIAL) /
DET. DAVID MICHAEL STARSKY,

June 26, 1979 – 11:15 AM, Memorial

Jacqueline©2020-02-24

 

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 assessment (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 psychological 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  antibiotics 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 successful. 
June 17, 1979 07:50 PM:    Patient spent majority of day in (semi-)seated position; all read-outs (BP/HR/O2sat) normal; breakfast: toast+
mashed banana, yoghurt; lunch: broth/toast; dinner: mash (potato/chicken/ Apple sauce)
June 18, 1979 02:20 PM:    P(a)MP/ROM & muscle stretching/ standing up (30 sec each time – 5 min intervals), strengthening exercises
extremities cont’d. 
June 19, 1979 08:50 PM:    Patient transfer to wheelchair practiced; time in wheelchair 5 min; readouts elevated; returned to normal after 4 min.
43 sec.; motor development test: negative; consultation Aaronson/Foretti/Jamison exercise plan 
June 20, 1979 09:20 AM:    Wheelchair transfer + seat. time in wheelchair 5 min., readouts elevated; returned to normal after 4 min. 02 sec.;
P(a)MP/ROM & muscle stretching/ standing up (45 sec each time – 5 min intervals), strengthening exercises
extremities cont’d. 
June 21, 1979 04:50 PM:    PT exercises expanded; readouts: cont’d improvement; pulmonary test level 5 successful 
June 22, 1979 03:30 PM:     PT exercises: on weekends will be continued as on weekdays (as in full sessions per instructions Aaronson/Foretti);
P(a)MP/ROM continued, standing extended. Last drain removed; bandage/ wound care instructions (team B) 
June 23, 1979 06:15 PM:    PT, P(a)MP/ROM continued, patient spent majority of day in seated position. Breakfast: toast+cheese and jelly; lunch:
broth/toast with boiled egg, ½ apple; dinner: baked potato/boiled chicken/steamed vegetables (carrots/green beans) 
June 24, 1979 06:30 PM:    PT, P(a)MP/ROM continued, patient spent majority of day in seated position. 
June 25, 1979 06:30 PM:    Multidisciplinary testing & evaluation of patient by BCPRC expertise team.  

   

 

June 26, 1979 – 11:15 AM, 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)
                                      Myrna Johanson, Ph.D. (psychologist)

CONSULTATION
Consultation / progress visit with patient regarding the evaluation by the BCPRC expertise team.

Consultation (Dr Jamison):
Note (June 26, 1979 11:50 AM): Consultation with patient after his morning routine and breakfast. Drs Johanson and Aaronson were also present for the consultation. Whittaker was there for recording and incidental notes.

Jamison:
Good morning, Detective Starsky. Have you rested enough after all the testing yesterday? How was your night?

S:
Yeah, they sure gave me a work-out. Slept like a log.

Jamison:
Did you experience any discomfort or other unpleasant effects from the evaluation?

S:
No, I’m okay. It was just a bit intense, that’s all.

Jamison:
I’m glad to hear that you’re feeling okay. Now, Detective Starsky, yesterday’s evaluation took place for us to be able to schedule the next phase of your rehabilitation, as I’ve told you before. The team that has been treating you here at Memorial has met and discussed the findings of the BCPRC team with them yesterday and we are here to inform you about what the next steps in your healing process will be. Should anything be unclear, Detective, do not hesitate to ask questions, alright?

S:
Sure. One thing, though, Doc. We’ve known each other for over a month now and I’m usually on a first name basis with folks by then. So, please just call me Dave, okay? Makes me feel less like a patient, you know?

Jamison:
Very well – Dave. And you are of course free to call me Doc (note: laughter). Alright, now, we’ve gone over the results of the tests and examinations with the BCPRC expertise team after they had finished their own evaluation, yesterday. The overall conclusion is that, considering the type of weapon and ammunition used, the location of the injuries, the distance from which you were hit, we all agree that – although it may not seem to you so right now – you were indeed extremely lucky to have survived the shooting. You have been informed, earlier, that you also survived two cardiac arrests, which in laymen’s terms means that you have come back from the dead.
You have told all of us to be honest with you at all times, so I’ll just put it as bluntly as I can: when you were brought in here on May 15, nobody at Memorial thought there was any chance that I would be telling you all this today, June 26. You are aware of your nickname here, aren’t you?

S:
Nickname?

Jamison:
You are not aware you’re known as The Miracle Man in this hospital?

S:
Oh! Yeah, my partner told me – yeah, and so did Moses. But, all kidding aside, doc. You’ve told me before how close I came to kicking the bucket. I owe you and your staff more than I can ever give in return.

