THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: October 20, 2009 07:00 AM Tuesday; Rod Welch

Angiogram test at VA in San Francisco delayed due to emergencies.

1...Summary/Objective


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CONTACTS 
0201 - US Department of Veterans Affairs                                                                                                                                  
020101 - Ms. Karen B Rehder, NP MPH; Administrator  
020103 - Cardiology Department  

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 7 0000. ref SDS 6 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040508 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - On 090916 VA performed stress test, which indicated possible heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040902 - and circulation problems.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040904 -  ..
040905 - On 091002 met with Doctor Egan, Cardiologist at the VA.  The doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040906 - advised that 10 of 11 test points in the stress test showed positive                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040907 - for circulation problems, and so the doctor ordered angiogram.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040908 - ref SDS 3 1W5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040910 -  ..
040911 - On 091006 0843 Karen called and scheduled angiogram test on 091020 at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040912 - the VA in San Francisco. ref SDS 4 1W5I  Received a letter from Karen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040913 - on 091006 at 1045 confirming schedule for the test which requires                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040914 - arriving at the VA on 091019 to do prep for the test on 091020.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040915 - ref SDS 4 GK8L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040917 -  ..
040918 - On 091007 0021 sent a letter notifying the medical team that Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040919 - Egan's treatment plan is being implemented, and asked a question about                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040920 - the cause of pain based on level of effort. ref SDS 5 4Z75                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040922 -  ..
040923 - On 091007 0818 received letter from Karen at VA in San Francisco                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040924 - responding to the letter this morning asking the medical team for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040925 - cause of chest pain that correlates to level of effort.  Doctor Egan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040926 - has not had time to respond.  Karen attributes pain to possible                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040927 - angina, but does not explain what causes pain. ref SDS 6 A68H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040929 -  ..
040930 - 091019 1300 meeting at VA in Cardiology for blood test to prepare for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040931 - angiogram test tomorrow, ref SDS 7 X59F, per Karen's letter on 091007                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040932 - 0818. ref SDS 6 A68H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040934 -  ..
040935 - 091020 0700 meeting at VA in San Francisco for angiogram test,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040936 - ref SDS 0 YQ9L, explained in the record on, ref SDS 7 VH6Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040937 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040939 -  ..
0410 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041301 - Meeting at VA Surgery Department at 0700.  Got a wakeup call from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041302 - Millie at 0530.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041305 -  ..
0414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0416 - 0615                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0417 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041701 - Visit VA Surgery Department.  Check in and fill out forms inventoring                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041702 - belongings.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041704 -  ..
041705 - Met Pastaveia St John, the receptionist.  She performed administration                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041706 - required to be admitted for the angiogram test.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041708 -  ..
041709 - Went down the hall and found a place to work until 0745.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041710 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041711 -        [...below, Pastaveia turns out to be an MBA student, also,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041712 -        working at the VA; discussed correlations with Welch work on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041713 -        Communication Metrics. ref SDS 0 XE8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041714 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041715 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041717 -  ..
0418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0419 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0420 - 0800                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0421 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042101 - Mariela took vitals, and then dressed for surgery.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042102 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042103 - IV started.  For some reason, Mariela used the top of the left hand,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042104 - after inspecting the upper left arm.  Evidently she did not see a good                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042105 - vein, despite having blood drawn on the right arm inner elbow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042106 - yesterday.  The IV was painful getting started.  Also presents a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042107 - hinderence using the left hand for using the keyboard to work, while                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042108 - waiting to be whelled into the Cath Lab for the procedure.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
042110 -  ..
042111 - Mariela advises that another patient just started the first angiogram                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042112 - test today, so the procedure ordered by Doctor Egan in this case will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042113 - be next, and may occur from 20 minutes to 4 hours later, per meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042114 - with Kurt yesterday, on 091019 1300. ref SDS 7 VH55                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
042116 -  ..
042117 - While working with Mariela being prepared for the procedure,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042118 - overheard several other patients getting care by other nurses.  It                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042119 - seemed odd to hear several times things along the lines...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
042120 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042121 -        Hello Fred, nice to see back.  How have you been?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
042122 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042123 -        Hey Bob, good seeing you again.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042125 -  ..
042126 - Asked Mariela how often patients and staff see each other, enough to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042127 - know their names from prior procedures?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
042129 -  ..
