CONTACTS 

SUBJECTS
Cat Bite Right Hand Causes Swelling Pain Temperature 101.9 Treatment

0803 -
0803 -    ..
0804 - Summary/Objective
0805 -
080501 - Follow up ref SDS 12 0000.
080502 -
080503 - Millie went to the emergency room at Kaiser in Walnut Creek.  She was
080504 - treated for infection from a cat bite with temperature of 101.9, and
080505 - diagnosed in "fairly dangerous" condition for a stage IV cancer
080506 - patient. ref SDS 0 OV5I  She will be hospitalized for 3 or 4 days of
080507 - treatment and observation. ref SDS 0 Z56V  It was a long day.  Called
080508 - and notified the kids.  Assembled things Millie wants from the house.
080509 - ref SDS 0 05G5
080510 -
080511 -     [On 061115 Millie had another cat bite; initially no reaction of
080512 -     temperature and no swelling. ref SDS 17 WF8T
080514 -      ..
080515 -     [On 070612 Millie suffered another cat bite while recovering from
080516 -     Cellulitis and fever. ref SDS 20 6G7N
080517 -
080518 -
080519 -
080521 -  ..
0806 -
0807 -
0808 - Progress
0809 -
080901 - Yesterday, Millie was trying to brush Tidbit, and the cat bit her
080902 - right hand, because she is sensitive in her hind quarters where Millie
080903 - was brushing.
080905 -  ..
080906 - Millie's hand swelled somewhat through the day, causing concern.
080908 -  ..
080909 - This morning swelling has increased with inflammation on the right
080910 - arm, and there is noticeable pain up the hand from the bite location.
080911 - Literature on cancer patients says to get immediate treatment for
080912 - anything that might spread infection through the blood stream,
080913 - especially of Stage IV patients.
080914 -
080915 -
080916 -
080918 -  ..
0810 -
0811 -
0812 - 0930
0813 -
081301 - Arrived at Walnut Creek hospital, and signed in for treatment.
081302 -
081303 - There are about 8 patients ahead of Millie.
081304 -
081305 -
081307 -  ..
0814 -
0815 -
0816 - 0943
0817 -
081701 - Patient administrator sees Millie at the front desk.  She prepares
081702 - case history and enters personal information in a computer, most of
081703 - which is already on file.
081705 -  ..
081706 - Millie now has a temperature of 101.9, which is well above 100.5 when
081707 - cancer patients should get emergency treatment.  On 041202 Millie was
081708 - admitted previously for emergency treatment due to elevated
081709 - temperature. ref SDS 12 IX9N
081710 -
081711 -    [On 070216 instructions call UCSF for emergency high fever
081712 -    spreading rash IBC cellulitis; conflicts with Kaiser instructions.
081713 -    ref SDS 18 UW9I
081715 -  ..
081716 - There is increased swelling of the right hand, going up the arm.  The
081717 - wound itself from the cat bite does not look bad.
081719 -  ..
081720 - Taking blood pressure with apparatus on the right arm where the bite
081721 - is on the right hand, caused increased pain and discomfort.
081723 -  ..
081724 - Front desk administrator gives Millie admitting documents with her
081725 - Kaiser card attached to the documents with a paper clip, and says to
081726 - place these materials in the black box on the wall about half-way to
081727 - the other end of patient waiting room, and explained that Millie will
081728 - be called for examination by an admitting nurse.
081729 -
081730 -
081732 -  ..
0818 -
0819 -
0820 - 1000
0821 -
082101 - Millie seen by case history technician, Coral.
082103 -  ..
082104 - Coral, the admitting technician, enters in the computer patient
082105 - medical history and personal information which seems to duplicate in
082106 - work at the desk when Millie came into the hospital ER. ref SDS 0 II7I
082108 -  ..
082109 - Millie taking AC chemotherapy, and Coumadin for blood clots.
082111 -  ..
082112 - Technician, Coral, examines wound notices infection swelling moving up
082113 - the right hand, and describes this as Cellulitis and lymphedema.
082115 -  ..
082116 - Pain rated 8 on scale of 8 - 10.
082118 -  ..
082119 - Coral asks if white blood cell count has been trending high or low?
082121 -  ..
082122 - She is encouraged to investigate the record of blood tests on file for
082123 - the patient in Kaiser's computers.  Coral finds this information in
082124 - about 10 seconds showing recent history of white blood cell count
082125 - within the target range.
082127 -  ..
082128 - Coral consults with colleagues.
082130 -  ..
082131 - She fills out patient admitting record on the computer.
082133 -  ..
082134 - She prepares a narrative explaining patient problem, and condition
082135 - based on observation.
082136 -
082137 -      Skin is hot to the touch, and erythma extends up the right hand.
082139 -  ..
082140 - Millie asks for her Kaiser card.
082142 -  ..
082143 - Coral says she cannot find the card among the stacks of documents on
082144 - her desk.
082146 -  ..
