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Wraythe
06-04-2014, 03:08 PM
Hey everyone,

I hope this wonít be going over something thatís already been asked. Iíve had a search through, and Iíve learnt a lot already on this area thanks to this board, but Iíd just like to throw this scene out there and see if Iím on the right track?

Any help is greatly appreciated!

-----

In the scene, a brother and sister have had a car accident (not paying attention). The brother was driving, but managed to get away from the crash, collapsing and losing consciousness some distance away (perhaps adrenaline kicks in - he wants to get help for his sister). The sister has been unconscious since the impact.

Theyíve both been taken to the hospital - letís say itís a medium sized hospital with everything they would need. I guess it might be possible that their specialists arenít always in the hospital, but on call or something? Is that possible?

The main conundrum Iím facing is that the brother has woken up with a lot of injuries and soreness, and I think I may be giving him a concussion of some sort, which has made him forget the incident itself. Heís in a private recovery room (in an ICU, I believe would be the correct area at this point?), and completely disorientated.

The sister is nowhere to be seen, but sheís off having surgery since her injuries were a lot more severe. Sheíll be out of the story and unconscious for the majority of the tale now.

I'm struggling to find what would be a realistic Ďepisodeí that could happen to the brother, to warrant a psych consult, or observation? Iím trying to go down a psychological route here, mixed in with a bit of guilt and potentially some instant-onset PTSD. Do you guys think this might be a stretch of the imagination at all? Too unbelievable, so to speak? I need this guy to stay in the hospital for at least several days, as thereís going to be some pretty weird stuff going on.

Iíve had a few ideas:

- Some form of seizure, but not sure if that would necessitate a psychiatrist or specialist in that area to be called.
- Aggression due to the disorientation, and not knowing whatís happened to his sister. Not entirely sure how far I can go with this, as a doctor would have to be quite daring to administer some form of tranquilliser or sedative without knowing medical history?
- Some form of abnormal behaviour, suggesting that heís seeing or hearing things - a result of the concussion/trauma/guilt/PTSD?

My next conundrum is also around their family situation. Theyíre both adults, but also orphaned. Their only relatives are an aunt and uncle, who donít really care. They also live a great distance away, which is unreasonable for them to travel.

Iíve done some investigation into things like HIPAA, but basically I have a friend of the brotherís who arrives at the hospital, and a woman who discovered the accident scene and phoned the ambulance. The friend was the last person to call the brother on his mobile phone, so Iím hoping itís reasonable that during the brotherís unconscious spell, they might have gone through his personal effects to identify him and contact someone? As he was the last call, is it reasonable that heíd be called in? Iíd also like the woman to be sticking around, as sheíll be somewhat of a surrogate for the sister in the story as well.

Would it be unrealistic for these two individuals to be told about the specifics of the case, by the doctorís. As the brother is an adult, would the doctorís wait for him to wake up, to ask if itís ok to discuss medical history with them (specifically the friend)? Iím trying to work with a bit of exposition with these two characters, as this is how weíll find out about their history and situation. This will then tie into later discoveries and revelations.

Would it be unreasonable for the woman to have stuck around, as she practically witnessed the accident, and then perhaps the friend to ask her to keep checking in when heís not around?

Itís a lot to go through, and I guess my thoughts are a little scattered - thanks for reading.

If anyone can weigh in on any of the questions, itíd be a huge help. Even to say that it sounds like Iím on the right track, or if Iím wildly wrong :).

Thanks!

waylander
06-04-2014, 03:23 PM
Where is this set?

ap123
06-04-2014, 03:34 PM
ICU rooms aren't very private, because patients are there to be watched closely.

A complex partial seizure can cause memory loss surrounding the time of the seizure, and depending on the path of the seizure itself (which parts of the brain get in on the action), it can cause aggression. CP seizures do not necessarily cause the jerking movements typically thought of when someone not experienced in seizures--again, depends on the path the seizure takes--but can cause someone to keep moving, though the movements might be somewhat robotic, and they might even say something. Conscious but not aware, if that makes sense.

The on-call neurologist would likely be who came to see him. I have heard of small hospitals without epilepsy units not recognizing CP seizures--but considering he just had a car accident, I'd find that unlikely. If the seizure doesn't resolve on its own within a few minutes, it's likely he would be given something like valium, ativan, etc, to stop the seizure, given an EEG, and then maybe put on an AED (anti-epileptic drug) for a while to try and prevent him seizing again.

