I am fascinated by the coordination of medical, surgical, and social care of patients in the SICU. Spending time on the floor Ive been observing the extreme importance of and consideration of social issues in various aspects of patient care (end of life decisions, resuscitation, post hospital placement) and also in direct patient care. One chronic alcoholic patient had a fall and resultant seizure after a history of previous fall with seizure and wound up in the SICU for close neurological monitoring after her laceration repair. This patient was not only a long term drinker, they were a heavy drinker, up to 20 drinks/day, and before the fall had reportedly drank two bottles of wine. Due to their intense alcohol use, they were seizing due to alcohol withdrawal and the knowledge of their alcohol use let the team treat them by starting a whiskey drip. Yes, literally an IV that dripped whiskey at 50cc/4h so they could slowly be weaned off the alcohol without seizing. Another young patient developed an unusual fungal infection while being treated for an unrelated condition on the floor. Knowledge of their socioeconomic background put them at an increased risk for HIV which he was then tested for and treated accordingly. On almost any floor of the hospital you can find a large poster of the Patient's Bill of Rights which delineates basic patient rights. However, what happens with various patient's rights with respect to social issues, such as the law, both as a victim or as a criminal? This past week I was able to observe.
The first patient was an 18 year old high school senior who was transferred to the Weill Cornell SICU from Jamaica Hospital after suffering a traumatic descending thoracc aortic dissection and subsequently developed massive bilateral hemathoraces. He needed intense hemodynamic monitoring and blood pressure control. The patient suffered these injuries as they were fleeing from the police as a restrained passenger after stealing a car and crashing into a church. As such, he had a policeman posted in his room 24/7 despite being in a coma, unable to move, and unable to breath without a mechanical ventilator. I found this a little ridiculous. I mean, really, where is this kid gonna go? However, that is legal. What isnt legal is officially charging or processing the patient until they are cognizant of their crimes and able their charge. The police began fingerprinting the patient one morning while they were still comatose and clearly not cognizant and so patient services was called and the fingerprinting aborted. A few days later the patient was on a sedation holiday to determine mental status and GCS. In this state they were able to open their eyes but still barely conscious and unable to talk. They were fully vented. Legally being able to open their eyes and show some purposeful movement was enough to be determined cognizant and allow processing; the fingerprinting was resumed successfully.
The second patient was a young female who lives with her boyfriend. Her initial story was that she went out with friends drinking one night, came back to the apartment with a bump on her head the boyfriend noted but that she didnt know how she got. They both went to bed and got up in the morning with no unusual symptoms. The patient went about her day and saw friends again. They possibly drank again. Patient came back home, went to bed around 11pm, but the boyfriend was then woken up at 2:30am by her vomiting in bed unresponsive. In the Emergency Department she was a GCS 3 (thats bad. really really comatose), intubated, and found to have a massive cerebral brain hemorrhage and subdural hematoma. Clot was evacuated and she was given a craniotomy to control the extreme swelling of her brain, but she remained nonresponsive with GCS 3-4 postop. The patients mother and brother flew in and mentioned patient had a possible history of drug and alcohol abuse boyfriend had not mentioned. After her surgery, she was taken for a full head and face CT and it was seen that patient also had multiple facial fracture. A bump on the head after drinking can be passed off but the prescence of multiple facial fractures undermines the initial story told. While it is still not exactly known what happened to the patient, it now appears she is the victim of some assault that the boyfriend was trying to cover up. It could be him, it could be from a drug-related crime, perhaps they owed money to someone...the only people that know exactly what happened is brain dead and lying. However, with no real story or strict evidence of a crime it is difficult to get the police involved. I am not entirely sure how this case will proceed or even if it will become a police case, but I am very interested to find out what happens.
Regarding research David was able to get the program to rudimentarily run after talking with IT people in Ithaca. Once David is back I am feeling more confident about moving forward on this project!
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