082147 - A suggestion is made to look in the box on the wall in the waiting
082148 - room, outside the patient interview room.
082150 -  ..
082151 - Coral retrieves patient's Kaiser plastic account card, it had fallen
082152 - loose and was still in the box outside in the waiting area where
082153 - anyone could have picked it up over the past 15 minutes.
082155 -  ..
082156 - Coral prepares forms for more blood tests.
082158 -  ..
082159 - Millie asks about using the port catheter, in order to avoid problems
082160 - of infection and swelling that occurs from excessive blood draws
082161 - using a conventional needle method?
082163 -  ..
082164 - Coral says the ER has nurses on staff trained to use the port for the
082165 - blood tests.
082167 -  ..
082168 - Blood pressure........ 120 82
082170 -  ..
082171 - Coral completes a number of paper forms.
082173 -  ..
082174 - Coral walks the patient from the interview room down the hall,
082175 - turning several corners.
082176 -
082177 -
082179 -  ..
0822 -
0823 -
0824 - 1020
0825 -
082501 - Millie admitted to examination room, and dresses down for
082502 - examination.
082504 -  ..
082505 - She is feeling cold.  Nurse is not available, so make inquiries and
082506 - obtain two warm blankets.  Millie is covered and feels better.
082508 -  ..
082509 - A nurse comes into the examination room and takes down in handwriting
082510 - the information taken initially by the administrator at the front
082511 - desk, and again by Coral in the admitting room a few minutes ago.
082512 - ref SDS 0 PP9P
082513 -
082514 -
082516 -  ..
0826 -
0827 -
0828 - 1028
0829 -
082901 - Dave arrives to draw blood from Millie's port.
082902 -
082903 - He wears coveralls that have ergonomic pockets for storing various
082904 - medical tools and documents.
082906 -  ..
082907 - Dave brings four small bottles containing some kind of liquid.  He
082908 - says they are for blood cultures.
082910 -  ..
082911 - People who come in with a fever and are on chemotherapy, they
082912 - automatically do blood cultures.
082914 -  ..
082915 - Dave washes hands thoroughly.
082917 -  ..
082918 - He starts with saline to flush the port.
082920 -  ..
082921 - Dave connects IV line to the port catheter.
082923 -  ..
082924 - Nurse LeAnn comes in and asks for signature.  LeAnn wants credit card
082925 - for $50 co-payment to cover the cost of emergency treatment.  She
082926 - says that if payment is not collected from patients right now in
082927 - Emergency Room, then the Kaiser Business Office sends an invoice that
082928 - includes a $13 extra charge for something.
082930 -  ..
082931 - Millie struggles to sit up and sign the documents LeAnn provides.
082932 - She winches grasping the pen with her injured right hand to sign the
082933 - paper.
082935 -  ..
082936 - Dave asks Millie if other nurses use a .5 inch or a 1 inch needle?
082937 - Millie explains nurses use a "butterfly" type equipment, not a
082938 - straight needle. Dave says the Emergency department does not have that
082939 - equipment, so he will use a .5 inch needle, and will be as gentle as
082940 - he can.
082941 -
082942 -
082944 -  ..
0830 -
0831 -
0832 - 1046
0833 -
083301 - Dispute Doctor Orders Collection Staff Out of Emergency Room
083302 -
083303 - LeAnn returns with credit card, receipt and needs Millie's signature
083304 - again for another transaction.  Dave is connecting Millie to the port,
083305 - and says Millie will sign the document later.
083307 -  ..
083308 - LeAnn wants to wait until Millie can sign the credit card payment.
083310 -  ..
083311 - Dave suggests she leave and that he will ensure the documents get
083312 - signed after the blood draw.
083314 -  ..
083315 - There is heated discussion about conflict between treating the patient
083316 - for an ailing right hand, and getting the patient to use the ailing
083317 - right hand to sign paperwork for payment of treatment.
083319 -  ..
083320 - LeAnn decides to leave.
083321 -
083322 -
083324 -  ..
0834 -
0835 -
0836 - 1046
0837 -
083701 - Dave tries to connect the IV line to the port catheter for blood
083702 - cultures.
083704 -  ..
083705 - He encounters a problem, causing patient discomfort, and leaves the
083706 - Examination room to get a longer needle.
083707 -
083708 -
083709 -
083711 -  ..
0838 -
0839 -
0840 - 1049
0841 -
084101 - LeAnn returns with receipt for co-payment.  She also holds a document
084102 - on a clip board.  Millie struggles to sign the payment authorization.
084103 - LeAnn says again this extra effort by the patient now, even though
084104 - very painful, saves the patient $13 extra charge, because Kaiser's
084105 - Business Office routinely overcharges when billing the patient for ER
084106 - services, and is unable to distinguish in their computer records when
084107 - patients are incapacitated.
084108 -
084110 -  ..
0842 -
0843 -
0844 - 1051
0845 -
084501 - Dave returns with a longer needle, and prepares again for drawing
084502 - blood from the port catheter.