Possibly a busy night/day in the hospital, if the staff on the floor were unsure...psych and neuro were called and the psych got there first?

Wraythe
06-04-2014, 03:38 PM
Where is this set?

Hi Waylander,

Completely forgot to include that.

The way that I'm writing it, and the way I'm seeing the story progress - it's looking like it's set in the US. It'll be a fairly metropolitan city centre, but with lots of suburban areas within driving distance as well (let's say within 20-30 minutes drive)?

I don't have a specific city or state in mind - I'm hoping that doesn't have too much of an impact? I suppose there's a small effort to keep it quite generic at this point.

Wraythe
06-04-2014, 03:51 PM
ICU rooms aren't very private, because patients are there to be watched closely.

A complex partial seizure can cause memory loss surrounding the time of the seizure, and depending on the path of the seizure itself (which parts of the brain get in on the action), it can cause aggression. CP seizures do not necessarily cause the jerking movements typically thought of when someone not experienced in seizures--again, depends on the path the seizure takes--but can cause someone to keep moving, though the movements might be somewhat robotic, and they might even say something. Conscious but not aware, if that makes sense.

The on-call neurologist would likely be who came to see him. I have heard of small hospitals without epilepsy units not recognizing CP seizures--but considering he just had a car accident, I'd find that unlikely. If the seizure doesn't resolve on its own within a few minutes, it's likely he would be given something like valium, ativan, etc, to stop the seizure, given an EEG, and then maybe put on an AED (anti-epileptic drug) for a while to try and prevent him seizing again.

Possibly a busy night/day in the hospital, if the staff on the floor were unsure...psych and neuro were called and the psych got there first?

Hey ap123,

Thanks for the response.

A CP seizure sounds promising (well, it sounds like something to avoid, but good for my situation). I've had a quick google, and can see that depending on the areas of the brain it hits, aggression and even 'seeing things' can be the result.

If he's going to have a seizure soon after waking up, would he then be kept in bed for a while? I'm imagining this room to be private, but with constant check-ups? Would there be any chance of him being moved to somewhere else in the hospital with this series of events? I've got it into my head that this character won't be in a critical state, but is kept for observation. He'd be taken for regular meetings in a separate 'interview' type room, moving back and forth from a bed? He'd be under escort and such - wondering if that would ever happen - possibly under unique circumstances?

One thing I probably should have mentioned is that this character is going to be 'seeing things' for the rest of the story - very real and reasoned hallucinations or manifestations - doctors can't attribute it to a particular trigger - could be something neurological, could be something psychological?

Hope that all makes sense. Thanks again for your help :)

ap123
06-04-2014, 04:02 PM
If nothing from the accident was critical, I'd think it was unlikely he'd be in the ICU.

Very likely they'd want him in bed if he'd just had a significant seizure--even more likely he wouldn't be getting out of bed anyway. Many people sleep deeply after szing (post-ictal period), not to mention the meds he would have been given.

Transport would likely be in a wheelchair, many large city hospitals have a "transport" dept, people whose jobs are to take patients from one dept to another.

*I am not a doctor, just someone with lots of hospital experience.

Wraythe
06-04-2014, 04:17 PM
I was going for something along the lines of him having lost a fair bit of blood, but since he was able to get himself clear of the wreck; a concussion would be his main ailment.

Is there a more suitable place for him to wake up in, if he's been unconscious for a few hours after the accident? Then when he does wake up, the doctors ask him the standard recollection questions - they don't get much out of him.

CP seizure happens at some point / possibly identified and medication administered. Neuro / Psych could be called? Would he be unresponsive / unconscious after the medication for some time? After his 'deep sleep', would he then be moved for evaluation to a psych ward, or just a separate area of the hospital, potentially isolated?

If it was just a small seizure - the straw breaking the camels back, so to speak - he could be wheeled about in a wheelchair for a few days, but eventually is able to start moving around himself, gradually regaining his strength?

Thanks for all the help ap123 - sorry I'm asking so many questions. Want to get it right :).

shadowwalker
06-04-2014, 04:22 PM
Because there would be every liklihood that any disorientation, memory loss, aggression, etc, would be the result of the car accident, highly unlikely there would be a psych consult. If these things were still happening some time after the accident (several days at the very least) and the neurologists could find no reason for it, then they might be called in. His feeling guilty wouldn't warrant it, either, since that would be considered a normal reaction. If it got to the point it was interfering with his normal life, that could be cause.

