CONTACTS 

SUBJECTS
Kathleen and Bob                  ~
Mother & Bob
Patti and Pablito Utzurrim
Robin Partee

0706 -
0706 -    ..
0707 - Summary/Objective
0708 -
070801 - Follow up ref SDS 15 0000, ref SDS 14 0000.
070805 -  ..
070806 - Kathleen drove with me, and Patty drove herself separately, in her
070807 - truck.  Drove to....
070808 -
070809 -                 Arroyo Grande Community Hospital
070810 -                 345 South Halcyon Road
070811 -                 Arroyo Grande, CA  93430
070812 -                 805 473 7650
070814 -  ..
070815 - Arroyo Grande is about 10 miles north of Nipomo.  Take the Grand
070816 - Avenue off ramp, and go west about .5 miles to Halcyon.  Turn left,
070817 - and go a few short blocks to the hospital on the left side of the
070818 - street.
070820 -  ..
070821 - At the hospital, we had a short wait until the nurse came for Kathleen
070822 - at 0600.
070824 -  ..
070825 - Patty and I were able to go back to the staging area where Kathleen
070826 - was prepared for surgery.  This took about 45 minutes.  She changed to
070827 - a hospital gown.  Kathleen felt cold, so the nurse brought a heated
070828 - blanket.  An IV was started by the nurse.  Leggings were put on Kath's
070829 - lower legs, evidently to reduce the chance of blood clots.  Doctor Ron
070830 - Smith, who called and talked to Kath last night, came by and installed
070831 - several procedures for the anesthesia.  He gave her some kind of
070832 - breathing device that may have been intended as a step to prepare the
070833 - lungs for the surgery.  Not sure about the purpose.  Looked like
070834 - smoking a piece pipe.  This was done for 5 minutes or so.
070836 -  ..
070837 - Mother and Bob drove over separately.  They arrived about 0630, so
070838 - Kathleen knew they had arrived.  At various times there were 2 to 4
070839 - people attending Kathleen, getting her ready for surgery.  The doctors
070840 - and nurses did a good job explaining everything they were doing.
070842 -  ..
070843 - Doctor Smith said she will experience some pain after surgery because
070844 - of a catheter that will be placed into her lung.  He will give
070845 - medication to reduce this pain to a minimum. The catheter will remain
070846 - until leakage from the lung is closed by healing, which usually takes
070847 - a few days, but varies from patient to patient.
070849 -  ..
070850 - The nurse asked that the family take Kath's cloths, and the suit case
070851 - we brought, back home.  She said these would not be needed for at
070852 - least 2 days, and Kath will not feel like doing anything.  We can
070853 - bring her things back in 2 or 3 days.
070855 -  ..
070856 - Kath was taken to surgery about 0700.  They expect this will take
070857 - about 2 hours, until 0900.  After surgery, the doctor will come out
070858 - and talk to the family in the waiting area.  Kath will begin waking up
070859 - about 30 minutes or so after the surgery, or about 0930.
070861 -  ..
070862 - Kath said earlier that she didn't sleep at all last night, or at least
070863 - from 0100, so she feels very tired.  This may cause her to sleep for
070864 - awhile even after surgery.
070865 -
070867 -  ..
0709 -
0710 -
0711 - 0713
0712 -
071201 - Patty, Bob, Mother and I went to the cafeteria.  They do not serve hot
071202 - food, so we did not order anything.
071204 -  ..
071205 - We went to the waiting room for about 30 minutes, where Bob read the
071206 - paper.
071208 -  ..
071209 - Patty went for a ride along the ocean in Pismo Beach, to be with her
071210 - own thoughts and have a cigarette.
071212 -  ..
071213 - Mother and Bob went to a restaurant for breakfast.
071214 -
071215 -
071217 -  ..
0713 -
0714 -
0715 - 0903
0716 -
071601 - Doctor Hioshi visited with the family after the surgery.