084504 -  ..
084505 - There is another problem of some kind, and Dave leaves again.
084506 -
084508 -  ..
0846 -
0847 -
0848 - 1053
0849 -
084901 - Doctor Koslap arrives and begins examination.
084902 -
084903 - The doctor says they see a lot of patients in the Emergency Room who
084904 - suffering effects from cat bites.
084906 -  ..
084907 - He says 85% of cat bites cause infection, and that examinations should
084908 - occur as soon as possible, especially for cancer patients because both
084909 - cancer and chemotherapy treatments weaken the immune system.
084910 -
084911 -      [...below, Dave repeats this advice for future reference.
084912 -      ref SDS 0 1555
084914 -       ..
084915 -      [...below, Doctor Kim says this again. ref SDS 0 Z56F
084917 -       ..
084918 -      [...below, Doctor Koslap reports findings from tests show lower
084919 -      WBC, which causes weakened immune system. ref SDS 0 I34W
084921 -       ..
084922 -      [...below, Millie hospitalized for 3 or 4 days because condition
084923 -      is fairly dangerous weakened immune system. ref SDS 0 OV5I
084924 -
084926 -  ..
084927 - He gives instructions for the nurse, Dave, to give Millie a
084928 - tetanus(??) shot.
084929 -
084931 -  ..
0850 -
0851 -
0852 - 1054
0853 -
085301 - Doctor Koslap leaves.
085302 -
085304 -  ..
0854 -
0855 -
0856 - 1058
0857 -
085701 - Dave returns to examination room and tries to insert a longer needle
085702 - into the port to draw blood.
085704 -  ..
085705 - This seems like a more painful experience than normally occurs drawing
085706 - blood from the port, and connecting the port to an IV for cancer
085707 - treatments.
085709 -  ..
085710 - Millie is a trooper.
085712 -  ..
085713 - Process was successful this time.  Dave fastens equipment to Millie's
085714 - chest with tape, getting ready to flush the port with saline.
085716 -  ..
085717 - Millie is thirsty.
085719 -  ..
085720 - Dave says have to wait until after the blood draw.
085721 -
085722 -
085723 -
085725 -  ..
0858 -
0859 -
0860 - 1102
0861 -
086101 - Dave says that the "sterile setup" part of the blood draw process is
086102 - completed.
086104 -  ..
086105 - He connects one of the blood culture bottles to the port.
086107 -  ..
086108 - Dave decides to draw two extra bottles of blood.
086110 -  ..
086111 - Observing Millie's right hand, the infection seems to be spreading
086112 - compared to last night, and just an hour ago.
086114 -  ..
086115 - Dave repeats Doctor Koslap's comments that when there is suspicion of
086116 - possible infection, as occurs with a cat bite, a cancer patient should
086117 - come in immediately for treatment.  The sooner infection is treated
086118 - the better. ref SDS 0 I25G
086120 -  ..
086121 - Last night we talked about coming into the emergency.  Millie wanted
086122 - to wait to see if the problem would correct itself.
086123 -
086124 -
086125 -
086127 -  ..
0862 -
0863 -
0864 - 1109
0865 -
086501 - Dave completes blood cultures.
086502 -
086503 - Dave will check with the doctor to see if Millie can now have
086504 - something to drink.
086505 -
086507 -  ..
0866 -
0867 -
0868 - 1114
0869 -
086901 - Dave returns.
086902 -
086903 - He verifies paperwork against information on patient wrist band.
086905 -  ..
086906 - Dave fastens identification labels to the blood vials and bottles.
086908 -  ..
086909 - The pink blood bottles are for use in the case Millie suddenly needs
086910 - blood due to unexpected problems.  So, Dave is planning ahead, and
086911 - being prepared, called out for effective management reported on
086912 - 950327. ref SDS 1 8822
086913 -
086915 -  ..
0870 -
0871 -
0872 - 1130
0873 -
087301 - Doctor Koslap arrives.
087302 -
087303 - Asks about pain.
087305 -  ..
087306 - Millie says her hand and her head hurt.
087308 -  ..
087309 - Doctor Koslap decides to administer Tordal for pain.
087310 -
087311 -
087312 -
087314 -  ..
0874 -
0875 -
0876 - 1132
0877 -
087701 - Nurse, Christi, arrives and uses the port to administer Tordal for
087702 - pain.
087704 -  ..
087705 - Christi examines Millie's injury
087707 -  ..
087708 - She connects an IV to administer Unasyn for an antibiotic.  Says this
087709 - will take about an hour.
087711 -  ..
087712 - Millie takes a nap.
087713 -
087715 -  ..
0878 -
0879 -
0880 - 1211
0881 -
088101 - Millie feels pain is less severe.
088102 -
088103 - She looks at her arm and comments that red rash and swelling seem to
088104 - be receding.
088105 -
088107 -  ..
0882 -
0883 -
0884 - 1248
0885 -
088501 - Doctor Koslap enters examination room.