As to the friend and the woman, neither would be given any details. And if the guy's injuries weren't that severe (and it doesn't sound like they were), the doctors would most likely wait until he regained consciousness and ask who they should call, if anyone, and he would have to sign consent forms for any medical info to be divulged. The woman would have been questioned at the scene, but have no "official" recognition at the hospital.

Wraythe
06-04-2014, 04:43 PM
Because there would be every liklihood that any disorientation, memory loss, aggression, etc, would be the result of the car accident, highly unlikely there would be a psych consult. If these things were still happening some time after the accident (several days at the very least) and the neurologists could find no reason for it, then they might be called in. His feeling guilty wouldn't warrant it, either, since that would be considered a normal reaction. If it got to the point it was interfering with his normal life, that could be cause.

As to the friend and the woman, neither would be given any details. And if the guy's injuries weren't that severe (and it doesn't sound like they were), the doctors would most likely wait until he regained consciousness and ask who they should call, if anyone, and he would have to sign consent forms for any medical info to be divulged. The woman would have been questioned at the scene, but have no "official" recognition at the hospital.

Hey shadowwalker,

Thanks for weighing in :).

Really looking for a believable sequence of events to warrant a psych consult, or at least drawing special interest. Would this then move down the path of hallucinations, resulting in abnormal behaviour (also possibly the result of a seizure, which would be looked into)?

Thanks for the information on the friend and woman as well. I guess it wouldn't be too much of a stretch for him to wake up and tell the doctor's to call his friend, after they ask. I'm guessing it would definitely have to be a consent form rather than verbal? I might have to make some changes, if there's no reasonable explanation for either of them to arrive?

I'll get my thinking cap on :).

jeseymour
06-04-2014, 04:46 PM
Have him try to kill himself when he realizes his sister is seriously hurt because of his driving. That'll get him psychiatric attention.

Wraythe
06-04-2014, 05:10 PM
Have him try to kill himself when he realizes his sister is seriously hurt because of his driving. That'll get him psychiatric attention.

That's something I hadn't even considered, and I think it could work!

I'm a rookie when it comes to Hospital environments - would there be anything in a recovery room to hand / within arms reach that he might be able to do this with later that day or something?

Thanks jeseymour :)

nikkidj
06-04-2014, 11:05 PM
That's something I hadn't even considered, and I think it could work!

I'm a rookie when it comes to Hospital environments - would there be anything in a recovery room to hand / within arms reach that he might be able to do this with later that day or something?

Thanks jeseymour :)

I've seen patients try to strangle themselves with sheets, telephone cords, blind cords, etc. Any of those would work. And it would definitely get him a psych evaluation, even possibly a 72-hour hold.

Be careful about where you have the accident, though. Most metropolitan areas have Level I trauma centers, where the most seriously ill are transported. Unless the sister's injuries are simply orthopedic, she'd likely be transported to a Level I facility, especially if she needs intra-abdominal surgery after a trauma. If he has to be in the same hospital, make the accident downtown, close to the trauma center, because unless he has life-threatening injuries, too, he wouldn't be transported to the level I center unless it was the closest facility. And if you have the accident in a rural or suburban area, the sister will be transported to the level I center while the brother is stabilized at the community hospital.

Now, if you're going for admission due to a seizure, you need to have a medical reason for admission, not a simple seizure. Maybe a temporal lobe cerebral contusion? This could cause a seizure, but doesn't need surgery, just monitoring. He could also have frontal lobe contusions, which could cause psychiatric symptoms. (just a thought) But unless there's a medical problem, like a tumor or low sodium, a first-time, or even second-time, seizure isn't likely to warrant admission. Of course, you don't necessarily need him admitted-- he could find out that his sister is in surgery while still in the ED and try to commit suicide at that time. They could do a psychiatric evaluation on him while in the hospital, and then admit him to the psychiatric unit. That is, of course, supposing the level I trauma center also HAS a psych unit, which doesn't always happen.

HTH

Wraythe
06-05-2014, 12:11 AM
Thanks nikkidj!

I'll work with one of those and see what happens :).