042130 - Mariela seemed to say that many patients require return visits every                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042131 - few years more or less surgery to place new stents and to repair or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042132 - replace  prior stents.  Some return 2 or more times, so the nurses get                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042133 - to know them.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042134 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042135 -            [...below on 091020 0700 at 1324 Karen, the Administrator                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
042136 -            for Cardiology, explained some patients require repeat                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042137 -            procedures on stents. ref SDS 0 3C9J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042139 -             ..
042140 -            [...below on 091020 0700 at 1324 Doctor Quinn also asked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
042141 -            patient about prior angiogram/stent procedures. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042142 -            C46L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042144 -             ..
042145 -            [On 091021 0716 meeting with Doctor Shunk during angiogram                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
042146 -            procedure in Cath Lab - doctor recommended heart bypass                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042147 -            surgery (CABG) to repair 3 blood flow blockages,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
042148 -            ref SDS 9 G15L; approved CABG as more reliable, safer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042149 -            procedure in this case. ref SDS 8 H87F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
042151 -  ..
042152 - This was a tiring thought, so instead of working, decided to sleep.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042153 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042154 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042156 -  ..
0422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0424 - 1000                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0425 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042501 - Woke up.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
042502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042503 - Rene Ruiz offered to get the computer.  She was terrific lugging                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042504 - everything from patient locker storage into the Pre-op waiting area.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042505 - Rene made all the connections, and configured extra blankets to keep                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042506 - warm, and provide a pad for the keyboard.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
042508 -  ..
042509 - Was able to work while waiting for the 1st test to be completed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042510 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042512 -  ..
0426 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0428 - 1214                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0429 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042901 - Renee advised that the medical team had to treat an emergency case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042902 - from the hospital, and so this may bump the test to tomorrow or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042903 - another date in a few weeks.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042905 -  ..
042906 - She will have Karen stop by to review scheduling options.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
042907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042909 -  ..
0430 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0431 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0432 - 1324                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0433 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043301 - Karen visited.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043303 - She brought a schedule chart for selecting another date for the test.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043305 -  ..
043306 - We considered standing down and doing the test tomorrow, or coming                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043307 - back at a future date.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043309 -  ..
043310 - Karen advised that she wants to try and get the test done today,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043311 - rather than schedule another visit.  She seemed to indicate patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043312 - history suggests that the angiogram test may only take 20 minutes to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043313 - establish that no additional procedures are needed, per Kurts'                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043314 - explanation yesterday, on 091019 1300. ref SDS 7 TH3O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043316 -  ..
043317 - The test could be delayed until 1600 or so, and could take up to 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043318 - hours if extensive repair is required.  If repair stents are needed,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043319 - then recovery remaining stationary on the gurney will take another 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043320 - hours.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043322 -  ..
043323 - Karen said she talked to the GI staff at the VA in Martinez about this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043324 - case.  They feel there is a strong possibility that chest pains may be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043325 - due to achalasia, as discussed with Doctor Lee on 090908 1130,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043326 - ref SDS 2 MY4N, so the test today will find no problems, and so only                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043327 - take 20 minutes.  Karen therefore recommended not standing down, but                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043328 - continuing to stand by to get the test done today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043330 -  ..
043331 - Agreed to this work plan.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043332 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043333 -        [On 091021 angiogram test positive; heart bypass surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043334 -        scheduled for 091022. ref SDS 8 7L43                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043335 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043336 -        [On 091022 0700 quadruple heart bypass surgery performed by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043337 -        Doctor Tseng, and her team; took about 8 hours. ref SDS 10 01F9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043339 -  ..
043340 - Karen ordered fluid injection with the IV, since nothing has been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043341 - eaten and no liquids since about 2000 yesterday.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043343 -  ..
043344 - Asked Karen about durability of stents.  Related experience this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043345 - morning overhearing nurses welcoming patients back, and Mariela's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043346 - explanation that many patients require rework on stents fairly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043347 - regularly, per above, ref SDS 0 U59M, which seems to align with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043348 - Hoffman's inquiries about patient's history of prior procedures,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043349 - reported on 091019 1300. ref SDS 7 CW6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043351 -  ..
043352 - Karen seemed to indicate that stent technology and procedures are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043353 - improving, but reliability depends a lot on patient health and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043354 - lifestyle.  She indicated active patients do better, but some                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043355 - patients are unable to be active, and so in many cases can be helped                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043356 - with mutliple procedures to implant additional stents, and replace                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043357 - prior ones.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043358 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043359 -            [...below on 091020 0700 at 1324 Doctor Quinn also asked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043360 -            patient about prior angiogram/stent procedures. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043361 -            C46L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043363 -             ..