Jamison:
You don’t owe us anything, Dave. We just did and do our job to help you and all our other patients get well again. And speaking about that, you are now very close to entering the next phase in your healing process. The physical damage to your body is almost healed. You have been able to begin your physical therapy schedule with Dr Aaronson and that will be expanded in the next phase. Now, you’ve not been shy to tell practically all the members of the team treating you, that you do not want to be transferred to a rehabilitation center. You do …….

S:
I really …. I’m sorry for interrupting, Doc. But I really don’t want to go to another hospital type thing. To be perfectly honest, I’m bored out of my skull in between PT sessions, you know? And, no offense, but the food ….. I mean….. Isn’t the food supposed to help me regain my strength? I’m kind of over oatmeal and applesauce. Sorry.

(note: laughter)

Jamison:
Yes, Dave, we can read your remarks regarding those things in the daily reports on your chart. That’s why I know you will be very pleased to hear that the conclusion of the BCPRC expertise team was that you do not need to be transferred to a specialized center for the next phase of your rehabilitation.

S:
Really? Alright!

Jamison:
However – Dave – however, you know as well as everybody else, that you still have a long way to go before you will be able to have full control over your physical abilities. Your muscles have been inactive for a long time and your nerves, tissues and bones in the affected areas received tremendous impact from the bullets. Again, per your request in layman’s terms, your whole physique is still in a state of shock from the impact and damage that was done on May 15. That is why even parts of your body that weren’t hit, are still out of sync. You just mentioned the diet you are still on. Well, Dave, you know that even though your digestive system was not hit, it still is affected by damage elsewhere in your body and by medication to fight off infections and to help you heal. Of the times we have incorporated more regular types of nourishment, 33% caused complaints and reactions that are unusual for you, as you’ve told us, remember?

S:
Yeah, I guess. So, if I don’t need to go to a rehab center, what’s going to happen next? Will you keep me here longer?

Jamison:
No, not longer than necessary. Don’t get your hopes up too soon. You’re not ready to be released from Memorial just yet. Dr Aaronson will start the pre-phase of the next rehabilitation phase with you this week. Dr Aaronson?

Aaronson:
Yeah, thank you. Dave, you and I have had quite a few conversations during our sessions and you had a wake-up call recently when I asked you to perform a very simple, physical, task and you couldn’t comply, remember?

(note: patient nodds in comfirmation)

Aaronson:
Right. The expertise team has confirmed Memorial’s team’s presumption that none of the injuries to your body have caused permanent neuro- and spinal damage. Like Dr Jamison just explained, the fact that you do not have full control over your abilities has to do with the amount of time that your body has been inactive, the shock your system has had to endure, the infections etcetera. The good news is that none of your neuro- or muscular memory is gone. You just lack the strength and coordination to make your body perform its tasks normally. Practice makes perfect and the next phase of your rehabilitation will consist of practice, truckloads of practice to be precise, to help you regain full functionality. The reason why you don’t need to be transferred to a rehab center as an in-patient is that you don’t need to relearn things, you just need to get back in shape. We’ve already practiced standing up and sitting back down. You can do that under your own power, but right now it takes a lot of effort. This week we’ll be starting your mobility exercises. A walker will become your best friend – don’t make a face. You’ll be grateful somebody invented the thing! (Note: laughter) So, because there is no permanent spinal or neurological damage resulting in permant loss of functionality, the emphasis of the exercises in the next phase of your rehabilitation will be on rebuilding strength, stamina and control. Your spine is fully intact, there is no neurological disconnect and therefore the entire exercise program does not require an in-patient stay at a rehab center. But, that next phase won’t start until you’ve been released from Memorial, which means we have to think about a location for you to stay that can accomodate what is needed for your therapy sessions.

S:
What does that mean? Can’t I just go home?

Jamison:
That needs to be considered carefully, Dave. What Dr Aaronson and I have just tried to explain to you is that your physical functionality is not up to the point where we think that it would be a responsible thing for Memorial to do to have you return to your home. We understand that you live by yourself in an apartment on the second floor, correct? No elevator? A modest apartment?

S:
Yeah, so? There’s only stairs leading up to the apartment. The apartment itself is single level….. But wait a minute. You just said that I’ll be starting with the walker this week. Surely I’ll be able to get up the stairs by the time I go home, right? I mean, you just said that I don’t have any spinal damage and I just need to get my muscles active again…….

Aaronson:
Dave, remember you told me you’ve been injured before?

S:
Yeah, several times.

Aaronson:
Can you recall for me the types of injuries you had in the past and how long you were in hospital and also how long you had PT, if any?

(note: patient is silent for a longer time)

Aaronson:
Come on, Dave, I need you to go back and try to remember. Tell us.

S:
Well, one time I was shot in the back – actually closer to my shoulder and got a nick on my head.

Aaronson:
How long were you out of commission?

S:
I don’t know – a couple of weeks. Back on desk duty first, because it was my shooting arm.

Aaronson:
How long were you in hospital for that?