I'm going for a deliberately general approach when it comes to details about a town/city and location overall. It'll be a fictitious hospital, so it's not beyond reach that it could have a Trauma Centre and a Psychiatric Unit? I hope not, anyway!

Great tip on the location of the accident as well. That details would have escaped me. Currently the accident is taking place on one of the main roads out of town, but just on the outskirts of the city centre, moving into a suburban area. I think that might just cut it in terms of having them both taken to the same hospital?

Am I right in thinking that a Frontal Lobe Contusion wouldn't necessarily be identifiable until my character wakes up? Then upon waking up, doctors would need to ask some standard questions to test mental function (names, counting numbers, general knowledge questions), and establishing a GCS?

Should my character make a suicide attempt - even a poor one - is there a chance that doctors may also have fears over increased intercranial pressure, due to stress and agitated behaviour? That would result in a few more tests and a longer time spent in hospital, right? This would be on top of the psychological evaluation, where he would be moved, leading to a full admission? Would the psychiatric evaluation take place in his current location (recovering after being patched up - would there be an area / room after the ED that's suitable for this?), or would he be transferred first?

Thank again! :)

WeaselFire
06-05-2014, 01:20 AM
I'm struggling to find what would be a realistic ‘episode’ that could happen to the brother, to warrant a psych consult, or observation?

Easy. Psychotic reaction to opiates used as pain killers. Got me a psych eval after surgery. Apparently I threatened to kill every one, injure or kill myself, etc. Couldn't vouch for it, I was on pain killers and never knew any of it happened.


They’re both adults, but also orphaned.

Nope, they're just adults. Relatives/guardians/etc. come into play but not whether their parents are alive.


... I’m hoping it’s reasonable that during the brother’s unconscious spell, they might have gone through his personal effects to identify him and contact someone?

Not reasonable, standard procedure. By the police, not the hospital staff.


Would it be unrealistic for these two individuals to be told about the specifics of the case, by the doctor’s. As the brother is an adult, would the doctor’s wait for him to wake up, to ask if it’s ok to discuss medical history with them (specifically the friend)? I’m trying to work with a bit of exposition with these two characters, as this is how we’ll find out about their history and situation. This will then tie into later discoveries and revelations.

Define "specifics of the case."

Staff would be asking anyone and everyone what they knew of the medical history of the patients. They would not be giving out case specifics, but that doesn't seem to be what you're looking for.


Would it be unreasonable for the woman to have stuck around, as she practically witnessed the accident, and then perhaps the friend to ask her to keep checking in when he’s not around?

Normal. People feel a social obligation in such cases, and will even put themselves at risk to meet the obligation they feel.

Now, what do you need to have happen for your story?

Jeff

ULTRAGOTHA
06-05-2014, 02:00 AM
Would it be unrealistic for these two individuals to be told about the specifics of the case, by the doctorís. As the brother is an adult, would the doctorís wait for him to wake up, to ask if itís ok to discuss medical history with them (specifically the friend)? Iím trying to work with a bit of exposition with these two characters, as this is how weíll find out about their history and situation. This will then tie into later discoveries and revelations.

Would it be unreasonable for the woman to have stuck around, as she practically witnessed the accident, and then perhaps the friend to ask her to keep checking in when heís not around?

Whether itís unreasonable for the woman to stick around is down to how you write her. I donít think, however, the hospital would want her hanging around as she is completely unrelated and not even a friend. And no, the medical personnel would not tell her anything. That would be a very expensive HIPAA violation.






My next conundrum is also around their family situation. Theyíre both adults, but also orphaned. Their only relatives are an aunt and uncle, who donít really care. They also live a great distance away, which is unreasonable for them to travel.

Iíve done some investigation into things like HIPAA, but basically I have a friend of the brotherís who arrives at the hospital, and a woman who discovered the accident scene and phoned the ambulance. The friend was the last person to call the brother on his mobile phone, so Iím hoping itís reasonable that during the brotherís unconscious spell, they might have gone through his personal effects to identify him and contact someone? As he was the last call, is it reasonable that heíd be called in? Iíd also like the woman to be sticking around, as sheíll be somewhat of a surrogate for the sister in the story as well.


The police might contact friends if they canít find family. Youíd need to account for the police not being able to find any family and therefore calling friends to try to find family. Not sure how that works.

