CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 21 0000. ref SDS 20 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 091103 Paula reported the VA has scheduled a meeting today with
040902 - Doctor Stewart for planning Heller Myotomy surgery to correct
040903 - achalasia problem. ref SDS 12 PS60 On 091104 0718 Medical Chart
040904 - discharge guidance lists meeting with Doctor Stewart 091117 1300,
040905 - which conflicts with patient history today. ref SDS 13 Q03J On 091119
040906 - 1000 Erick confirmed visit with Doctor Stewart on 091208, and is
040907 - reviewing date of surgery scheduled for 091217. ref SDS 15 935H
040909 - ..
040910 - On 091208 Doctor Stewart advanced the schedule for surgery one day to
040911 - 091216. ref SDS 17 6E41
040913 - ..
040914 - On 091216 0600 meeting Doctor Stewart for Heller Myotomy surgery to
040915 - correct achalasia; check in at ASU. ref SDS 20 PP8W
040917 - ..
040918 - On 091217 0600 meeting with Joe and Jon on recovring from Heller
040919 - Myotomy surgery; report of complication during surgery on 091216,
040920 - which was repaired, with plan for test to evaluate recovery. reported
040921 - on 091217 0600, ref SDS 21 0042 Doctor Stewart visited and expects
040922 - can start eating after favorable test. ref SDS 21 027A
040924 - ..
040925 - On 091218 0600 xray with gastrogafin to evaluate repair for
040926 - complicaiton during Heller Myotomoy surgery Wednesday, ref SDS 0 PP8W,
040927 -
040928 -
040930 - ..
0410 -
0411 -
0412 - Progess
0413 -
041301 - Have been taking medication every hour to relieve pain from surgery on
041302 - 091216, reported yesterday on 091217 0600. ref SDS 21 PP8W
041304 - ..
041305 - Rose visits to take vitals and blood sugar this morning at 0530.
041307 - ..
041308 - Rose reports vitals are good, including low blood sugar, below 100.
041310 - ..
041311 - Still have considerable pain getting up and laying down in bed and
041312 - when sitting down and getting up from a chair, because this requires
041313 - bending the stomach.
041314 -
041315 - [On 091220 0500 medical chart lists Vicadin medication for pain
041316 - relief from surgery. ref SDS 23 415P
041317 -
041318 -
041319 -
041321 - ..
0414 -
0415 -
0416 - 0600
0417 -
041701 - Joe the neighbor visited by a doctor, and complains of nausea.
041702 -
041703 - The doctor orders treatment.
041704 -
041706 - ..
0418 -
0419 -
0420 - 0630
0421 -
042101 - Saw Joe and Jon, the doctors, in the hallway making their rounds.
042102 -
042103 - Joe said they would visit later for progress review.
042104 -
042106 - ..
0422 -
0423 -
0424 - 0713
0425 -
042501 - Saw Neil and Paula in the hallway making their rounds for the CT
042502 - Surgery Team.
042504 - ..
042505 - Neil was aware they missed the meeting yesterday.
042507 - ..
042508 - He plans to visit later today.
042509 -
042510 -
042512 - ..
0426 -
0427 -
0428 - 0800
0429 -
042901 - Shift change. Elizabeth is the new nurse, assisted by Danny.
042902 -
042903 -
042905 - ..
0430 -
0431 -
0432 - 0820
0433 -
043301 - Joe the neighbor is very upset swearing at the nurse because he asked
043302 - for relief from nausea 2 hours ago. He understood the doctor
043303 - prescribed medication.
043305 - ..
043306 - Several more nurses come into the room to assist Joe.
043308 - ..
043309 - Joe continues to complain in frank and explicit terms.
043311 - ..
043312 - The nurses explain that for some reason an order was not entered in
043313 - the computer for Joe to get medication for nausea. Joe is very
043314 - frustrated, saying he has been treated for 26 years by the VA and he
043315 - has never experienced this delay getting medication to relieve trauma.
043317 - ..
043318 - One of the nurses develops a good rapport with Joe; he seems to be
043319 - handling the situation more calmly. They seem to have a long standing
043320 - relationship, which helps resolve emotionally charged situations.
043321 - This nurse was very skilled deflecting invective, and focusing on
043322 - solving the problem as quickly as possible.
043324 - ..
043325 - One of the nurses leaves and evidently places a call, and gets
043326 - permission to give the Joe the medication to relieve symptoms.
043328 - ..
043329 - This was a fairly major incident with 4 or 5 nurses in the room, and
043330 - others observing and standing by outside the door to lend further
043331 - assistance if needed.
