Primum Non Nocere II

(part one) (part three) (part four) (part five) (part six) (part seven) (part eight)

(A brief follow up to the last post regarding my sister's health, culled mainly from internal emails between those of a shared surname.)


Update August 1, 2007

As to the very serious fuckup that was poured atop my sister's brain like some sinister marinade: I don't know, and we won't know, exactly what has happened to E---'s brain and body because of that inexcusable transgression. Only that it was Dr. P---, who is her primary physician, but not her neurologist, that did in fact write the prescription for Depakote incorrectly, writing ER when he should have written EC or just left it at Depakote. CVS filled the prescription that all but lobotomized my sister, and probably would have had the family not intervened. I have neither the luxury of throwing all blame one direction (and partially obfuscate the higher principle of getting E--- to assume control, if possible, of her health), nor the tendency to just "wait and see" or "hope for the best" or some sort of like acquiescence. There were plenty of instances with E---'s faculties impaired to the point of her needing assistance just like an infirm small child or elderly Alzheimer's patient in the past; this is but a new wrinkle, and one, I think, she will bounce back from. Am not yet willing to envisage a scenario where E--- and Moms, sans insurance, try in vain to seek recompense for sustaining E---'s present and future daily needs - but it is a real fear nonetheless.

There was a previously scheduled check-up appointment Monday with Dr. P---, her primary and the one who wrote the Depakote prescription incorrectly, and I attended. Lab reports back, and she doesn't have arthritis. She said, "I hurt." He said, "I want to get you to a pain management specialist." I asked, "Given that her neurological condition's extreme symptoms present when you met her in the hospital in mid-May have subsided, replaced instead with increasing joint pain and decreasing lack of mobility, what can we do to determine the cause?" He said "I don't have all the answers" and "I'm referring you to a rheumatologist (should take about three to four weeks)" and "Is the Aleve helping?" and it devolved further from there. A few more I wish I had all the answers and one I'll be on vacation for two weeks after filling out the sought after Oxyscripts. He ask what happened with Dr. H--- on Friday (the neurologist who didn't make a mistake when writing Depakote EC for E--- as she was leaving the hospital - Dr. P--- fucked that up by turning it into Depakote ER - but nonetheless did not check the lab results from the blood work done on June 6 until July 27, though there were several calls to do so, allowing E--- to languish in a state ethically untenable - especially if we had not intervened that second week of June and decreased her dosage ourselves. H--- was the one that said "I would never prescribe Depakote ER" repeatedly when this all came out last Friday). It was mentioned to P--- that the Depakote dosage had been changed after Friday's visit to the neurologist, and he was informed that it was switched from Depakote ER to Depakote. He scribbled away, understandably oblivious, and we left it that way.

My instinctive leanings (for now) are to collate the info gleaned these past few days, put it in context with the brief case history written in my "First, Do No Harm" pseudo-letter, remove all juvenile traces and adopt a professional and impersonal tone to the final draft and - as long as my mother and sister say "go," with the understanding that there is no "wait, now turn around" later - present a formal request for E--- to have new physicians based on the negligent and quality-of-life endangerment action of her current primary doctor when writing that one prescription, and the negligence and malfeasance exhibited by her current neurologist ignoring vital test results for six weeks that he himself ordered. And I realize that far and away the most likely result, aside from CCing it to anyone and everyone and their various replies, will be request denied and insurance dropped.

I will wait to present that letter, and consult with an attorney, for now. If E--- gets her strength together, and feels confident enough to leave these bastards in the rearview where they belong, then perhaps it will be green-lighted.


Update August 11, 2007

Li'l Sis is going to join my mother in Albuquerque tomorrow. The change in the last 36 hours has been significant. She has walked up and down the stairs today, several times and with relative ease, and that is something. Plus, as I mentioned a few days ago, her brain is (90%) back. Two weeks ago her Depakote level was changed after the visit to the neurologist (home of the "toxic" comment), and last Friday her blood work was done to see what changes had transpired. A couple (polite, but with toxicity) "what the fuck?" calls today inquiring about the lab work results (what, they should call?), and, while I was away this afternoon a call came in with the D-level as of last Friday: 6.5, about one-third the level 18 she was sporting 7 days earlier.

I don't feel bad in the least asking / insisting that E--- only take two, instead of three, of these new doses daily. Obviously, I will feel horrible if it somehow backfires, and I fully concede that doctors falling out of fourth-floor windows will do precious little to allay that guilt. Interesting to note: she was supposed to have been prescribed, upon leaving the hospital May 19, 500mg three times a day of the Depakote. During the two weeks before we pulled back a dose of the wrongly-filled prescription (Depakote ER), she was taking 1500mg a day of that shit, enough for three people, 24/7, for about fourteen days, with steroids countering it. When this blew up in the neurologist's office two weeks ago (July 27), he cut her prescription to half of what it was supposed to be upon leaving the hospital (250mg instead of 500mg thrice daily), even though she had been on triple, and then double, doses of the high octane stuff for five weeks!

So much for cutting down gingerly...this prick panicked at the thought of a brain-dead E--- blemishing his record and had no qualms about drastically reducing her intake - WebMD, Google searches and Depakote's Abbot Lab's own warning label be damned - so no, I'm cool with taking her from 250mg three times a day to just two doses...then one, and so on...no lawsuit tastes as good as getting her the fuck away from all that feels...

E---'s still a bit from acquiring normal, physically, and it will perhaps be Sissyphean in certain psychological respects, but it's better. Today.


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