071602 -
071603 - The advised that Kath has stage-4 lung cancer.  The cancer is much
071604 - larger than expected from pre-operation testing, examination, CAT
071605 - scan, and other diagnostics.
071606 -
071607 -     [...below, Doctor Vendegna explained detection of cancer is not
071608 -     very effective. ref SDS 0 YQ9I
071610 -      ..
071611 -     [On 010516 oncologist plans to evaluate size of tumor again after
071612 -     chemo therapy to decide about a 2nd operation, if the CAT scan
071613 -     shows the tumor has shrunk. ref SDS 17 UR7H
071615 -  ..
071616 - Doctor Hioshi observed that the cancer has begun spreading into tissue
071617 - that surrounds the heart, and has spread higher up the lung tube.  As
071618 - a result, the surgery failed.  The doctor did not remove any cancer,
071619 - nor any part of the lung.  He took a biopsy and closed the operation
071620 - incision.  Doctor Hioshi cited studies showing that removing a large
071621 - mass, which he observed inside Kathleen, places the patient at greater
071622 - risk due to trauma from invasive surgery, than does treatment with
071623 - radiation and chemo therapy to restrain the growth of the cancer.
071624 -
071625 -     [On 010522 Patty relates information from research indicating Kath
071626 -     may have needed cardiac surgeon, and that Doctor Hioshi may be a
071627 -     pulmonary surgeon, and this difference in expertise may have
071628 -     caused hesitation to proceed with the surgery today. ref SDS 22
071629 -     XP3M
071631 -  ..
071632 - He said radiation and chemo therapy might prolong her life for a few
071633 - years.  He has two patients who have survived for 9 years with similar
071634 - condition, and treatment to contain the cancer.  One of those two
071635 - patients has suffered continuous medical problems, because of the
071636 - treatment regimen.  He feels Kathleen has about 6 months to live, if
071637 - there is no further treatment.  Doctor Hioshi seemed to indicate that
071638 - survival beyond 6 months depends on the patient's general health, and
071639 - on attitude and determination to make difficult choices for treatment
071640 - and for change in life style.
071641 -
071642 -     [...below, Doctor Vendegna commented about success rates
071643 -     continuing treatment. ref SDS 0 HX8J
071645 -      ..
071646 -     [On 010522 Patty's research indicates chemo therapy and radiation
071647 -     may be successful in causing cancer to recede from nearby tissue,
071648 -     and organs, in this case the heart. ref SDS 22 TV5G
071650 -      ..
071651 -     [On 011128 Kath died from lung cancer. ref SDS 25 0001
071653 -      ..
071654 -     [On 101029 1733 Millie's son hospitalized painful breathing,
071655 -     possible diagnosis lung cancer, lymphoma, inoperable, systemic
071656 -     treatment planned. ref SDS 26 X06U
071658 -  ..
071659 - Doctor Hioshi will coordinate with the oncology doctor on the scope of
071660 - the cancer problem he observed during surgery, for determining follow
071661 - on treatment.
071663 -  ..
071664 - I asked about getting a written report of findings from the surgery to
071665 - guide treatment going forward. The doctor seemed to indicate a
071666 - preference for talking to the oncology doctor, rather than issue a
071667 - written report.
071669 -  ..
071670 - It seems peculiar that a critical operation would be performed,
071671 - and no findings would be reported for the record, particularly where a
071672 - patient's life is at risk.
071673 -
071679 -       ..
071680 -      [On 010516 Doctor Palchek, the oncologist, proposes treatment
071681 -      plan. ref SDS 17 UR7H
071683 -       ..
071684 -      [On 010517 Kathleen plans to seek other opinions on treatment, to
071685 -      supplement Doctor Palcheck's initial proposal prepared with the
071686 -      aid of Doctor Hioshi's direct discussion of findings.  Getting a
071687 -      second opinion would be aided by a written report and a video of
071688 -      the operation performed by Doctor Hioshi. ref SDS 18 PK5H
071690 -       ..