043332 -
043333 -
043335 - ..
0434 -
0435 -
0436 - 0939
0437 -
043701 - Danny says Doctor Stewart has ordered medication for upset stomach
043702 - from not eating the past few days.
043704 - ..
043705 - Connects IV on the inner right wrist. There is a lot of pain.
043706 - Recalled this occurred previously when potassium was given as drip
043707 - treatment on 091030. ref SDS 10 05CA
043709 - ..
043710 - Danny said this first treatment has potassium. He stops that and
043711 - starts the antibiotic.
043713 - ..
043714 - Danny is checking to see when the CT test will be done to evaluate the
043715 - repair to the Heller Myotomy surgery complication this past Wednesday.
043716 -
043717 -
043719 - ..
0438 -
0439 -
0440 - 0916
0441 -
044101 - Ellena here for EKG test. She feels results look normal.
044102 -
044103 -
044105 - ..
0442 -
0443 -
0444 - 1035
0445 -
044501 - Saw Joe in the hallway again. He said the CT swallow study with
044502 - gastrogafin will be at 1300.
044503 -
044504 -
044506 - ..
0446 -
0447 -
0448 - 1120
0449 -
044901 - Joe the neighbor is taken for surgery to remove toes on left foot
044902 - which has suffered from diabetes.
044903 -
044904 - [...below Joe returns from surgery in good spirits. ref SDS 0
044905 - JQ9F
044907 - ..
044908 - [...below, Joe moved to another ward. ref SDS 0 JQ4F
044909 -
044910 -
044911 -
044913 - ..
0450 -
0451 -
0452 - 1123
0453 -
045301 - Millie arrives for visit. It's great seeing her.
045302 -
045303 - She looks terrific as always, but is tired from the drive, because she
045304 - had chemotherapy 2 days ago on Wednesday. This means fatigue and
045305 - discomfort are rising quickly now.
045307 - ..
045308 - On hearing I will be having a CT test with gastrofrafin, Millie smiles
045309 - that I will share this experience with her, which she has had 20 times
045310 - or so the past 8 years.
045311 -
045313 - ..
0454 -
0455 -
0456 - 1315
0457 -
045701 - Rosie arrives with a wheelchair. She helped previously following
045702 - heart surgery on 091022, and is seen often on the ward taking
045703 - patients for tests.
045704 -
045713 - ..
045714 - Millie goes to cafeteria for lunch.
045716 - ..
045717 - Taken to Radiology for study to evaluate resolution of complications
045718 - from Heller Myotomy surgery on 091216.
045720 - ..
045721 - Waiting in holding area for xray test. The room was full, with 5
045722 - other patients, though not all for xray testing.
045724 - ..
045725 - Was placed next to an elderly man on a gurney, who was constantly
045726 - moaning and requesting relief from pain. This patient is from the TCU
045727 - ward, a few rooms down the hall. Another patient asked the attendant
045728 - about helping the patient, because the moaning was disturbing. The
045729 - attendant eventually went to the elderly patient and asked for the
045730 - scale of pain from 1 - 10. The patient said 10, but was unable to
045731 - explain where pain occurred or the cause. This was a very difficult
045732 - situation that shows frustrations of health care,
045733 -
045734 - [...below this patient was moved into the adjacent bed in TCU, and
045735 - continued to make disoriented pleas for help. ref SDS 0 ZQ67
045736 -
045737 -
045738 -
045740 - ..
0458 -
0459 -
0460 - 1336
0461 -
046101 - CT swallow study with gastrogafin.
046102 -
046103 - The technician assisting the doctor doing the test was familiar from
046104 - prior work with radiology during the many tests for heart surgery
046105 - beginning on 091019.
046107 - ..
046108 - The radiologist warned that gastrogafin tastes terrible, but is
046109 - necessary for the test. The doctor said he has personally tasted all
046110 - medium used with radiology tests, and so speaks from experience.
046112 - ..
046113 - Good news - this test only requires drinking a few sips, unlike
046114 - Millie's CT tests that require drinking what seems like a quart, shown
046115 - by the record on 080718 1030. ref SDS 7 2U6L
046117 - ..
046118 - Stand on a pedistal and drink sips of Gastrografin.
046120 - ..
046121 - Can see the monitor during the test. Like the angiogram test on
046122 - 091021 0716. ref SDS 9 7L43, that supported successful heart surgery
046123 - the next day on 091022, seeing realtime test images today is a big
046124 - help understanding results of Heller Myotomy surgery on 091216,
046125 - ref SDS 20 KE9U, and planned to relieve achalasia, explained during
046126 - the meeting with Doctor Stewart on 091030 ref SDS 10 KE3B
046128 - ..
