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MULTIDISCIPLINARY MEDICAL TEAM MEETING RE: DET. DAVID MICHAEL STARSKY, July 9, 1979

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THE POST GUNTHER SESSIONS

 

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

Jacqueline©2020-09-27

 

July 9, 1979 – 5:10 PM, Memorial

 

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 05:25 PM:    PT, P(a)MP/ROM continued, patient spent majority of day in seated position. Breakfast: toast+cheese and jelly; lunch: mixed salad with boiled egg, 1 banana; dinner: baked potato/boiled chicken/ steamed vegetables (carrots/green beans) (optional Prochlorperazine)  
June 27, 1979 06:30 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (1 min each time – 5 min intervals), strengthening exercises extremities cont’d. Patient spent majority of day in seated position
June 28, 1979 04:15 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (1 min each time – 5 min intervals), strengthening exercises extremities cont’d; pulmonary check-up: positive. Patient spent majority of day in seated position
June 28, 1979 04:15 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (1 min each time – 5 min intervals), strengthening exercises extremities cont’d; pulmonary check-up: positive. Patient spent majority of day in seated position
June 29, 1979 05:05 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (1 min each time – 5 min intervals), strengthening exercises extremities cont’d. Patient spent majority of day in seated position
June 30, 1979 05:15 PM:    Weekend schedule; PT, P(a)MP/ROM & muscle stretching, massage, dexterity exercises: moderately successful
July 01, 1979 05:25 PM:    Weekend schedule; PT, P(a)MP/ROM & muscle stretching, dexterity exercises: same as 06/30
July 02, 1979 04:45 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (2 min each time – 5 min intervals), mobility exercises (Zimmer frame; ass. w wheelchair; Aaronson/Frantz/Kramer): 30 yards; readouts elevated; returned to normal after 7 min. 09 sec; tremor right sd; muscle weakness more pronounced right side
July 03, 1979 05:05 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (2 min each time – 5 min intervals), mobility exercises (Zimmer frame; ass. w wheelchair; Aaronson/Whittaker/Kramer): 30 yards; readouts elevated; returned to normal after 6 min. 49 sec; as of today extra attention right side
July 04, 1979 04:05 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (3 min each time – 5 min intervals), mobility exercises (Zimmer frame; ass. w wheelchair; Aaronson/Whittaker/Frantz): 30 yards; readouts elevated; returned to normal after 6 min. 15 sec; as of today extra attention right side; lung capacity exercise level 1: passed
July 05, 1979 05:05 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (3 min each time – 5 min intervals), mobility exercises (Zimmer frame; ass. w wheelchair; Aaronson/Colley/Sarge): 30 yards; readouts elevated; returned to normal after 5 min. 25 sec; brain scan
July 06, 1979 05:15 PM:    PT, P(a)MP/ROM & muscle stretching/ standing up (4 min each time – 5 min intervals), mobility exercises (Zimmer frame; ass. w wheelchair; Aaronson/Colley/Sarge): 30 yards; readouts elevated; returned to normal after 4 min. 15 sec; dexterity exercises, lung capacity exercise level 2: passed
July 07, 1979 04:25 PM:    Weekend schedule; PT, P(a)MP/ROM & muscle stretching/ standing up (4 min each time – 5 min intervals), endurance exercises (stationary bike; Colley/Frantz): readouts elevated; returned to normal after 5 min. 25 sec; dexterity exercises
July 08, 1979 04:35 PM:    Weekend schedule; PT, P(a)MP/ROM & muscle stretching/ standing up (4 min each time – 5 min intervals), endurance exercises (stationary bike; Whittaker/Frantz): readouts elevated; returned to normal after 5 min. 05 sec; dexterity exercises

   

Status updates:
Cavanaugh (pulmonologist):
Patient’s progress is quite astounding. Lungs continue to improve both in capacity and output; saturation too. Lung capacity training already shows better results than we had estimated. Detective Starsky seems to be mocking all existing schedules.

Johanson (psychologist):
I’m usually the one who tempers all optimism in our team; a real Debbie Downer (note: laughter) but I must say that patient’s spirits are definitely up which has an obvious positive effect on the state of his physical wellbeing as well. He is one of the strongest examples of mind over matter that I have encountered in my entire career. Fascinating. But I need to stay true to myself and repeat for the record that although we may be tempted to surf with Detective Starsky on this wave of optimism, we really should protect him from his over enthusiasm. We don’t want this surge of improvement to blow up in his and our faces. So, please, for his sake, stick to the schedule as we have set up.

Aaronson (physical therapist):
I agree with Dr Johanson. On a personal level, I’m baffled by Detective Starsky’s resilience and adaptability. But like our collegue of the BCPRC told us in his assessment: Detective Starsky is an emotional and intuitive man and by now I’ve found that he is also extremely loyal to those near and dear to him, be it on a personal or professional level. So, he’s not just fighting for himself, for the quality of his life for his own sake, but also for the sake of those around him, to not burden them. I am very impressed with the overall improvement he’s made over the past week or so, but I do still see some aspects of his ability that lag behind, for no detectible physical reason, such as his equilibrium problems. That’s still a mystery to me. But overall, he is heading for the exit of Memorial. The man has set himself a goal, and I think he will succeed in obtaining it sooner rather than later.

Foretti (neurologist):
I agree with Dr Aaronson that patient’s progress continues to lag behind in certain areas. His fine motor skills (hand-eye coordination) and equilibrium are still not improving as much as the rest of his abilities. We really cannot explain why this is because there is no neurological defect. We will continue monitoring this, also during his out-patient status.

Jamison (head of trauma 1, critical care, physiatrist):
Thank you all for your reports. I, too, have noticed that if it were up to Detective Starsky, he would have left us last week so that he could celebrate the fourth at home! (note: laughter) I believe that if his progress continues at the same level as this past week, Detective Starsky will be dismissed from Memorial next week, if his apartment has been adjusted and if his assigned caregivers are ready for their task …. We’d better pencil in a meeting with them, Joan, Nurse Calahan, would you see to that? Thank you. Have you all filled out your therapy schedules for his home therapy? Dr Aaronson will add Detective Starsky to his home-therapy schedule – his list of outpatients …. How many now, Moses?

Aaronson (physical therapist):
With Detective Starsky added, four, Dr Jamison.

Jamison (head of trauma 1, critical care, physiatrist):
Four? Let me see, Mrs. Gullickson, Miss Penza, Mr. Cole, Mr. uhm, Richards …. That would make Detective Starsky five…..

Aaronson (physical therapist):
No, sir, Miss Penza’s outpatient status 2 now; she’ll be coming in for her sessions herself as of next week.

Jamison (head of trauma 1, critical care, physiatrist):
Aha, well, I think Detective Starsky lucked out. I’ve read Dr Johanson’s recommendation that you’d continue his therapy with him for the great rapport you have established with him. I was already considering putting Dr Edwards on one of your four patients, but now that Miss Penza is downgraded, everything just falls into place. If that’s not an omen, I don’t know what is. On that note, if nobody has something to share anymore, we’ll close this meeting. Thank you all.

Conclusion:
Jamison (head of trauma 1, critical care, physiatrist):
Full team on case Detective Starsky will continue as is to work towards his release from Memorial to home situation for next phase of rehabilitation as an in home-care patient, in the week starting July 16.