Thursday, March 31, 2011

patient #0017983

Facility archive records search – searching…
Complete – found 19 results for search terms “patient #0017983″
Chronological listings follow:
1. ) admission form, patient #0017983 – 11/18/05 15:12
Involuntary admission requested by patient’s relatives in response to apparent self-destructive conduct cycle. Self-damage apparent in physical exam: signs of past abrasions on head and neck, apparently because of self-inflicted scratching, and both fresh and partially-closed surface lacerations on arms and legs. Signs of ultimate fatigue as well apparent – in examination patient admitted insomnia for, as quoted, “longer than you’d believe. ” patient unable to give exact time for length of insomnia, likely because of extended amount of time of insomnia itself. Confusion and moderate delerium apparent. Preliminary medication issued: triazolam 0. 25mg for insomnia, topical bacitracin for wound care.

2. ) admission evaluation, patient #0017983 – 11/18/05 16:56
Performed by: dr. Emil lafayette. Self-damage confirmed. Patient got rid of dressings from arm lacerations, reopened wound while waiting for interviewer. Definite evidence of somniphobia in patient justifications for damage; patient refers to sleep with anxiety, and consistently acts versus self to cause pain in response to lengthy periods of silence or other lack of stimuli. Issue of insomnia needs immediate attention, given evidence of extremely prolonged duration. Similarly possible agoraphobia. Patient requests an aside bed, becomes withdrawn/agitated when request is refused, refuses to cooperate farther with consultation. Offers vague suggestion of hostile “other” in justification, but will not detailed, as quoted, “because you’re not going to believe she exists until she hurts somebody anyway. ” evidence for likely paranoid schizophrenia. Recommend farther consultation with full psychological spectrum testing for exact diagnosis. Final recommendation: admit patient. Preliminary medication issued: cancel triazolam, rather 5mg diazepam twice each day for insomnia, anxiety, and probable sleep disorders.

3. ) final admission report, patient #0017983 – 11/18/05 17:13
Patient issued bed in room 409. Current occupant(s): patient #0017802, patient #0017983. Clothes from admission remanded to family of patient, three sets of common dress issued for immediate needs. Farther psych eval scheduled for 10:00 11/19/05, determining future length of remain.

4. ) ward event report – 11/18/05 17:30
During mundane new patient room check, patient #0017802 places request with staff for transfer to, as quoted, “some other room. ” appears agitated, claims patient #0017983 has been disturbing him. Patient #0017983 similarly requests transfer, to aside bed. Both requests refused. Orderly note: followup room check suggested to avoid possible intrapatient conflict.

5. ) ward event report – 11/18/05 19:00
Followup room check. Patient #0017983 claims dr. Lafayette has ordered him moved to isolation. Patient #0017802 backs claim. Administration records demonstrate no such order. Upon informing room occupants, patient #0017983 attempts to assault staff and patient #0017802 becomes uncontrolled agitated. Additional personnel expected to comprise incident. Both people who are in need of medical care restrained, sedated, forced into early lights out. Orderly note: exercise caution in all future room checks for 409.

6. ) ward event report – 11/18/05 23:57
Staff on hall 1, floor 4 report loud sounds from room 409 after facility lights out, disturbing other rooms and people who are in need of medical care. Patient #0017983 found awake, extremely agitated and struggling versus restraints. Demands lights be turned back on, as quoted, “before she comes. ” self-sustained injuries to wrists and ankles at points of restraint. Patient efforts to struggle versus staff during trade to more comprehensive restraint, calling for additional personnel to comprise incident. Additional sedation required for patient #0017983. Patient #0017802 doesn’t respond during course of event, likely because of sedation from earlier incident. Orderly note: maintain restraints on patient #0017983 until farther observe. Sedate patient before removing restraints for any reason. Recommend anti-psychotic be considered in future psych eval.

7. ) ward event report – 11/19/05 00:20
Staff on hall 1, floor 4 again report loud sounds from room 409. Patient #0017983 found catatonic on floor, with serious self-inflicted scratches on head and neck. Restraints are severed at connection points, with serious bruising on limbs perchance indicating more serious injury at restraint points with patient. Patient #0017802 is found deceased. Serious disfiguring wounds to face, complete with destruction (orderly note: ingestion? ) of patient’s eyes. Moved to room 101, locker 2, awaiting autopsy. Patient #0017983 transfered to isolation, room 626, given injected dose of 100mg zuclopenthixol on attending physician’s orders to manipulate acute psychosis. Orderly note: recommend video observation to grant better control of future outbursts. Remain leastwise an arm’s length away from patient upper body restraints always. Just in case.