046129 - The video stream of images show gastrografin contrast medium flowing
046130 - from the throat through the lower esophageal sphincter valve into the
046131 - stomach. Looked like the same swelled "bird beak" esophagus was still
046132 - restricted at the bottom connecting to the stomach, reported for the
046133 - barium meal test performed on 050714. ref SDS 3 WE4H This is
046134 - worrisome, since the objective is to elimiate this narrowing, so that
046135 - food and liquid can fall freely into the stomach, explained by Doctor
046136 - Stewart on 091030 0810. ref SDS 10 GM5I
046138 - ..
046139 - Radiology Report dated 091218 1334 is shown in VA Progress Notes
046140 - saying...
046141 -
046142 - FINDINGS:
046143 -
046144 - Scout view of the abdomen demonstrates median sternotomy
046145 - wires and surgical clips in the region of the stomach.
046147 - ..
046148 - Beak-like configuration of the distal esophagus with
046149 - persistent narrowing of the gastroesophageal junction may
046150 - be due to postoperative edema. Dilatation of the more
046151 - proximal esophagus is compatible with history of achalasia.
046152 - ref DRP 6 3G6M
046154 - ..
046155 - [On 100928 0706 report of this 2nd barium swallow test
046156 - performed on 091218 (today), 2 days after Heller Myotomy
046157 - surgery at VA in San Francisco on 091216, again reported
046158 - "bird beak" appearance, dilated and persistent narrowing of
046159 - esophagus common to achalasia. ref SDS 36 R43F
046161 - ..
046162 - [On 121113 1100 looks similar to prior test on 091218, 2
046163 - days after Heller Myotomy surgery, showing large bulge -
046164 - "bird beak" - distortion of esophagus. ref SDS 37 4X5H
046166 - ..
046167 - [On 130117 0900 and 7 days after EGD dilatation procedure,
046168 - barium swallow CT test shows significant improvement
046169 - compared to original condition on 050714, ref SDS 3 B94J -
046170 - follow up testing after surgery on 091218, and the test
046171 - last month on 121113, in that testing today shows there is
046172 - no big bulge and no long string-like structure preventing
046173 - content from flowing into the stomach. ref SDS 38 OH6G
046175 - ..
046176 - The radiologist explains that surgery removing half of the esophageal
046177 - sphincter valve causes initial swelling which creates some
046178 - restriction. The doctor feels surgery edema will heal over the next
046179 - few days and weeks. As swelling subsides, this will increase the
046180 - opening into the stomach.
046182 - ..
046183 - The doctor and the technician conferring during and after the test
046184 - both note no evidence of contrast medium leaking from the esophagus.
046185 - This is the primary objective of the test, and indicates effective
046186 - recovery from the minor hole that was caused and repaired during
046187 - surgery on 091216, reported by the medical team yesterday on 091217
046188 - 0600. ref SDS 21 0042
046189 -
046190 - [...below Joe confirms Radiology report for the xray test shows no
046191 - evidence of continuing tear in esophagus, so repair was effective,
046192 - indicating Heller Myotomy surger was successful. ref SDS 0 FU8V
046193 -
046195 - ..
0462 -
0463 -
0464 - 1403
0465 -
046501 - After the test, the doctor asked the technician to wheel the patient
046502 - into the Radiology Holding area to wait for someone, like Rosie, to
046503 - wheel the patient back to TCU on the 3rd floor. While the technician
046504 - was pushing the wheelchair to the Holding area, offered to push the
046505 - wheelchair back to TCU to save time. The technician decided to do
046506 - this himself, since the trip only takes about 3 minutes.
046508 - ..
046509 - Thanked the technician for taking immediate action. Exemplifies VA
046510 - spirit and dedication to patient care.
046511 -
046512 -
046514 - ..
0466 -
0467 -
0468 - 1423
0469 -
046901 - Back in the room at TCU, Joe the neighbor returns from surgery arising
046902 - from diabetes, per above. ref SDS 0 SN9I He seems in good spirits.
046903 - He now has a wheelchair to help get around.
046904 -
046905 - [...below, Joe moved to another ward. ref SDS 0 JQ4F
046906 -
046908 - ..