S:
About a week. Had a mild concussion from the bump on my head.

Aaronson:
Any other injuries?

S:
Got shot in my calve. Was in hospital overnight, stayed home for a couple of days. Again, desk duty until I was mobile again.

Aaronson:
Did you receive PT after those incidents?

S:
Yeah, for the shoulder I did.

Aaronson:
Do you remember how long?

(note: patient is silent for a longer spell)

S:
About a month.

Aaronson:
Do you understand what I’m trying to say, Dave? A bullet to the shoulder or calve does not compare to what your body has had to withstand this time. You have never been bedridden before, let alone for this amount of time. You wanted us to be honest with you, so I will. This rehabilitation is going to be long, hard, painful and frustrating at times – and probably never easy. You’ve never experienced what it’s like to do without one third of a lung before. That will have its influence on your regimen, too. When your physical wounds have healed enough for you to start the next rehab phase, you simply will not be able to function well enough yet to be returning to your appartement by yourself. You will not have enough control over your body yet to be able to take care of yourself, period. But you’re also not so impaired that you meet the requirements to be an in-patient in a care or rehabilitation facility. That’s what makes your situation special, though not unique.

Jamison:
Usually, with patients in similar situations, they either spend their convalescence on the first floor of their homes, when they own family homes. They temporarily clear out dens or any other spare rooms to make room for special equipment such as adjustable beds, wheelchairs, crutches – walkers…… so that the recuparating patient can get around easily or be taken care of easily. They have their spouses or families in the same home to help out. Memorial has a responsibility to ensure that patients we release either are transferred to another care facility, or move to a situation that is safe for them and will accomodate their needs of the moment. So, in your specific case, I would prefer to have you move to a downstairs apartment or an apartment with an elevator. I realize that will be hard to acquire on such relative short notice. In any case, I would not release you, not even to a downstairs apartment, unless you had somebody in the home with you, 24/7, to help you. Because you will not be able yet, to do everything yourself.

S:
So…… what? I got to move? How long you think before I can be released from hospital?

Jamison:
That’s hard to predict, Dave. It all depends on whether your progress will continue. But you need not worry about your housing situation. There is a Law Enforcement Officers Assistance Fund that you can apply to which can accomodate you with temporary housing, best suited to your situation of the moment.

S:
Oh, geez, I don’t want that – I don’t need that. Doc, what if I just work hard, can’t I just go to my own home?

Jamison:
Dave……

S:
What if I got someone to move in with me, to help me out in the beginning? Could you live with that?

Jamison:
Dave ….. Dr Aaronson ….. Could you weigh in, please?

Aaronson:
I don’t know, Dave….. I just don’t know if that’s a wise thing to do. You’re still a ways off from being able to care for yourself and I have no intention of increasing the level of your therapy to accomodate your wishes. This is serious, Dave. I can tell you feel a lot better than even last week. But I will not cut corners in your program now to accomodate you, because if I do, chances are you may have to pay a very high, and permanent, price for that. Do you understand what I’m saying here?

S:
Yeah – alright.

Aaronson:
We’re already getting ahead of ourselves. Let’s just take a few steps back. First we have to get you well enough to even begin thinking about the next phase. Dr Jamison, why don’t we check with the BCPRC program to see what the minimum requirements are according to their criteria for a patient to start the next phase? Then you and I, Dave, will focus on that in your therapy. I want to visit your apartment to see the lay-out. And I want you to tell us, now if possible, who you have in mind for helping you out around the house, should – and I emphasize the word SHOULD – we agree to let you spend the next phase of your rehabilitation at your own apartment rather than temporary housing provided by the LEOAF. How’s that for a plan?

(note: patient unresponsive)

Jamison:
Dave?

S:
What exactly would somebody …… what exactly do you mean with helping me out around the house? You mean cleaning? Cooking?

Aaronson:
It all depends on those minimum criteria from the BCPRC. Personally I think you should think of that in the best case scenario. In the worst, or most realistic, case scenario I’d say you have to think of – you still want me to be honest?

(note: patient nods affirmation)

Aaronson:
Personally I think of the help the nursing staff provides you now as far as your personal hygiene and grooming is concerned.

Jamison:
Well, we’ve given you enough to contemplate, Dave. Is there anything on your mind right now? Any questions?

S:
No, not right now. I guess I got some thinking to do.

Jamison:
That’s right. I suggest you mull it over. Consider what you think will suit you best: your own apartment, provided Dr Aaronson concludes it will accomodate your needs, or temporary housing by LEOAF. In both situations you will need somebody there with you, to help you, so think hard on who you think would be able to stand by you during the next phase. Okay? Let the nursing staff know if and when you’ve made your decision, or to notify us should you want to ask more questions and such. Is that okay?

S:
Yes, Doc, I will. Thanks.

Jamison:
Good. Have a good day, Dave.