043364 -            [On 091021 0716 meeting with Doctor Shunk during angiogram                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043365 -            procedure in Cath Lab - doctor recommended heart bypass                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043366 -            surgery (CABG) to repair 3 blood flow blockages,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043367 -            ref SDS 9 G15L; approved CABG as more reliable, safer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043368 -            procedure in this case. ref SDS 8 H87F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043369 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043370 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043371 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043372 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043374 -  ..
0434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0435 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0436 - 1416                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0437 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043701 - Still standing by.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043702 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043703 - Renee connects fluids to IV ordered by Karen, per above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043704 - PQSR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043706 -  ..
043707 - No other patients are in the holding area.  Seems like the team has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043708 - processed 6 or 8 patients today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043709 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043711 -  ..
0438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0439 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0440 - 1553                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0441 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044101 - Rene says the medical team is now ready for this case.  They are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044102 - coming to get the patient.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044103 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044105 -  ..
0442 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0443 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0444 - 1609                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0445 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044501 - Jacqueline St Paul arrives.  She is the charge nurse for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044502 - angiogram test department.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044504 -  ..
044505 - Jacki has good news and bad news.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044507 -  ..
044508 - The test can be performed immediately.  However, if any problems are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044509 - discovered that require repair, e.g., stents, then this work will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044510 - require coming back tomorrow.  In that case, the patient will be a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044511 - "floater" again, and may get bumped several more times, as occurred                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044512 - today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044514 -  ..
044515 - Alternatively, Jacki has arranged for the patient to be the first                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044516 - procedure in the morning, which starts at 0930 on Wednesdays.  Both                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044517 - the test and any repair will be performed all at once.  If no repair                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044518 - is needed, then the work will only take 20 minutes or so.  If repair                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044519 - is needed, then it will be performed immediately.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044521 -  ..
044522 - Decided to do all of the work tomorrow.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
044524 -  ..
044525 - Rene called and found that the Hoptel is booked for tonight.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044526 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044527 -        [On 091021 angiogram test positive; heart bypass surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044528 -        scheduled for 091022. ref SDS 8 7L43                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044529 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044530 -        [On 091022 0700 quadruple heart bypass surgery performed by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044531 -        Doctor Tseng, and her team; took about 8 hours. ref SDS 10 01F9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044533 -  ..
044534 - Jacki called Evelyn in the Post-op ASU to arrange for a room in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044535 - hospital.  This makes the case an "inpatient" matter, and so will have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044536 - priority for care tomorrow.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044538 -  ..
044539 - Patient will not come back to the Pre-op ASU waiting area tomorrow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044540 - morning, but will be wheeled on the gurney from the hospital room                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044541 - directly to the treatment area for immediate care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044543 -  ..
044544 - While Rene and Jacki arranged to implement the new work plan,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044545 - Pastaveia St John stopped by, ending her day, per above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044546 - XU5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044548 -  ..
044549 - She asked about computer c16 being used to report on events today, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044550 - to plan tomorrow.  Explained the HP HDX 18t, purhcased on 090623 1648.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044551 - ref SDS 1 294M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044553 -  ..
044554 - Pastaveia is an MBA student.  We discussed POIMS, concepts for working                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044555 - intelligently, ref OF 3 6221, including Communication Metrtics.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044556 - ref OF 6 685K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044558 -  ..
044559 - Pastaveia looked up welchco.com on the Internet and sent an email to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044560 - provide contact for follow up...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044564 -  ..
044565 - Thanked Pastaveia for supporting the angiogram test.  Will try to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044566 - follow up tomorrow after returning home following the test.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044567 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044568 -        [On 091130 2007 follow up delayed due to complications of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044569 -        quadruple heart bypass surgery on 091022. ref SDS 11 PB5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044571 -  ..
044572 - Rene disconnected the IV.  The needle will remain overnight so it                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044573 - does not have to be done again.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044574 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044575 -        [On 091021 angiogram test positive; heart bypass surgery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044576 -        scheduled for 091022. ref SDS 8 7L43                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044577 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044578 -        [On 091022 0700 quadruple heart bypass surgery performed by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044579 -        Doctor Tseng, and her team; took about 8 hours. ref SDS 10 01F9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044581 -  ..
044582 - Rene and Jacki assembled belongings, including the computer, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044583 - wheeled the gurney from Pre-op ASU into Post-op ASU to wait for a room                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044584 - to stay the night.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044586 -  ..