0470 -
0471 -
0472 - 1431
0473 -
047301 - Went for a hike, and saw Joe behind the counter of the control station
047302 - on the other side of TCU. He was talking on the telephone, and there
047303 - was someone at the counter waiting to speak with him. When Joe hung
047304 - up the phone and looked up, he smiled and advised that results are
047305 - favorable for the xray study earlier today. This aligns with
047306 - understandings from the Radiologist, per above. ref SDS 0 ES5H
047308 - ..
047309 - [...below, Doctor Stewart advises that Heller Myotomy surgery
047310 - successful; patient NPO status ends, can begin eating and
047311 - drinking, and go home tomorrow or Sunday. ref SDS 0 ER4F
047313 - ..
047314 - Before Joe could relate details on implications for starting to eat,
047315 - and getting discharged, there was an announcement of Code Blue. Joe
047316 - and other doctors had to rush to the parking lot in front of the VA to
047317 - assist someone who was suffering serious distress, like a heart attack
047318 - or stroke.
047319 -
047320 -
047322 - ..
0474 -
0475 -
0476 - 1538
0477 -
047701 - Back in the room was awakened by another visitor, following up meeting
047702 - with Molly yesterday on 091217 at 1729, ref SDS 21 PQ9R, when she
047703 - planned to arrange for transportation home after discharge from the
047704 - hospital, hopefully tomorrow.
047706 - ..
047707 - Rodney explained he and Molly are with...
047708 -
047709 - Services and Rehabilitation Department
047711 - ..
047712 - Their office is on the ground floor.
047714 - ..
047715 - Rodney said he prepared VA Forms from information on file with the
047716 - Medical Center, in order for the VA to make payments for medical
047717 - disabilities, because social security isn't enough to live on in the
047718 - Bay Area. He opened a sheaf of paper, and pointed where to sign.
047720 - ..
047721 - Rodney said payments following heart surgery will start this month,
047722 - and will take a few months to process.
047724 - ..
047725 - Thanked him for taking initiative getting money to supplement social
047726 - security.
047739 - ..
047740 - [On 100604 1520 VA letter dated 100601, approves payments
047741 - effective 091222, ref SDS 34 4M9K, and based on 100% disability
047742 - rating. ref SDS 34 6B4R
047744 - ..
047745 - [On 100611 0054 letter thanking Rodney for assistance of AMVETS
047746 - filing application for VA disability pension, and advising that
047747 - application was approved by VA. ref SDS 35 HG3V
047749 - ..
047750 - [On 200612 1139 letter from VA saying patient was awarded basic
047751 - pension, and payments for the past 10 years exceed amounts
047752 - authorized by law; VA proposes ending payments in 60 days, and
047753 - patient must make restitution of prior payments.
047754 - ref SDS 39 PP8W
047755 -
047756 -
047757 -
047759 - ..
0478 -
0479 -
0480 - 1613
0481 -
048101 - Awoke to see another visitor - Father Lawrence Gould, PhD. He is a
048102 - Catholic Chaplin for the San Francisco VA Medical Center.
048104 - ..
048105 - Today, Father Gould is making the rounds in TCU, helping patients deal
048106 - with difficult, and life-ending medical situations.
048108 - ..
048109 - We recalled meeting in the ICU on 091024, a few days after heart
048110 - surgery, and so continued considering the nexus between "religion" and
048111 - "science," explained in about 10 pages of NWO. ref OF 12 4723
048113 - ..
048114 - Today, we touched on the correlation of the phrase "The Word," with
048115 - the rise of Christianity based on faith in God, noting historical
048116 - coincidence, where emerging literacy skills enabled the Desciples to
048117 - spread the "word" with a consistent message, cited in NWO, ref OF 12
048118 - LA9O, that reflects the inherent power of knowledge evident from the
048119 - "locality principle," also, discussed in NWO. ref OF 12 I38N
048121 - ..
048122 - Scientists often criticize religion for dogmatic resistance to
048123 - evidence. Science, however, has it's own dogmatic ways of avoiding
048124 - inquiry, seen in recent revelations on "global warming" fanatacisim.
048125 - NWO reviews this issue for about 10 pages, beginning with house arrest
048126 - of Galielo, to consider why dogma arises, and how time resolves
048127 - initial resistance. ref OF 16 ZD4F
048129 - ..
048130 - The Conclusion of NWO presents again the concept of religion as the
048131 - "science of life." ref OF 18 42FF
048133 - ..
048134 - Father Gould has a broad grasp of history, and seems fluent in
048135 - numerous languages. This strong grounding enables constructive
048136 - feedback on NWO.