071691 -      [On 010520 Bob Chapman provided references to specialists who may
071692 -      be able to help Kath. ref SDS 19 S76J
071694 -       ..
071695 -      [On 010520 Kath said the oncologist has not yet received a report
071696 -      or briefing from Doctor Hioshi. ref SDS 20 UY4K
071698 -       ..
071699 -      [On 010526 Pablito says family received report from oncology
071700 -      doctor, Palchek. ref SDS 23 LH6N
071702 -  ..
071703 - The doctor volunteered that he heard from a nurse that Kathleen had
071704 - gone out to the car for a cigarette, after checking into the hospital
071705 - this morning, and before preparation for surgery.  He said that people
071706 - with a strong drive to smoke are at greater risk, and often have more
071707 - difficulty recovering from lung cancer, which requires changes in life
071708 - style.
071710 -  ..
071711 - We assured Doctor Hioshi that his understanding is incorrect,
071712 - reflecting a communication, error.  We advised that Kathleen did not
071713 - go out for a cigarette.  She went directly from the waiting room to
071714 - the surgery preparation cubicle, and stayed there until taken to
071715 - surgery.
071717 -  ..
071718 - Doctor Hioshi noted he received incorrect information.  He planned to
071719 - inquire further about which patient went for a cigarette before
071720 - surgery for lung cancer.  He seemed to place importance on this
071721 - incident.  Hopefully, it did not influence professional judgements in
071722 - conducting the surgery, particularly since it was a mistake.  This
071723 - further suggests verbal communication is risky in medical situations,
071724 - as reported on 990912. ref SDS 6 0001 and ref SDS 6 0960
071726 -  ..
071727 - Kath will have to stay in the hospital for 5 days to recover from the
071728 - invasive surgery.
071729 -
071730 -      [On 010517 Kath was discharged 2 days early because she recovered
071731 -      faster than expected. ref SDS 18 0001
071733 -  ..
071734 - Doctor Hioshi will visit with Kathleen about results of the surgery,
071735 - and treatment ideas, before she sees the family in about 30 minutes.
071737 -  ..
071738 - About 20 minutes after the consultation concluded with Doctor Hioshi,
071739 - I visited the nurses station.  Explained Doctor Hioshi's plan to talk
071740 - with the oncology doctor about treatment, rather than issue a written
071741 - report.  A volunteer nurse, Bea, who is a retired surgical nurse from
071742 - UCLA Medical Hospital, advised that we can meet with the oncologist
071743 - this morning to hear about treatment planning, based on Doctor
071744 - Hioshi's verbal report.
071746 -  ..
071747 - About 10 minutes later, Bea came over and advised there is a call for
071748 - me from my sister.
071750 -  ..
071751 - I asked if the call is from Kathleen, since this would be unexpected
071752 - for her to be able to call after just being wheeled into the recovery
071753 - room.
071755 -  ..
071756 - Bea said the call is from outside the hospital, that it is not from
071757 - Kathleen.
071759 -  ..
071760 - I explained that my sister Stephanie died several years ago, and my
071761 - other sister, Sally, is unaware I am at the hospital.
071763 -  ..
071764 - Bea investigated and determined this seems to be another error,
071765 - although the caller could have been Sally, if Patty or Kath gave her
071766 - the name and/or number of the hospital.  When I spoke to Sally on
071767 - 010509, ref SDS 14 LA6K, neither of us knew the hospital where the
071768 - surgery would occur.
071769 -
071771 -  ..
0718 -
0719 -
0720 - 0939
0721 -
072101 - Visited Kathleen.
072102 -
072103 - She was groggy from the surgery, but remarkably composed and
072104 - determined under the circumstances.  We talked about continuing
072105 - treatment, and coming home.  Reminisced about our days growing up in
072106 - Cupertino.  We remembered around 1955, when Dad had to put put Kath in
072107 - charge of the house in Garden Gate. She shouldered responsibilities
072108 - beyond her years, caring for siblings, while, also, building an
072109 - identity of her own.  Those were not easy times; but, Kath was equal
072110 - to the task, making all of us kids grateful for her strength.