044587 - Rene met with Carol and explained the work plan for Welch to stay                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044588 - overnight in the hospital.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044589 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044590 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044592 -  ..
0446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0447 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0448 - 1644                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0449 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044901 - Carol introduced herself.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
044902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044903 - She will call Evelyn on progress arranging for a room in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044904 - hospital.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
044905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044907 -  ..
0450 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0452 - 1652                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0453 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
045301 - Carol asked about ordering dinner.  She thinks it might be another                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
045302 - hour before a room is available, and then it could take another hour                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
045303 - after that to get a meal.  She suggests ordering dinner now.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
045305 -  ..
045306 - She does not know the menu.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
045307 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045309 -  ..
0454 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0456 - 1705                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0457 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
045701 - Millie called.  Filled her in on the work plan.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045702 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
045704 -  ..
0458 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0459 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0460 - 1729                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0461 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
046101 - Carol reports a room has been assigned.  There is more administrative                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
046102 - work to file reports required for getting into the room.  Carol is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
046103 - having problems explaining there is no medical record in this case,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
046104 - because no work was actually done today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
046106 -  ..
046107 - Carol asked for the color of the IV needle.  Looks like pink.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
046108 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046110 -  ..
0462 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0463 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0464 - 1748                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0465 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
046501 - Michale and Carol moved patient from Post-op ASU into a hospital                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
046502 - room.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
046504 -  ..
046505 - Dinner showed up in the Pre-op ASU.  Carol took the dinner tray, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
046506 - Michael wheeled the patient in a wheelchair.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
046508 -  ..
046509 - Met Ed the orderly, and the nurse.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
046511 -  ..
046512 - Got the computer set up.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
046514 -  ..
046515 - Vitals were taken for record purposes only since the patient has no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
046516 - actual treatable condition at this time.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
046517 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046518 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046520 -  ..
0466 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0467 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0468 - 1835                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0469 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
046901 - Nurse brought another dinner tray.  Same menu, ravioli.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
046902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
046904 -  ..
0470 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0471 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0472 - 2310                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0473 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047301 - Doctor Gene R. Quinn, MD MS, visited.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047302 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047303 - He is a doctor in training with UCSF and working at the VA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
047305 -  ..
047306 - Reviewed medical history of current problem, reported on 091002 0900.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047307 - ref SDS 3 1W5I, citing the record meeting with Doctor Lee at the VA in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
047308 - Martinez on scheduling a procedure to resolve achalasia, reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
047309 - 090908 1130, ref SDS 2 MY4N, and further and cited in the letter to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
047310 - Karen on 091007 0021. ref SDS 5 VM4V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047312 -  ..
047313 - The doctor asked about prior stent procedures, and was told that this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047314 - will be the first one, if necessary, per discussion with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047315 - Hoffman, last night, shown on 091019 1300. ref SDS 7 CW6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047317 -  ..
047318 - This question on prior angiogram/stent procedures, aligns with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
047319 - experience this morning overhearing nurses welcoming back prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047320 - patients for follow up work, per above. ref SDS 0 U59M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047322 -  ..
047323 - Gene has not worked with Doctor Rugo, but seemed to indicate having                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
047324 - worked with Doctor Hsu in Radiation Oncology at UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047326 -  ..
047327 - Reviewed advantages of a well ordered record, explained in POIMS,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047328 - ref OF 3 ZC6N, and in NWO. ref OF 12 Q07K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047329 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047330 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047332 -  ..
0474 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0475 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0476 - 0026                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0477 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
047701 - Julie Ishida, MD visited and made another review, exactly as performed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
047702 - by Doctor Quinn. ref SDS 0 PS5U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047704 -  ..
047705 - Julie explained that she supervises Gene's work, and so she will work                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047706 - with him on writing up the record on these meetings.  She advised                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047707 - there will be only one report for the two separate consultations.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
047709 -  ..
047710 - Explained medical history again for current problem, reported to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
047711 - Doctor Egan at the Va in Martinez, on 091002 0900. ref SDS 3 1W5I,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
047712 - citing the record meeting with Doctor Lee at the VA in Martinez on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
047713 - scheduling a procedure to resolve achalasia, reported on 090908 1130,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
047714 - ref SDS 2 MY4N, and further and cited in the letter to Karen on 091007                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
047715 - 0021. ref SDS 5 VM4V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
047716 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047717 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047718 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047719 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047720 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047721 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
047722 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0478 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
Distribution. . . . See "CONTACTS"