048137 -
048138 - [On 091223 1503 letter thanks Father Gould for discussing
048139 - religion, and submits links to NWO on correlation between religion
048140 - and science. ref SDS 24 566L
048141 -
048142 -
048143 -
048144 -
0482 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
0504 - 1647
050501 - ..
050502 - Doctor Stewart, Chief of General Surgery, visits.
050504 - ..
050505 - The doctor is pleased with results of xray gastrogafin study showing
050506 - no perforations in the esophagus, per Joe's report above, ref SDS 0
050507 - FU8V, and thereby indicating repairs were successful for the tear that
050508 - occurred during Heller Myotomy surgery on 091216, reported yesterday
050509 - on 091217 0600. ref SDS 21 0042 Test findings today indicate full
050510 - recovery from achalasia, pending since 050714, shown in case study on
050511 - this issue discussed with Doctor Lee on 090908 1130. ref SDS 8 FT6M
050513 - ..
050514 - The doctor indicated NPO status invoked on 091216, following Heller
050515 - Myotomy surgery, ref SDS 20 HQ5M, has ended. Patient can now eat and
050516 - drink normally, but will start with softer food. She recommends
050517 - things like steak should be avoided for 3 or 4 days.
050519 - ..
050520 - Medications can now be taken orally, which is just in time, because
050521 - using the IV catheters has become painful.
050522 -
050523 - [On 091219 0600 medical team approves switching from IV
050524 - injections to pills for oral medications, following Doctor
050525 - Stewart's approval to resume eating solid food. ref SDS 22 0L90
050527 - ..
050528 - [On 091219 0600 coordinate with nurse on transitioning from IV
050529 - to oral medication treatments, and to reduce pain from using IV
050530 - catheters which have expired and now cause pain getting
050531 - medication. ref SDS 22 PQPX
050533 - ..
050534 - Discharge expected tomorrow or Sunday, based on evaluating patient
050535 - beginning to eat and drink normally starting this evening. Discussed
050536 - continuing with Ensure to transition from liquid diet the past few
050537 - months to solid food.
050539 - ..
050540 - Doctor Stewart will add Ensure to patient diet that supplements
050541 - Nutrition Department menu, and starting this evening.
050543 - ..
050544 - Thanked Doctor Stewart for resolving achalasia, as planned in the
050545 - meeting on 091030 0810. ref SDS 10 GM5I
050546 -
050547 -
050548 -
050549 -
050550 -
0506 -
SUBJECTS
Default Null Subject Account for Blank Record
0603 -
0604 - 2020
060501 - ..
060502 - Joe the neighbor is taken to another ward. He expects to be in the
060503 - hospital another week to get physical therapy learning to deal with
060504 - his foot situation.
060505 -
060506 -
0606 -
SUBJECTS
Default Null Subject Account for Blank Record
0703 -
0704 - 2210
070501 - ..
070502 - New patient brought into the room.
070504 - ..
070505 - Seems to be having serious problems moaning continuously, as if
070506 - hallucinating or dreaming. There are no intelligible words, just
070507 - constant motion turning side to side, and moaning loudly.
070509 - ..
070510 - Since this was occurring when the patient arrived, did not call for
070511 - help.
070512 -
070514 - ..
0706 -
0707 -
0708 - 2350
0709 -
070901 - Heard a loud noise next door so called the nurse.
070902 -
070903 - The nurse came into the room. Explained problem of loud noise from
070904 - the new neighbor, who has been moaning severely.
070906 - ..
070907 - The nurse investigated and said the patient has fallen off the bed.
070909 - ..
070910 - Gets help from 5 nurses; patient having difficulty communicating,
070911 - just moaning.
070913 - ..
070914 - Bring equipment into the room to lift patient back into bed. He is a
070915 - big man, so this is difficult.
070917 - ..
070918 - Nurse explains the patient has disease (bacteria or fungus?) on his
070919 - brain, and this creates disorientation. He will now get 24-hour
070920 - nursing. He came from ICU, so they thought he was ready for reduced
070921 - level of care.
070923 - ..
070924 - Another patient is moved out of the room to make room for the other
070925 - patient to be constantly observed by a nurse.
070927 - ..
070928 - The new patient is now moaning "God help me!" This is the patient who
070929 - was in the Radiology Holding room early today, and was asking for help
070930 - at that time. ref SDS 0 ER79
070931 -
070932 - [On 091219 0600 patient moved to private room for increased
070933 - care. ref SDS 22 OE5I
070934 -
070935 -
070936 -
070937 -
070938 -
070939 -
0710 -