8. ) autopsy report, patient #0017802 – 11/19/05 09:44
Performed by: dr. Julius tweed. Ragged lacerations prominent around subject’s head and neck, incrementing in severity and depth on the regions of the face itself – at assorted points, the flesh is cut to the bone. More disconcertingly, subject’s eyes seem to be violently got rid of from their sockets and are missing. Cause of death: exsanguination from wounds. Final judgement: homicide. Coroner note: recommend thoughtfulness of patient #0017983 as dangerous to staff and facility residents. Urge continued maintenance of restraints and isolation from contact with others in patient population. As well recommend digestive endoscopy to determine destiny of missing tissues for staff cohesion purposes – orderlies from floor 4 suspect cannibalism, promise to refuse isolation shifts until such faith is disproven.

9. ) medical report, patient #0017983 – 11/19/05 10:07
Performed by: dr. Antoinus cayle. Patient is cooperative, if withdrawn, during examination. No outbursts or threats. Current drug regimen appears effective. No strange tissue or objects came across in digestive endoscopy. Radiology tests discover hairline fractures in tibia, fibula of right leg. Serious abrasions apparent on skin of restraint points, as well head and neck, calling for topical treatment. Troubling instability in vitals – bp is acutely elevated, pulse rapid and weak for patient’s size. Extended stress from anxiety, elevated mood, and insomnia likely cause. Physician note: patient will have to sleep to begin recovery routine. Recommend elevated dosage of diazepam to give hope or courage to this result. Firm contact-point restraints not commended for this patient due to attempt a campaign without regard to possible loss or injury of farther injury. Full-body restraint will have to be considered as alternative.

10. ) psychiatric evaluation, patient #0017983 – 11/19/05 10:39
Performed by: dr. George tulling. Definite evidence indicating disassociation of identity from activities. Patient expresses remorse for death of patient #0017802, yet refuses to admit obligation for activities in said event. Rather externalizes blame into antagonistic female “other. ” same figure, apparently referenced in prior evaluation, seems to be central actor in patient’s paranoid psychosis. Conduct and activities of said “other” justified through magical thinking, despite recognition of depicted individual’s illogically-defined capablenesses to sustain reported antagonism. As quoted, “i don’t acknowledge, you don’t acknowledge, and she doesn’t care. ” patient requests observation of room be terminated, grows agitated when request is refused, makes threats, refuses to proceed consultation. Diagnosis: paranoid schizophrenia manifesting in somniphobia, violent psychosis, and disassociative episodes. Medication issued: up dosage for diazepam to 10mg twice each day, on 11/24/05 start out issuing 2. 5mg doses of haloperidol twice each day for psychosis. Interviewer note: apply patient observation protocols and ward rounds to check for possible drug fundamental interaction effects, followup without delay if found or on 11/30/05 otherwise.

11. ) ward event report – 11/19/05 14:32
During general rounds patient #0017983 requests that observation of room be terminated. Warns staff of sensed threat inherently in observation protocol. When request is refused, begins struggling versus restraints and screaming warnings to staff, observation camera operator with regards to disassociative, antagonistic “other. ” acting physician note: reject recommendations from orderlies to sedate patient #0017983 unless medically or procedurally sound. Sedatives are not a safety blanket. Orderly note: they say this guy is at his sedative limit, and he was closely pulling his bed off its bolts. Use double staff if at all possible when transaction with him. Whatever’s in his head… it’s strong.

12. ) staff communications – 11/19/05 16:53
From: charles mckinney – head of patient care department
To: patient care staff list
Subject: re:fwd:patient #0017983
This has officially gone far sufficient. I didn’t intervene in this matter before, because i was underneath the impression that the men and women underneath my supervision were beyond such things as this, but circumstances have proven me to be mistaken and i will not grant these rumors to progression any farther. The only thing “wrong” with patient #0017983 is that he is badly ill and contingent upon us for care and assistance in his recovery. He is not the firstborn patient with explosive episodes we have treated, he is not even the only one presently in our facility, and he will not be the last. It thence pains me to discover that one singular breach of safety, which was in the proper manner addressed by facility protocol, has left my staff whispering superstitions to one another and accepting the delusions of our patient as truth. We are better than this. There are in truth risks inherently in this profession, risks we all knew with regards to upon assuming it, but that is the burden we bear to render aid to those who find themselves in our beds.
Until otherwise noted i will not approve of any shift changes from scheduled isolation hours. Our staff counselors are always available during general hours for those who must consult with somebody in light of the recent event and related workplace anxiety. It is a fringe gain of working in mental health, and i suggest anyone having troubles apply of it. This matter is closed, and i want to listen no farther mention of it. As previously stated, i expected more from all of you.
– charles