Read this for information about sharing medical details with family.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/familyfriends.html


2. If I am unconscious or not around, can my health care provider still share or discuss my health information with my family, friends, or others involved in my care or payment for my care? Yes. If you are not around or cannot give permission, your health care provider may share or discuss your health information with family, friends, or others involved in your care or payment for your care if he or she believes, in his or her professional judgment, that it is in your best interest. When someone other than a friend or family member is asking about you, your health care provider must be reasonably sure that you asked the person to be involved in your care or payment for your care. Your health care provider may share your information face to face, over the phone, or in writing, but may only share the information that the family member, friend, or other person needs to know about your care or payment for your care. Here are some examples:
ē A surgeon who did emergency surgery on you may tell your spouse about your condition, either in person or by phone, while you are unconscious.
ē A pharmacist may give your prescription to a friend you send to pick it up.
ē A doctor may discuss your drugs with your caregiver who calls your doctor with a question about the right dosage.

BUT:
ē A nurse may not tell your friend about a past medical problem that is unrelated to your current condition.

MDSchafer
06-05-2014, 03:39 AM
It can be something as simple as saying the hospital has a policy where anyone who has gone through a traumatic injury is offered the chance to speak to a counselor within 24 hours of their admissions.

The counselor would literally walk into the room and say, "I'm Mike, I'm a counselor here at St. Katness. We want to speak to everyone who has gone through a traumatic event. How are you doing?

frimble3
06-05-2014, 09:23 AM
Re: the woman who almost witnessed the accident and is still hanging around.
The police would have got her story at the accident scene, surely. Why did she come to the hospital? It's not like she can do anything. They wouldn't have let her ride in the ambulance.
WeaselFire says 'sense of social obligation', but doesn't she have any real obligations? Job? Family? How long was she planning to hang around?

Wraythe
06-05-2014, 01:42 PM
Wow! Thanks for all the feedback and ideas guys. Lots of interesting points in there - let’s see:


Easy. Psychotic reaction to opiates used as pain killers. Got me a psych eval after surgery. Apparently I threatened to kill every one, injure or kill myself, etc. Couldn't vouch for it, I was on pain killers and never knew any of it happened.

That sounds pretty intense. I'm imagining that this character will be on somewhat heavy painkillers - some form of TBI, along with multiple cuts, bruises, strains etc. From what you describe, it would also fit nicely in with the 'not remembering' angle, which is useful for my story.



Nope, they're just adults. Relatives/guardians/etc. come into play but not whether their parents are alive.

I understand. I mentioned that they were orphaned as a point of reference - the parents aren't in the picture to be contacted about medical history or to come down to the hospital. I've got an aunt and uncle, but they've not been mentioned yet. They only currently exist in my character profiles. I'm guessing an attempt to contact them would be made in the first instance?




Not reasonable, standard procedure. By the police, not the hospital staff.

Ah, I see! So the police would hand over any information that they think would be useful to the hospital? Contact information and ID, which would them give them access to any medical and family history perhaps? Family history in the sense of who is deceased and key medical facts - not any exposition on personal matters, of course. Unless potentially in police reports - but would the hospital be able to see those? His parents died in a car crash many years ago - I'm guessing a record of any treatment or time(s) of death would be in the records for the hospital to see?


Define "specifics of the case."

Staff would be asking anyone and everyone what they knew of the medical history of the patients. They would not be giving out case specifics, but that doesn't seem to be what you're looking for.

That's great. I don't need the friend to be necessarily told about the specifics of the case (condition, procedure, private information pertaining to treatment - sorry I didn't make that clearer), but rather have him talking to the doctors about anything he might know that could help speed up the recovery, or prevent any mishaps. So what you say would be ok to work with - friend is called in, and doctors are asking for more information from him?


Normal. People feel a social obligation in such cases, and will even put themselves at risk to meet the obligation they feel.

Now, what do you need to have happen for your story?

It may very well be a good point to bring in frimble3's point here too:


Re: the woman who almost witnessed the accident and is still hanging around.
The police would have got her story at the accident scene, surely. Why did she come to the hospital? It's not like she can do anything. They wouldn't have let her ride in the ambulance.
WeaselFire says 'sense of social obligation', but doesn't she have any real obligations? Job? Family? How long was she planning to hang around?