088502 -
088503 - The doctor reports that white blood cell count is low.  This increases
088504 - risk of infection due to weakened immune system.  He cites Millie's
088505 - temperature 101.9, per above, ref SDS 0 5V8J, and spreading rash-like
088506 - inflammation and swelling on the arm.
088507 -
088508 -            [...Doctor Kim prescribes antibiotics to treat low counts
088509 -            and reduce inflammation. ref SDS 0 Z56V
088511 -  ..
088512 - The doctor discussed cancer patients being treated with chemotherapy
088513 - should avoid cat bites that cause inflammation, swelling from
088514 - lymphedema, fever, and low blood counts that weaken the immune system,
088515 - as related above. ref SDS 0 F26L
088516 -
088517 -            [...Doctor asks if Millie has on file power of attorney in
088518 -            case complications from cat bite cannot be contained.
088519 -            ref SDS 0 Z56F
088521 -             ..
088522 -            [On 070419 cat bites considered for causing erratic
088523 -            inflammation on IBC rash infecting upper right arm, patient
088524 -            had slight fever. ref SDS 19 P67J
088526 -  ..
088527 - The doctor seems to indicate that Millie will be admitted to the
088528 - hospital to maintain close surveillance so that timely treatment can
088529 - be given as needed.
088531 -  ..
088532 - Doctor did not discuss treating with neupogen to raise white blood
088533 - cell count, which Millie has had previously, beginning on 020520.
088534 - ref SDS 6 RF4M
088535 -
088536 -      [...below, Doctor Kim prescribes Neupogen to treat low white
088537 -      blood cell condition. ref SDS 0 0T6O
088538 -
088539 -
088540 -
088542 -  ..
0886 -
0887 -
0888 - 1250
0889 -
088901 - Doctor Koslap leaves the room.
088902 -
088903 - Millie feels that being admitted to the hospital will mess up plans
088904 - for lunch at the mall.  We decide to re-schedule lunch.
088905 -
088906 -
088907 -
088909 -  ..
0890 -
0891 -
0892 - 1316
0893 -
089301 - Doctor has not returned.
089302 -
089303 - Millie prepared a list of items she wants from the house....
089304 -
089305 -       Dental floss
089307 -        ..
089308 -       Centrum vitamins (Silver)
089309 -
089310 -          Medicine Cabinet in Kitchen
089312 -        ..
089313 -       moisturizer
089314 -
089315 -          Turquoiz bottle about 5" tall 1" diameter
089316 -          Anew
089317 -          Right side shelf at bathroom sink
089319 -        ..
089320 -       Scarfs
089321 -
089322 -          In drawer on right side of armour, below the VCR control
089323 -          panel; bring orange color, not silk.  There are two other
089324 -          scarfs -- a red one and a blue one.
089326 -        ..
089327 -       Underwear
089329 -        ..
089330 -       Nightgown
089331 -
089332 -
089333 -
089335 -  ..
0894 -
0895 -
0896 - 1346
0897 -
089701 - Visited with Dave in the common administration area.  He is back from
089702 - lunch.
089704 -  ..
089705 - Asked Dave about progress on Millie's case over the past 30 minutes
089706 - of inactivity?
089708 -  ..
089709 - Dave examined the record.
089711 -  ..
089712 - He explained that Doctor Koslap has requested examination and
089713 - consultation with a doctor who is an internal medicine specialist.
089714 -
089715 -
089717 -  ..
0898 -
0899 -
0900 - 1350
0901 -
090101 - Nurse returns Millie's Kaiser account card.
090102 -
090103 - Millie getting hungry; has not eaten since 1700 yesterday.
090105 -  ..
090106 - Decide to wait while Kaiser executes next step of examination by an
090107 - internal medicine doctor.
090108 -
090110 -  ..
0902 -
0903 -
0904 - 1421
0905 -
090501 - Doctor Koslap enters examination room.  He does a procedure to test
090502 - for puss, and will take a culture of the cat bite wound.
090504 -  ..
090505 - He says the internist is now on site in the Emergency common area and
090506 - he is examining Millie's patient history records to prepare for
090507 - visiting with Millie, and deciding whether to admit Mil to the
090508 - hospital.
090510 -  ..
090511 - Millie asks about red blood cells.
090513 -  ..
090514 - Doctor Koslap says red blood cell count is normal.
090516 -  ..
090517 - The doctor reports finding very small amount of puss drained this from
090518 - the cat bite wound.  Doctor Koslap seems to indicate that minimal puss
090519 - is a good sign.
090520 -
090521 -
090522 -
090524 -  ..
0906 -
0907 -
0908 - 1424
0909 -
090901 - Doctor Klaxon leaves the examination room.
090902 -
090903 -
0910 -
0911 -
091101 -
0912 -

SUBJECTS
Patient History Obtained from Patient Doctor Cannot Find Relevant De

3303 -
3304 - 1429
330501 -  ..
