CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 14 0000. ref SDS 13 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 4 1W5I
040910 - ..
040911 - On 091006 0843 Karen called and scheduled angiogram test on 091020 at
040912 - the VA in San Francisco. ref SDS 5 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 5 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 8 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 9 A68H
040929 - ..
040930 - 091019 1300 meeting at VA in Cardiology for blood test to prepare for
040931 - angiogram test tomorrow, ref SDS 10 X59F, per Karen's letter on 091007
040932 - 0818. ref SDS 9 A68H
040934 - ..
040935 - 091020 0700 meeting at VA in San Francisco for angiogram test delayed,
040936 - ref SDS 11 01F9, explained in the record on 091019 1300. ref SDS 10 VH6Q
040938 - ..
040939 - 091021 0716 Meeting at VA to complete angiogram test orientation
040940 - meeting, ref SDS 13 01F9, and perform test.
040942 - ..
040943 - On 091022 0700 Doctor Seng, Casey and others performed the surgery.
040944 - ref SDS 14 01F9
040946 - ..
040947 - On 090123 0445 Recovery from heart bypass surgery yesterday.
040948 - ref SDS 0 01F9
040949 -
040950 -
040951 -
040953 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Wake from surgery in something of a panic. Expected to wake up OA
041302 - 1900 Thursday evening to watch the Yankees Angles game, planned in the
041303 - call from Eddie Wednesday eveing, reported on 091021 0716. ref SDS 13
041304 - UI6J But since surgery was not completed until 1800, per the record
041305 - yesterday on 091022 0700. ref SDS 14 LO3G, slept through until about
041306 - 0500 this morning. Didn't know date nor time. Was it 0500 in the
041307 - evening, or in the afternoon?
041309 - ..
041310 - [On 100928 0706 received CD with VA medical records on
041311 - heart surgery, showing incorrectly patient was "educated"
041312 - which means notified to be prepared for post-op
041313 - conditions that cause anxiety and fear, in this case
041314 - having a tube inserted into the throat needed to prevent
041315 - complications from achalasia during heart surgery.
041316 - ref SDS 14 4Q4N
041318 - ..
041319 - Had been dreaming and so forgot and was not aware of heart surgery
041320 - yesterday. Immediately realized there was a tube in the throat that
041321 - prevented talking, and it seemed to be impacting breathing. Hands
041322 - were restrained to prevent heart surgery patients from removing
041323 - support aparatus. There was a moment of panic while trying to recover
041324 - breathing and explain the problem to several doctors and nurses in
041325 - conversation at the foot of the bed providing post op support.
041327 - ..
041328 - Was finally able to get Genenine's attention by tapping on the sides
041329 - of the gurney. Since could not talk, Genine asked a series of
041330 - questions.
041332 - ..
041333 - When she finally mentioned breathing, was able to single yes to the
041334 - breathing problem. Genine looked at the monitor and said breathing
041335 - was fine. Since breathing did not seem "fine," was concerned there
041336 - was a false reading on the monitor.
041338 - ..
041339 - Genine was sure breathing was adequate. She said severe discomfort
041340 - with tubes in the throat was necessary in this case to prevent
041341 - vomitting and choking due to achalasia, and must continue post-heart
041342 - surgery for another few hours until the doctor issues an order to
041343 - remove the tubes.
041345 - ..
041346 - Yesterday morning, Doctor Brezinski, the anesthesiologist, planned for
041347 - aparatus to prevent choking and vomitting during heart surgery. 091022
041348 - 0700, ref SDS 14 GX4J
041350 - ..
041351 - Genine will send a note to the medical team that the patient wants the
041352 - tubes removed, to relieve extreme distress. Genine said that
041353 - ramaining very still will reduce discomfort caused by being awake with
041354 - breathing tubes.
041355 -
041356 - [On 100305 1000 Progress Notes for endoscopy and colonosocopy
041357 - procedure call for providers to explain and discussion to warn
041358 - patient about sedation issues. ref SDS 13 5L4O
041359 -
041361 - ..
0414 -
0415 -
0416 - 0745
0417 -
041701 - Genine removed the tube from the throat. This provided considerable
041702 - relief from physical pain and discomfort. Further relief from
041703 - emotional distress not being able to talk.
041705 - ..
041706 - Continued to sleep.
041707 -
041709 - ..
0418 -
0419 -
0420 - 0849
0421 -
042101 - Neal, Joe, and KC came by for assessment.
042102 -
042103 - Neal gave a "thumbs up" sign. He said the operation went very well
042104 - with no complications. Doctor Tseng expects full recovery, and faster
042105 - than other patients due to good conditioning. This aligns with
042106 - comments Dennis made after the angiogram test on Wednesday, and Doctor
042107 - Shunk recommending heart surgery, reported on 091021 0716. ref SDS 10
042108 - 7249
042110 - ..
042111 - Did not feel well despite report that the opration went well. This
042112 - may be due to adding a number of drugs for medication to support post
042113 - surgery requirements. The body has never had any drugs, and so
042114 - adding new stuff seems foreign.
042116 - ..
042117 - Fentanyl is a direct injection that acts very fast to relieve pain,
042118 - but it only lasts 40 minutes or so, and then has to be repeated.
042120 - ..
042121 - Percocet combines oxycodone with acetaminophen (Tylenol) and in this
042122 - case taken in pill form is a challenge to injest with achalasia.
042123 - However, it lasts 6 hours or so, after taking 30 - 60 minutes to take
042124 - effect.
042126 - ..