I'm probably going to be writing this woman as a concerned party - gets emotionally attached after seeing the state of my character after the accident. She's also single, living on her own, has family but out of town, and has a regular job. Maybe she hears something at the scene of the accident, suggesting that they don't have any 'next of kin' or primary emergency contacts (other than each other - brother and sister)? Thus, she gains that sense of social obligation to make sure that they'll be alright. She also initially thinks it's just the brother who's injured, but when the police and ambulance arrive, they examine the sister as well, adding to her concern?

However, frimble3's right. She wouldn't be able to be their 24/7 - she's got to live her own life. Would it be possible that she doesn't ride in the ambulance, but maybe turns up the day after the accident (the episode has happened), and the friend is also at the hospital. She asks about the two of them at the front desk / relevant department desk. The friend hears, and they strike up a relationship over mutual concern? She might then pop in and out occasionally, just to check up on them?

It sounds like a stretch as I write it, but it's possible, right?

As a final note, the events after the accident take place over 4-7 days, possibly longer. The sister will be waking towards the end of this, but the brother is still under observation and concern by the psych department. It's not unreasonable for the friend / woman to be 'taking shifts' and coming to check up on the pair of them, right? After work, on days off, fly-by visits perhaps? I'm hoping that might add a bit of depth to the doctor characters as well - find out a few personal facts as they get to know one another - random conversation getting a coffee (whilst still being careful discussing anything not pertinent to the current conditions). Not sure if this is also a stretch, but I'm throwing it out there as a sense check as well :).


Whether it’s unreasonable for the woman to stick around is down to how you write her. I don’t think, however, the hospital would want her hanging around as she is completely unrelated and not even a friend. And no, the medical personnel would not tell her anything. That would be a very expensive HIPAA violation.

The police might contact friends if they can’t find family. You’d need to account for the police not being able to find any family and therefore calling friends to try to find family. Not sure how that works.

Read this for information about sharing medical details with family.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/familyfriends.html

Thanks for the link and information ULTRAGOTHA. That's really useful, and seems to help the case for having a friend come in to give more information to the doctors. Especially around 'genuine' concern to help the patient whilst they are unconscious. Again, I only really need the friend to be speaking with the doctors, and not necessarily him being told anything too much about the condition itself - maybe just context around questions?

For example, "We think he might have <x symptom>, do you know of any <y history> that might help us look into this?" - something like that.

My only concern will be the aunt and uncle I've mentioned. If they are uncooperative, or maybe have given all the information they can over the phone and it isn't a complete picture, would friends still be contacted? Do the relatives need to waive anything at this point for this to happen, or should I consider writing them out perhaps? Maybe an incomplete family history, with discovery of relatives later in the story? There's going to be exploration of memories later down the line, so it's not out of the question.


It can be something as simple as saying the hospital has a policy where anyone who has gone through a traumatic injury is offered the chance to speak to a counselor within 24 hours of their admissions.

The counselor would literally walk into the room and say, "I'm Mike, I'm a counselor here at St. Katness. We want to speak to everyone who has gone through a traumatic event. How are you doing?

Thanks MDSchafer - hadn't even considered a counselor. Considering the guilt factor as well, this might work out too.

I've got lots to think about. Apologies for any chaos in my replies and further questions - there's a bit of brainstorming in there as well. I'm glad I joined this community - you guys get the brain cells pumping :).

If any of you have any further advice or comments - it's all a huge help, and I'm so grateful.

Thank you!

melindamusil
06-05-2014, 05:40 PM
I was in a bad car accident and experienced a TBI when I was 17. In my case, I was in a coma and on life support for 11 days, followed by a boatload of rehab. I am not a medical professional - all my knowledge comes from personal experience.

Seems like I read something about not being able to diagnose TBI until the patient wakes up. Not true. One of the first "tests" was a CT scan, which was how the neurosurgeon was able to diagnose a frontoparietal TBI.

Keep in mind that when he comes to the ER, especially if he was unconscious, he'll likely be on a backboard and in a c-collar. If the accident was bad enough to knock him out, then it's possible there's a spinal injury and they will be taking all precautions.

Re: psych consult - not at all uncommon after a TBI. Getting your brains scrambled can make you go a bit nuts and act unpredictably.

Re: amnesia - not at all uncommon after ANY major accident. In my case I have amnesia surrounding the accident as well as the months before and after. But, the way the brain processes memory - well, if you've ever heard someone describe an accident as "the car was a mile away and the next thing I knew, it had hit me" - that's basically amnesia. It all has to do with emotion and with the brain "moving" memory from short term to long term storage.

