Friday, January 20, 2012

Chart Excerpts

This is a cautionary post from the memoir. It took a decade and a half before I was able to start writing about what happened to my daughter, about being able to look over my old neighborhood from the hospital window, my daughter struggling for life behind me in the room. It all started with Jennifer suddenly developing cognitive problems; a trip to the emergency room (cursory at best, no blood tests, no spinal tap) lead to her admittance to the Behavioral Unit/Chemical Dependency Unit. No visitors allowed. Lots of chart notes about assessing for encephalitis but it was Thanksgiving morning before there was a call asking for permission to do a spinal tap. It was finally done Sunday, three days later. Lessons to be learned: you are your loved one's best advocate; step on toes, demand things get done. Surprising how much power you have.

From the hospital chart:

1.   BEHAVIORAL UNIT Psycho Social Assessment dated 11/24/93; Jennifer Cothern, 21 years old; admitted; brief reactive psychosis; very anxious; weeks before; 101 fever, complained of very bad headaches, being dizzy.

2.   NURSING SERVICE CALL SHEET dated 11/24/93:
      11:00: Dr. Campo requested neurological consult for encephalitis.
      11:30: Dr. Robertson and nurse notified of consult needed for encephalitis.
      19:35: Dr. Campo told of Dr. Rogers' assessment and recommendations.   

3.   DOCTOR'S ORDER SHEET dated 11/24/93: Patient to be assessed for encephalitis; Dr. Robertson to be notified.

4.  BEHAVIORAL UNIT/CHEMICAL DEPENDENCY UNIT Multidisciplinary Progress Note dated 11/23/93:
      04:00: "thinks she's going crazy."
      07:30: fearful, disoriented, frightened, and disoriented.
      08:20: hallucinations; administered Ativan, Haldol.
      08:45: restraints; intense startle reflex to noise or quick movements.
      09:00: wrist restraints continued; thinks worms are crawling across face.
     23:00: disoriented and saying, "we're had this conversation before" regarding most conversations she has.

5.   BHU/CDU/MPN dated 11/24/93:
       01:00: very delusional and paranoid.
       10:00: hallucinations, violent tendencies.
       11:55: family therapy scheduled for Friday.
       15:10: hallucinating. Valium for sedation.
      19:35: Dr. Rogers recommended Lumbar Puncture under Fluoroscopy and EEG; Dr. Campo called and told Dr. Rogers' recommendations, ordered EEG in a.m.
       21:45: increasingly agitated; coming to nurses' station more frequently, complaining that she is in a dream, rambling, speaking mostly of fear, death; says someone is "tapping into my brain trying to release the children, release the children, release the children . . ."

6.   BHU/CDU/MPN dated 11/25/93:
      07:00: documentation of fever and need for spinal tap. Dr. Campo in phone contact with parent, consent obtained for spinal tap.
    11:45: Dr. Carolyn Baker recommended CT of the brain and EEG; Jennifer lying in bed mumbling incoherently.
       19:55: Jennifer confused, disoriented, and paranoid, showing fear and confusion. 

7.   BHU.CDU/MPN dated 11/26/93:
        08:30: Jennifer paranoid, confused, and disoriented; began "word salad."
        13:00: rambling speech, delusional content, confused, disoriented.
        14:30: delusional thought process and paranoia.
        16:25: Jennifer pulling out her hair.

8.   BHU/CDU/MPN dated 11/27/93:
        08:00: has not improved, possible encephalitis.
        11:05: paranoid delusions, hallucinations.
        21:00: can't process answers, aggressive behavior.
        23:00: mumbling in her sleep.
        (no time noted): has not improved, possible encephalitis.

9.   BHU/CDU/MPN dated 11/28/93:
        08:30: lethargic, hard to arouse, speech rambling and incoherent, confused and disoriented.
        13:35: lumbar puncture done.
        14:10: yelling, screaming, anxious, confused, disoriented, clenching bed rails.
        16:30: BP 126/80, HR/82, R/20, T/97 degrees.
        16:45: Dr. Proctor notified of CSF results; new orders noted.
        16:55: Dr. Campo notified of CSF results and to call Dr. Proctor.
        23:00: screaming and putting feet through bed rails. 

10.  BHU/CDU/MPN dated 11/29/93:
         05:00: Zovirax administered.

11.  EEG of 11/29/93: adnormal EEG compatible with a herpes encephalitis.

12..  DISCHARGE SUMMARY dated 11/29/93:
         11:03: transfer to the Medical Floor for further medical attention and treatment.

Shortly after being transferred, Jennifer went into a coma for two months. The battle to save her life really began.

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