330502 - Patient History Obtained from Patient Not Kaiser's Records
330503 - Find Case History from Patient Cannot Find in Knowledge Data Base
330504 -
330505 - Doctor John Kim arrives.
330507 -  ..
330508 - He asks many questions about patient history, which Millie cannot
330509 - remember due to trauma causing diminished capacity that requires
330510 - treatment in Emeergency Room.
330512 -  ..
330513 - Millie explains patient history is in the medical chart, including
330514 - test scans and pathology reports going back many years stored on the
330515 - Kaiser computer.
330517 -  ..
330518 - Doctor Kim says Millie's patient history is very long and complex in
330519 - Kaiser's medical chart, which he just checked, per above. ref SDS 0
330520 - I460
330522 -  ..
330523 - The doctor could not find critical details in Kaiser's computer
330524 - knowledge data base which he needs to know for diagnosis and deciding
330525 - treatment.  This aligns with experience on 041230 when the primary
330526 - care physician could not find details on patient history in the
330527 - medical chart, ref SDS 13 XQ84, and so intended to plan the work based
330528 - on guessing from personal memory. ref SDS 13 437N  Reliance on
330529 - ambiguity of personal memory seems conflicting with the report at
330530 - Boeing on 041013 citing Kaiser for Knowledge Management technology
330531 - support. ref SDS 9 W14V  Doctor Kim's experience today further aligns
330532 - with Doctor Benz work on 041018 when patient history was not available
330533 - on the UCSF computer. ref SDS 10 EN63
330534 -
330535 -     [On 050414 John Maloney cites UCSF for using Knowledge Management
330536 -     in medical practice, ref SDS 14 LX7F, with "earth-shattering
330537 -     achievements" over the past 10 years. ref SDS 14 JY5Y
330539 -      ..
330540 -     [On 061024 case study medical practice computer access limited
330541 -     even with everything on the computer, people can't find details
330542 -     stored in parts of the computer (software modules) that are not
330543 -     frequently used. ref SDS 16 JD9L
330545 -  ..
330546 - Doctor Kim indicated today that general impressions remembering the
330547 - gist of patient history is accurate enough for emergency treatment.
330549 -  ..
330550 - Millie recalled that specific details were obtained from SDS records
330551 - needed by the doctor on 041230. ref SDS 13 XQ88  Similarly, today the
330552 - patient used precision access in SDS records to answer the doctor's
330553 - questions for the following dates...
330554 -
330555 -        1.  discovering original
330556 -            cancer........................... 020208, ref SDS 2 0001
330558 -             ..
330559 -        2.  surgery performed to
330560 -            remove tumor..................... 020312, ref SDS 3 0001
330562 -             ..
330563 -        3.  follow up surgery
330564 -            to obtain "clear margins"
330565 -            removing tumor................... 020327, ref SDS 4 0001
330567 -             ..
330568 -        4.  chemotherapy treatments
330569 -            began, scheduled for 020423,
330570 -            as reported in a meeting on...... 020405, ref SDS 5 549R
330572 -             ..
330573 -        5.  IBC was discovered, as
330574 -            shown in a pathology report
330575 -            received from Kaiser on.......... 040517, ref SDS 7 6T5G
330577 -             ..
330578 -        6.  patient notified of
330579 -            IBC diagnosis 040614............. 040614, ref SDS 8 6T5G
330581 -             ..
330582 -        7.  discovery of Pulmonary
330583 -            Emboli and commence
330584 -            treatment........................ 041104, ref SDS 11 N43I
330586 -  ..
330587 - Millie recalled this chronology is shown in case studies on 040517,
330588 - ref SDS 7 VM6K, which enables accurate understanding of work history
330589 - despite difficulty using personal memory for remembering critical
330590 - details from 2 years ago, due to stress and discomfort from current
330591 - trauma, and grogginess from medication.
330593 -  ..
330594 - Doctor Kim also asked about details of the cat bite, e.g., date and
330595 - time, whose cat, did the cat have shots, circumstances, for example
330596 - was the cat fighting another cat or animal that might be carrying
330597 - disease, etc.,
330599 -  ..
330600 - Millie explains the cat bite occurred yesterday OA 0930, per above.
330601 - ref SDS 0 6T5L
330602 -
330603 -
330604 -
330605 -
330606 -
330607 -
3307 -

SUBJECTS
Patient Admitted to Hospital for Treatment Fairly Dangerous Conditio
Hospitalized 101.9 Temperature Patient Fairly Dangerous Condition St

3604 -
360501 -  ..
360502 - 101.9 Temperature Patient Dangerous Condition Weak Immune System
360503 - Patient Admitted to Hospital for Treatment Fairly Dangerous Condition
360504 - Fairly Dangerous Condition Patient Admitted to Hospital for Cat Bite
360505 - Neupogen Raise WBC Strengthen Immune System Prescribed in Hospital
360506 -
360507 - Temperature still 101.9, same as 5 hours ago at the time of admission,
360508 - per above. ref SDS 0 5V8J
360510 -  ..