042127 - Was given Fentanyl regularly througout the day and through the night
042128 - for pain management, and this was very effective. Joe gave an
042129 - injection through a port catheter whenever asked.
042130 -
042131 - [On 091024 0600 continued getting Fentynal, because
042132 - swallowing problems prevented oxycodone from being
042133 - effective. ref SDS 12 01F9
042134 -
042135 -
042136 -
042138 - ..
0422 -
0423 -
0424 - 0930
0425 -
042501 - Called Millie.
042502 -
042503 - She was crying and emotional from not knowing results of the operation
042504 - yesterday. She was up all night with worry from not being able to
042505 - communicate with the medical team.
042507 - ..
042508 - She expected to get a call yesterday afternoon. When no one called,
042509 - Millie called the VA to find the patient somewhere in the hospital;
042510 - but she could not get through to anyone who could find the patient or
042511 - explain if things went well, or badly, so she assumed the worst.
042513 - ..
042514 - Explained change in work plan. Did not wake up until this morning; it
042515 - was somewhat traumatic. ref SDS 0 01F9
042517 - ..
042518 - Gave assurance that so far the work seems to be effective, per Neal
042519 - above. ref SDS 0 VR4G
042520 -
042521 -
042522 -
042523 -
042525 - ..
0426 -
0427 -
0428 - 1105
0429 -
042901 - Was lifted by two nurses to sit on the edge of the bed, and then to
042902 - sit in a chair next to the bed. This was a painful experience. Was
042903 - dizzy for a few minutes. Eventually made it to the chair tethered to
042904 - a lot of support and diagnostic cables.
042906 - ..
042907 - Blood pressure dropped, so decided not to do an initial walk at this
042908 - time.
042909 -
042911 - ..
0430 -
0431 -
0432 - 1133
0433 -
043301 - Millie arrived for a visit.
043302 -
043303 - She was very relieved to hear from the doctor that the surgery was a
043304 - success, and full recovery expected, after problems getting through on
043305 - the telephone yesterday and all last night, per telecon above.
043306 -
043307 -
043308 -
0434 -
SUBJECTS
Advance Directive End-of-life Approved Signed No Recissitation Excep
1703 -
1704 - 1215
170501 - ..
170502 - End-of-life Advance Directive Approved No Recessitation
170503 -
170504 - Pat and Kathy arrived from the social department for a meeting.
170506 - ..
170507 - Reviewed documentation for end-of-life Advance Directive required for
170508 - medical decisions in case the patient becomes incapacitated.
170509 - ref DRP 6 XSTT
170510 -
170511 - [On 140819 0800 notified VA Clinic Martinez that Advance
170512 - Directive was filed on 091023; for some reason VA filed "PC
170513 - Preventive Health 60498" Note saying "The patient indicates
170514 - that they do not have an Advance Directive." ref SDS 16
170515 - 0Y5L
170517 - ..
170518 - Listed Millie as the primay contact, and Lilly as secondary.
170519 - ref DRP 6 E87F
170521 - ..
170522 - Discused patient choices on life support. ref DRP 6 388M
170524 - ..
170525 - This seemed like an end-of-life directive.
170527 - ..
170528 - Signed and initialed documents showing each circumstance was
170529 - considered in the meeting. Life sustaining care will only be given as
170530 - part of recovery. If the medical team decides recovery is impossible,
170531 - treatment will not be continued, with patient in vegatitive condition.
170533 - ..
170534 - The problem is defining "vegative" condition. People in a hurry with
170535 - meetings, calls, email, patients, parties, Little League, and so on
170536 - can render summary judgement for death despite prospects for recovery.
170537 -
170538 - [On 100305 1000 Progress Notes for endoscopy and colonoscopy
170539 - test report that patient has not filed "end-of-life Advance
170540 - Directive, ref SDS 13 MV6M, which seems conflcting with work
170541 - today on 091023, per above. ref SDS 0 WO5Y
170543 - ..
170544 - [On 100928 0706 received CD with medical records from VA
170545 - showing Advance Directive was filed today on 091023.
170546 - ref SDS 14 PQ5R
170548 - ..
170549 - [On 110218 0730 Iris, lead nurse in GI Department for VA
170550 - Martinez advised that patient medical records for Advance
170551 - Directive on file in the San Francisco Medical Center is
170552 - not available to the VA Clinic in Martinez. ref SDS 15 EE4L
170553 -
170554 -
170555 -
170556 -
170557 -
1706 -
SUBJECTS
Default Null Subject Account for Blank Record
1803 -
180401 - ..
180402 - Millie left to get home without a lot of traffic.
180403 -
180405 - ..
1805 -
1806 -
1807 - 1400
1808 -
180801 - The team decided the patient could be released from post-op ICU, so
180802 - was moved back to general ICU unit at the other end of the department.
180804 - ..
180805 - This just entailed pushing the gurney which is on wheels to the end of
180806 - the hallway, and back into the room I had yesterday.
180808 - ..
180809 - Benny was the nurse again today. Great to see a familiar face.
180811 - ..
180812 - Arvine, the charge nurse, reconnected probes to the equipment
180813 - monitoring patient progress, principally heart rate (pulse), blood
180814 - pressure, and oxygen.
180816 - ..
180817 - Wonderful to work with Arvine again, following up initial entry to ICU
180818 - on Wedeesday, and noting Arvine's exceptional skill and assistance for
180819 - the patient, reported, 091021 0716, ref SDS 10 733A
180821 - ..
180822 - Craig visited to perform another sonogram that evaluates
180823 - post-operation condition of the heart.
180824 -
180825 -
180826 -
180827 -
180828 -
180829 -
1809 -