072112 -  ..
072113 - Kathleen asked for assistance.  She needed to cough to clear phlegm
072114 - leaking into her throat, but coughing was very painful.  The nurse
072115 - said medication can relieve this.
072117 -  ..
072118 - Beth, the nurse said Kath will be hospitalized for 5 to 7 days.  She
072119 - gave a phone number where we can reach Kath....
072120 -
072121 -
072122 -                          805 473 7650
072123 -
072124 -
072125 - ...this is the number for the nurse's station in the Intensive Care
072126 - Unit.  They will forward calls to Kathleen, if she can take the call.
072128 -  ..
072129 - Patty will stay with her mom at the hospital tonight.  Beth said they
072130 - can bring a bed in for Patty, and the hospital will provide meals.
072132 -  ..
072133 - Beth advised that visiting hours end at 2000, but this is not rigidly
072134 - enforced.
072136 -  ..
072137 - As we were leaving, mother saw her pulmonary doctor.....
072138 -
072139 -                    Thomas R. Vendegna, M.C., F.C.C.P.
072140 -                    Central Coast Chest Consultants
072141 -                    Specialist in Pulmonary & Critical Care Medicine
072142 -                    1428 Phillips Lane, Suite 203
072143 -                    San Luis Obispo, CA  93403
072144 -                    805 543 4407
072146 -  ..
072147 - Doctor Vendegna just happened to be in the ICU area on an unrelated
072148 - matter.  He knew about Kath's general condition.  Mother related
072149 - Doctor Hioshi's report. ref SDS 0 SQ5I  Doctor Vendegna was surprised,
072150 - and supportive.  The doctor feels there is a good chance Kathleen can
072151 - survive for some time longer than 6 months.  He said radiation and
072152 - chemo therapy have advanced in recent years.
072154 -  ..
072155 - Mother was concerned that this treatment would be very painful for
072156 - Kathleen.
072158 -  ..
072159 - Doctor Vendegna said new methods of administering radiation and chemo
072160 - therapy are easier to tolerate now.  He was reassuring that Kathleen
072161 - may have a good chance of effective treatment beyond 6 months, which
072162 - seems to clarify Doctor Hioshi's initial view. ref SDS 0 FP9G
072163 -
072164 -     [On 010515 discussed with Kath. ref SDS 16 5W4J
072166 -      ..
072167 -     [On 010522 Patty's research indicates chemo therapy and radiation
072168 -     may be successful in causing cancer to recede from nearby tissue,
072169 -     and organs, in this case the heart. ref SDS 22 TV5G
072171 -  ..
072172 - We discussed significant disparity between Doctor Hioshi's discovery
072173 - today of advanced cancer that is beyond the reach of surgery, per
072174 - above, ref SDS 0 SQ5I, and earlier reports based on pre-surgery
072175 - investigation using xrays, MRI and other procedures, that indicated
072176 - the problem was localized and susceptible to surgical treatment.
072178 -  ..
072179 - Doctor Vendegna seemed to say that cancer is difficult to diagnose
072180 - because symptoms are not evident to patients until the problem has
072181 - grown significantly.  He said xrays and MRIs only have a 20% chance of
072182 - showing the actual scope of the problem, or of detecting a problem
072183 - that can be treated successfully.
072185 -  ..
072186 - We reviewed new technologies being deployed that aid interpretation of
072187 - xrays to increase significantly the chances of early detection. Work
072188 - is being done for breast cancer detection, that may useful for other
072189 - cancers.  Doctor Vendegna was familiar with this work, but noted that
072190 - a lot work is underway to improve medical practice, particularly in
072191 - the area of early detection.
072192 -
072194 -  ..