360511 - Doctor Kim takes 5 or 6 cell phone calls on other matters, while
360512 - treating Millie.
360514 -  ..
360515 - The doctor asks Millie if she has on file at Kaiser a durable power of
360516 - attorney. ref SDS 0 SP7G
360518 -  ..
360519 - Millie says no, and asks how this relates to a cat bite?
360521 -  ..
360522 - Doctor Kim advised that severe reactions can result from cat bites,
360523 - especially to stage IV cancer patients, restating Doctor Koslap's
360524 - comment about getting an examination immediately, rather than
360525 - delaying, per above. ref SDS 0 I25G  The doctor asked if the primary
360526 - care physician, or anyone at Kaiser, has talked to Millie about
360527 - getting her affairs in order for life ending scenarios common to stage
360528 - IV cancer patients?
360530 -  ..
360531 - Millie said that Doctor Johnson discussed this generally when IBC was
360532 - discovered, and staging was changed from II to IV, reported on 040614.
360533 - ref SDS 8 QH8F
360534 -
360535 -            [On 090213 case study patient advised to get affairs in
360536 -            order for life ending in months. ref SDS 21 L19H
360538 -  ..
360539 - Doctor decides patient needs IV antibiotics because white blood cells
360540 - are low and this weakens immune system needed to fight infection, per
360541 - Doctor Kislop's analysis, also, above. ref SDS 0 I34W
360543 -  ..
360544 - Doctor Kim decides to admit Millie for 3 - 4 days in the hospital,
360545 - because she has a fairly "dangerous" situation.
360546 -
360547 -            [On 050520 doctor approves dental examination to check for
360548 -            infection and treat to avoid danger to cancer patients.
360549 -            ref SDS 15 ND9F
360551 -  ..
360552 - Neupogen will be used to build white blood cells, reported by Doctor
360553 - Koslap, per above, and citing prior history taking Nupigen.
360554 - ref SDS 0 I34W
360556 -  ..
360557 - Doctor Kim feels that low white blood cell count can cause minimum
360558 - swelling.  He likes the fact there is some swelling, showing white
360559 - blood cells are attacking the problem.  He indicated that as white
360560 - blood cell count rises with nupigen, the condition eminating from the
360561 - wound could begin to look much worse.
360562 -
360563 -        [...later swelling and inflamed coloration increases on right
360564 -        hand. ref SDS 0 Q67U
360566 -  ..
360567 - Doctor Kim will notify the primary care physician for input on
360568 - treatment.
360570 -  ..
360571 - Doctor Kim will remain the attending physician.
360573 -  ..
360574 - Millie asked if she can dress and walk through the administrative
360575 - process for admission as a patient?
360577 -  ..
360578 - Doctor Kim said that nurses will transport Millie on the gurney to her
360579 - hospital room.
360580 -
360581 -
360582 -
360584 -  ..
3606 -
3607 -
3608 - 1452
3609 -
360901 - Doctor Kim leaves the examination room.
360903 -  ..
360904 - We need to notify Millie's office.
360906 -  ..
360907 - We should notify the kids.  Millie wants to do this tomorrow, and tell
360908 - Steve not to come all the way from Grass Valley to visit.
360910 -  ..
360911 - We will give them her telephone number, and Millie can coordinate on
360912 - visits.
360913 -
360914 -
360916 -  ..
3610 -
3611 -
3612 - 1500
3613 -
361301 - Life Support Patient Instructions in Case Recovery Fails
361302 -
361303 - Doctor Kim returns and asks Millie about staying on life support, if
361304 - conditions deteriorate from the current diagnosis of "fairly
361305 - dangerous," per above. ref SDS 0 Z56F
361307 -  ..
361308 - Millie says to try life support for a week, and if there is no
361309 - recovery, then remove artificial support and let nature take its
361310 - course.
361312 -  ..
361313 - Doctor Kim leaves.
361314 -
361316 -  ..
3614 -
3615 -
3616 - 1515
3617 -
361701 - Doctor Kim returns and examines the wound on Millie's right hand.
361702 -
361703 - Says nothing, and offers no treatment at this time.
361704 -
361706 -  ..
3618 -
3619 -
3620 - 1516
3621 -
362101 - Doctor Kim leaves.
362102 -
362104 -  ..
3622 -
3623 -
3624 - 1527
3625 -
362501 - Nurse Diane comes into the examination room, and says without any
362502 - inquiry or notice that the patient's support computer must be
362503 - unplugged from the wall socket.  Diane begins to unplug the computer
362504 - before any work is saved, before even a sentence is completed.  She
362505 - advised this is more urgent that attending to the patient, because
362506 - customer equipment to capture the record for case management requires
362507 - a signed work order from the head of the hospital.  Diane did not ask
362508 - if a signed work order was on file; she simply began to unplug the
362509 - customer's tools.
362511 -  ..
362512 - Upon discussion, Diane decided to stand by while the system was saved,
362513 - and then the customer unplugged the computer.