Re: same/different hospitals - my accident occured in Kansas City, MO, and I was taken to Truman Med Center, which is the biggest university hospital in the area. Great ER, btw. TMC has two different campuses (one is called "lakewood", the other is called "hospital hill"). I was in the surgical ICU on hospital hill. There IS a psych unit on the Lakewood campus. (and since you're not naming a specific hospital, you could fudge this and make the psych unit in the same hospital.) BUT - remember that your patient will not be released to the psych unit until he has sufficiently healed from his physical injuries... by which time he may not need psych unit treatment at all.

melindamusil
06-05-2014, 05:49 PM
Ah, I see! So the police would hand over any information that they think would be useful to the hospital? Contact information and ID, which would them give them access to any medical and family history perhaps? Family history in the sense of who is deceased and key medical facts - not any exposition on personal matters, of course. Unless potentially in police reports - but would the hospital be able to see those? His parents died in a car crash many years ago - I'm guessing a record of any treatment or time(s) of death would be in the records for the hospital to see?

In my case they were not able to ID me until after I got to the hospital. My wallet was in my pocket, and they didn't exactly go digging in my pockets until after they'd cut my clothes off. (So glad I don't remember THAT part!) Police obviously contacted my parents, since I was a minor at the time. So it wasn't until a good hour after the accident (took some time to cut me out of the car) before they knew my name and age.

On the parents' accident - was it particularly famous or somehow noteworthy? Perhaps you could have a nurse at the hospital who remembers the accident and the two orphaned little kids. ("I was working in the ER at the time, it was my first accident, I'll never forget the look on the kids' faces...")



That's great. I don't need the friend to be necessarily told about the specifics of the case (condition, procedure, private information pertaining to treatment - sorry I didn't make that clearer), but rather have him talking to the doctors about anything he might know that could help speed up the recovery, or prevent any mishaps. So what you say would be ok to work with - friend is called in, and doctors are asking for more information from him?

I am pretty sure doctors are allowed to give out very general info on a patient, unless the patient says otherwise. Like when you hear on the news, "there was an accident and the driver is in critical condition". But I'm not 100% sure on this so it would be great if one of the medical people could clarify.

WeaselFire
06-06-2014, 12:53 AM
As far as the medical staff, once they know parents are deceased or otherwise not available, they wouldn't normally concern themselves with the facts of the parents. They also wouldn't say "we think he has this, do you have any information to support that?" If they thought he had something specific wrong, they'd simply ask about specific issues that might support that. "Did he have syphilis as a child?" for example.

Jeff

MDSchafer
06-06-2014, 01:57 AM
As far as the medical staff, once they know parents are deceased or otherwise not available, they wouldn't normally concern themselves with the facts of the parents. They also wouldn't say "we think he has this, do you have any information to support that?" If they thought he had something specific wrong, they'd simply ask about specific issues that might support that. "Did he have syphilis as a child?" for example.

Jeff

Nurses and Docs aren't stupid. We do this a lot. The script typically goes, "Can you tell me something about his medical history? Is he allergic to anything? Have you seen him have adverse reactions to medication. Is he allergic to shellfish? Has he been involved in an accident before? Was he drinking at the time? Was he using any drugs near the time of the accident? Did you notice any changes in his personality before the accident?"

In other words we will pepper people with questions, a fairly standard battery of questions, and see if you have any useful information without letting anyone slip. We're going to ask about signs and symptoms if we think he has some sort of non-obvious disease. We typically don't ask about specific diseases with non-family members, but we might ask about specific symptoms. For example, a nurse might ask, "Have you seen any rashes on his skin lately?" instead of, "Do you know if he has herpes?"

Wraythe
06-08-2014, 02:44 PM
Hey guys,

Been stuck with my day job for a couple of days.

I wanted to swing by and say a big thank you to everyone. I've made some progress, and it's thanks to everyone here! All the suggestions and ideas you've put into this thread have given me a lot to work with, and the details on the procedures, possible events, even down to what should or shouldn't be said has been a HUGE help!

I'm actually out of questions on this one for now, but who knows... there's a rewrite or thirty to go down the line :).

If anyone else does have any other nuggets of information to share, I'll still be checking this thread out!

Thanks again all!