0722 -
0723 -
0724 - 1736
0725 -
072501 - Visited Kathleen at hospital.
072502 -
072505 -  ..
072506 - We stopped at McDonalds and got a hamburger, on the way to the
072507 - hospital.  Patty had a fish burger, because her health regimen does
072508 - not permit meat in her diet.
072509 -
072510 -      [On 010929 Patti having a veggie burger for dinner. ref SDS 24
072511 -      2R8K
072513 -  ..
072514 - Suggested to Patty that when Kathleen is feeling better, Patty might
072515 - discuss getting a second opinion on the course of treatment, per
072516 - Doctor Hioshi's comments about a communication mistake that could have
072517 - influenced treatment. ref SDS 0 0K5F
072518 -
072519 -      [On 010517 Kath is considering getting another opinion on
072520 -      treatment options. ref SDS 18 PK5H
072522 -       ..
072523 -      [On 010521 submitted information to Patty for getting a second
072524 -      opinion. ref SDS 21 0001
072526 -  ..
072527 - Rita called Patty on her cell phone, just before we arrived at the
072528 - hospital.  Patty explained the situation.
072530 -  ..
072534 -  ..
072535 - Robin was visiting Kathleen when we arrived.  Robin looked well, and
072536 - had clearly raised Kath's spirits.
072538 -  ..
072539 - Kath related plans to see the oncologist for planning treatment.  She
072540 - was very concerned about Mother, and is anxious to get home, sounding
072541 - much stronger this evening.  It was hard to believe she was suffering
072542 - anything, much less the dire findings this morning.
072543 -
072544 -      [On 010515 reviewed treatment issues. ref SDS 16 5W4J
072546 -       ..
072547 -      [On 010515 oncologist proposes treatment plan. ref SDS 16 KP4M
072549 -       ..
072550 -      [On 010517 Kath to consider range of treatment options.
072551 -      ref SDS 18 NG4G
072553 -  ..
072554 - Mother and Bob arrived about 20 minutes later.
072556 -  ..
072557 - Kathleen seemed to get stronger as we talked more about plans for the
072558 - future.  It was difficult to believe she had just undergone major
072559 - surgery.  She asked for magazines, and gave a list of items she needs
072560 - from the house, including her address book.  She asked the nurse,
072561 - Beth, about making calls.  The nurse set up a phone.  Patty will help
072562 - Kathleen make a list, and will call me in the morning with things to
072563 - bring for Kathleen when I visit about 1000.
072564 -
072565 -      [On 010520 Kath experiencing greater pain from surgery, after
072566 -      release from hospital. ref SDS 20 946H
072568 -       ..
072569 -      [On 0105221 receive morphine for pain relief. ref SDS 21 WZ3G
072571 -  ..
072572 - Nurse Beth was impressed by Kathleen's request for reading materials.
072573 - She complimented Kath's interest in science and current affairs.
072575 -  ..
072576 - Kathleen suddenly mentioned similarities between her surgery, and that
072577 - for her husband, Bob, who died of pancreatic cancer.  Beth looked
072578 - Kathleen in the eyes and explained calmly and carefully that every
072579 - patient is unique and has different potential for treatment and
072580 - recovery.  Kathleen's condition is much less dramatic than pancreatic
072581 - cancer, so, unlike Bob, Kath will survive to be discharged from the
072582 - hospital, can go home, and treatment is a viable option in her case.
072583 - Kathleen smiled.
072585 -  ..
072586 - We all appreciated Beth's expertise in caring and listening.
072587 -
072588 -     [On 010516 letter from Patty discussed this issue again.
072589 -     ref SDS 17 WR4J
072590 -
072591 -     [On 010517 Kath was discharged from the hospital, and was able to
072592 -     go home. ref SDS 18 0001
072593 -
072594 -
072595 -
072596 -
072597 -
072598 -
072599 -
072600 -
072601 -
072602 -
0727 -