362515 -  ..
362516 - Diane said she is taking Millie to another room where Millie will be
362517 - staying for several days of observations and treatment, in accordance
362518 - with planning by Doctor Kim, per above. ref SDS 0 0T78
362520 -  ..
362521 - Millie asked if she can get something to eat?
362523 -  ..
362524 - Diane said the hospital staff will feed her at the next work station.
362525 -
362526 -
362527 -
362529 -  ..
3626 -
3627 -
3628 - 1536
3629 -
362901 - We travel down the hall, and into another area of the Emergency
362902 - Treatment Area (ETA), and Millie is placed in room #1.
362904 -  ..
362905 - Millie has to go to the bathroom.
362907 -  ..
362908 - Diane said the hospital needs a specimen, and gives explicit
362909 - instructions for this task.
362911 -  ..
362912 - Diane suggests that while Millie is in the bathroom, her things can be
362913 - moved into the new room, since she will be here for 3 - 4 days.
362915 -  ..
362916 - Dave the nurse who did the blood work earlier, comes into the room.
362918 -  ..
362919 - He says Millie will not be staying in this room, but will moved to a
362920 - patient room on the 3rd floor.  This may occur within a few hours, or
362921 - tomorrow, depending upon when the 3rd floor notifies the ER team that
362922 - a room is available.
362924 -  ..
362925 - Marie comes into the cubicle, and says she will Millie's nurse while
362926 - she is still in the ER.
362928 -  ..
362929 - She points out the plastic bags for storing patient's personal
362930 - effects, including clothing, jewelry, and purse.
362932 -  ..
362933 - Marie records in handwriting patient medical history and personal
362934 - information.  This duplicates the work at the desk when Millie came
362935 - into the hospital ER, the same information was prepared again by Coral
362936 - when Millie as admitted into the ER for treatment, and was prepared
362937 - again and by Christi while Millie was getting treatment by Dave,
362938 - Doctor Koslap and by Doctor Kim.
362940 -  ..
362941 - Marie leaves.
362942 -
362943 -
362945 -  ..
3630 -
3631 -
3632 - 1602
3633 -
363301 - Millie is still hungry; she has not eaten anything since 1700
363302 - yesterday.
363304 -  ..
363305 - Since the nurse has not returned, inquiries are made at the common
363306 - administration area.  People are talking about betting on the super
363307 - bowl last weekend.  Diane suddenly walks by.  Ask about getting food
363308 - for Millie.  She said that Marie has taken over for her, and she
363309 - should be somewhere on the floor.  Diane will ask Maria to visit with
363310 - Millie as soon as possible.
363311 -
363313 -  ..
3634 -
3635 -
3636 - 1608
3637 -
363701 - Doctor Gyero (spelling???) visits Millie.  He is an orthopedist.
363702 - Doctor Kim asked him to examine Millie.
363704 -  ..
363705 - The doctor confirms Doctor Kim's earlier diagnosis of a cat bite on a
363706 - stage IV cancer patient must automatically be admitted for treatment
363707 - and observation for 3 - 4 days.
363709 -  ..
363710 - The doctor reviewed patient history again, repeating questions asked
363711 - by Doctor Kim at the previous work station. ref SDS 0 PU4T
363713 -  ..
363714 - Swelling on Millie's hand seems to be getting more severe; may
363715 - indicate positive effect of treatments with antibiotics, per Doctor
363716 - Kim's comments earlier. ref SDS 0 SP75
363718 -  ..
363719 - The doctor places a gauze bandage on the wound and wraps the hand to
363720 - protect the bandage.
363721 -
363723 -  ..
3638 -
3639 -
3640 - 1626
3641 -
364101 - Look for Marie.  Found her in the hallway and ask about getting
364102 - Millie some food.
364104 -  ..
364105 - She expects to be able to bring food into Millie in about 10 minutes.
364107 -  ..
364108 - Millie talks about going across the street to get a takeout hamburger
364109 - and fries.
364110 -
364112 -  ..
3642 -
3643 -
3644 - 1715
3645 -
364501 - Marie arrives with dinner.
364502 -
364503 - This is a chicken dish of some kind.
364505 -  ..
364506 - The dining table will not swing fully across Millie's lap for some
364507 - reason.  Millie is not impressed with the meal.  She eats a few bites
364508 - of the chicken and tries the bold biscuit.  Somehow the milk is
364509 - spilled, because of awkward arrangements of the tray.  Found some
364510 - towels to clean things up.
364511 -
364512 -
364514 -  ..
3646 -
3647 -
3648 - 1731
3649 -
364901 - Maria comes back and Millie asks if we can fetch a hamburger and fries 065702 - from the Taxicab restaurant across the street.
364903 -  ..
364904 - Maria says to hold off until the doctor clears this plan.  She removes
364905 - the uneaten meal tray, and says Kaiser is working on improving the
364906 - menus.
364908 -  ..