13. ) ward event report – 11/19/05 20:44
During general rounds patient #0017983 requests that lights be left on after scheduled lights out time. After consultation with attending physician and therapist, request granted. Room check proceeds uneventfully until staff move to depart, at which point request is made for observation to be terminated. Upon denial of request, patient rather requests for lights to be doused as general. Request granted. Another request is made, now for red-bulb sleep lights to be doused during scheduled lights out time. Patient grasps that low-level light is necessary for room observation – as quoted, “that’s why i want them off. ” warns observation camera operator versus her. Attending therapist denies request. Sorry jacob…

14. ) staff communications – 11/19/05 21:12
From: dr. Emil lafayette
To: patient care staff list
Subject: lights in 626
I happened to observe tonight while in final checks that the sleep lights in isolation 626 were turned off after general rounds – without my noesis, or assent. As i am certain you’re all conscious, this is a serious breach of facility protocol. When video observation of a patient is commended and approved, there’s one of the reasons for such a decision to be made. Patient #0017983 has violent episodes and will have to be monitored to denigrate the risk of him causing farther damage to his already precarious physical state. You have absolutely no authority to override conclusions made by the medical personnel of this, or any other, facility. None.
I have been hearing talk around the halls that numerous of you’re affrighted of this man. He is bound to a bed, underneath the most eminent sedation we can medically provide, and both physically and mentally suffering from acute fatigue. Do you as well jump at shadows? No matter of the reason, i will not permit without training orderlies to begin intervening in the care provided to our people who are in need of medical care. If such an event occurs again, i will inform mr. Mckinney and see the entire night’s orderly staff barred from the premises. Do i make myself clear?
– dr. Emil lafayette md, facep, mhsc

15. ) ward event report – 11/19/05 23:27
[patient #0017983, name redacted] won’t stop screaming. It just won’t stop. Hours of it. It echoes in my ears, in my skull. Whenever he’s coherent he begs us to turn the camera off, or the lights off, or just make everything go away. I’m sorely tempted, poor [software censored], but doc lafayette pulled jacob from observation and is looking at everybody from the video room for the rest of his shift thanks to michael’s business with the lights earlier. Last i saw of him, he was headed for the elevator with his jacket saying he “just can’t do this to my kids. ” i don’t acknowledge why i’m here anymore. I just keep staring up at the cameras. Is that [software censored] busier looking at his patient, or us?
I’d only need one needle to come to a halt the screaming…
16. ) ward event report – 11/20/05 00:01
It stopped. Just… stopped. No one’s willing to check why. I think [patient #0017983, name redacted] is gone. I pray she is gone.

17. ) staff communications – 11/20/05 00:04
From: dr. Emil lafayette
To: all
Subject: patient #0017983 again
I said no one is to enter isolation 626 without my express permission, god [software censored] you all! I will have all your jobs forohgod
I will be good mommy
Please not the belt please
He is dead i am dead she is dead we are dead and
We. All. Fall. Down.

18. ) admission evaluation, patient #0017986 – 11/20/05 9:25
Performed by: dr. George tulling. Previous staff. Patient came across in locked observation room setting fire to instrumentation and recordings. Attempted suicide in flames before rescue by staff. Claims to be antagonized by same female “other” as previous patient #0017983. Perchance involved in death of said resident. If so, evidence apparent for disassociation of self from activities. Likely paranoid schizophrenia. Patient will not respond to farther questions – as quoted, “don’t go on the lookout for her. She’ll find you. ” final recommendation: admit patient. Preliminary medication issued: 2. 5mg doses of haloperidol twice each day for schizophrenic psychosis.

19. ) staff communications – 11/20/05 9:36
From: dr. George tulling
To: charles mckinney – head of patient care department
Subject: i’ve just heard.
Seal him in isolation, wait her out, cremate both bodies. As far as the relatives are concerned, patient #0017983 passed away in the fire set by lafayette in consecrating suicide. That’s all anyone needs to acknowledge.
Let’s just hope the rest of us don’t wind up calling for time in these beds as well.