364909 - Maria says that Millie has been assigned a room on the 3rd floor, and
364910 - will moved upstairs in about 10 minutes.
364912 -  ..
364913 - Millie tries the cell phone to call Pam about power of attorney, asked
364914 - by Doctor Kim earlier, per above. ref SDS 0 I556  Cell phone fails to
364915 - get a dial tone in the hospital, so Millie uses the telephone on the
364916 - wall in the room.  Figure out how to dial the operator, who dial's
364917 - Pam's number.
364919 -  ..
364920 - Millie asks Pam to check the documents and confirm that Pam has power
364921 - of attorney in case Mil becomes incapacitated.
364922 -
364923 -
364925 -  ..
3650 -
3651 -
3652 - 1804
3653 -
365301 - Male nurse comes into the room and pushes Millie on the gurney to the
365302 - elevator and into her room 3024 on the 3rd floor.
365304 -  ..
365305 - Millie is sharing the room with a women who seems to have heart
365306 - disease.
365308 -  ..
365309 - There is initial problem with lights and getting the television to
365310 - work.  The male nurse who brought Millie up to the room will check
365311 - with the maintenance people
365313 -  ..
365314 - The nurse Cycline asks Millie the same patient history and personal
365315 - information requested 4 times previously.  She explains that Kaiser has
365316 - good computer technology, but each department keeps separate medical
365317 - chart history.
365319 -  ..
365320 - Millie asks the Cycline about getting a hamburger and fries from
365321 - across the street.
365323 -  ..
365324 - Cycline that Millie's chart and the doctor's instructions do not
365325 - support getting food outside the hospital.  She offers to call the
365326 - doctor to request clarification.
365327 -
365328 -
365330 -  ..
3654 -
3655 -
3656 - 1813
3657 -
365701 - Cycline returns to the room and says unfortunately, she could not talk
365702 - to the doctor because his cell phone seems to be out of order, who
365703 - took 5 or 6 calls earlier while examining Millie, per above.
365704 - ref SDS 0 OV5I  She left a message on the doctor's office line, but
365705 - does not expect to hear back in time for Millie to get a hamburger,
365706 - etc, before visiting hours end at 2030.
365708 -  ..
365709 - At this time, Doctor Kim came into Millie's room to see how she is
365710 - doing.
365712 -  ..
365713 - Cycline explained she tried to reach him earlier by cell phone.
365714 - Doctor Kim said the batteries must have failed, and he had to fix
365715 - this immediately.  He left the room.
365717 -  ..
365718 - Cycline seemed to say the Kaiser regulations required that Doctors be
365719 - reachable by cell phone at all times.  This is an internal Kaiser
365720 - system, and does not tie into an outside cell phone system.
365722 -  ..
365723 - Doctor Kim returned and checked on Millie.  She asked about having a
365724 - hamburger and fries, that she is still hungry.  Doctor Kim this would
365725 - be okay.
365726 -
365728 -  ..
3658 -
3659 -
3660 - 1827
3661 -
366101 - Took Millie's things to the car in the garage, and stored in the
366102 - trunk.  Walked across the street to the Taxicab restaurant and ordered
366103 - a hamburger, fries, and a drink, to go.
366104 -
366106 -  ..
3662 -
3663 -
3664 - 1917
3665 -
366501 - Walked back to Millie's room in the hospital.
366502 -
366503 - Met Cycline outside the room, and she said that Millie cannot have
366504 - fresh vegetables, like pickles, lettuce and tomato that are on the
366505 - hamburger.
366507 -  ..
366508 - We reviewed the discussion with Doctor Kim, who did not list these
366509 - limitations, per above. ref SDS 0 636G
366511 -  ..
366512 - Cycline said the written guidance on Millie are to avoid fresh
366513 - vegetables.  Explained that this is a hamburger from a fast food
366514 - restaurant, where nothing is fresh.  Decided that Millie would
366515 - advised not to eat the lettuce and the tomato and pickle.
366517 -  ..
366518 - Went into the room, and Millie had mastered the television, though it
366519 - is not an efficient system to use.
366521 -  ..
366522 - Millie enjoyed the hamburger and fries, and avoided the forbidden
366523 - items.
366525 -  ..
366526 - She seemed in good spirits but tired.  It was a long day.
366527 -
366529 -  ..
3666 -
3667 -
3668 - 2014
3669 -
366901 - Left the hospital.
366902 -
366904 -  ..
3670 -
3671 -
3672 - 2031
3673 -
367301 - Arrived home.
367302 -
367303 - Millie called with her direct line telephone number.
367305 -  ..
367306 - After this call, called Pam and Bill, Steve and Lilly, and Ron and
367307 - Kim to review major issues.
367309 -  ..
367310 - Helen called, and so I gave her a brief run down.  She will call
367311 - Janna.
367313 -  ..
367314 - Assembled the things Millie wants, per above. ref SDS 0 05G5
367315 -
367316 -
367317 -
367318 -
367319 -
367320 -
367321 -
367322 -
3674 -