Medical Timeline Mon 11-Thur14

MEDICAL TIMELINE:

Monday, August 11

~11:20 AM Jillian is hit by a car at the corner of Myrtle and Marcy Avenues in Bed-Stuy, Brooklyn and is rushed to the hospital. The detective will later report that she was semiconscious at the scene. (Can we confirm this? Does it matter?)

11:50 AM JP is checked in to Bellevue Hospital.

1:20 PM JP goes in to surgery to remove lemon-sized epidural hematoma on the left side of her brain and smaller hematoma by her left eye.

~4:40 PM JP is moved to the recovery room.

~7 PM: JP is moved to the neuro ICU. Her intracranial pressure (ICP) elevates to the mid-twenties, and a CAT scan shows another hematoma and additional bleeding.

~11 PM or midnight: JP returns to surgery to remove the bleeding and second hematoma.

~2 AM: JP returns from surgery. Her mid-cranial pressure drops to 8. She is given a coagulation aid to help her blood clot.

Dr. Kang reports that while the surgery has removed the clots, there are many bruises on her brain, contusions on the right side. The rest of her brain looks ok, although more bruises could show up later. Her skull had been fractured in the accident, which sounds obvious but hadn’t been stated outright yet. Diffuse axonal injury is still a possibility, but no devastating deep-in-brain-tissue injury is visible. Dr. Kang reports that there are no signs yet of severe neurological damage (things like pupils, gag reflex, and posture). He explains, “In some cases, we’re fighting just to keep the person alive. That’s not the case here; it’s not a salvage operation. We’re trying to maximize neurological function.”


Tuesday, August 12

around 6 AM JP goes for a CAT scan to check on the post-surgery state of her brain.

8:10 AM JP returns from CT. Doctors report that the scan looks really good. Bleeding looks good. No more operations foreseen.

8:45 AM Frangos, Stapleton, and three other docs go in with a half dozen nurses. They tell her, “Wiggle your feet.” Stapleton asks, “Why isn’t she in a Miami J?” (a soft cervical collar as opposed to the rigid one she’s in), expresses concern about her eye and asks that ophthamologists be called in to check it out.

2 PM Briefing with the doctors. Dr. Kang says she’s stable but “not out of the woods yet.” Doing really well neurologically; all her vitals are good. Being monitored in the ICU for things like electrolytes and blood pressure (sedation makes her blood pressure go down, so this has to be monitored in order to make sure it doesn’t go down too far). Some things that might happen to her in terms of effects on her brain: The hematoma was near the language section of her brain, so language stuff might be difficult for her—she might mix up words for a while. Short-term memory might be affected. She might have some dizziness for the next year. The right side of her body might be weaker for a while. He says basically it’s a matter of time and we have to wait and see what happens.

2:45 PM Marissa, a witness, comes with her son Mahleek and tells their story: They were stopped at a light on Myrtle at Marcy—heading west, it seems necessary to me—and from what I can tell, JP was waiting at the SE corner when the driver came up heading north on Marcy, a one-way street, to turn right (east) onto Myrtle. He swerved to avoid hitting Marissa’s car and hit Jillian. Marissa states that JP was not talking on her cell phone.

Afternoon—JP is changed into a soft cervical collar. Two ophthamologists come to check out her eye and say it looks OK.

Evening—JP’s ICP fluctuates between 13 and 28, occasionally dipping above 30. The nurses say these fluctuations are normal. An orthopedic team comes to check out JP’s right ankle, which had looked abnormal but that could just be because she’s a dancer. X-rays at some point today show that her ankle is fine and there are no broken bones in her legs or feet.

Around midnight: JP’s ICP is up around 30 for twenty minutes. Amber asks nurses and a doctor whether this is OK, and why it should be OK now when the same ICP the previous evening meant additional surgery was required. A physician finally says, “Fine, I’ll order a CAT scan.” She goes for the CAT scan, which comes back normal. The next day the nurse explains that the elevated ICP is now not due to any more clotting in her brain, only due to anxiety or disturbance in her brain.

Wednesday, August 13

around 8 AM JP is removed from sedation, kicks her feet and moves her arms.

around 9 AM Frangos, Stableford, and the rest of the team come by on their rounds. JP does not respond to commands. Dr. Gupta explains that when people don’t respond to commands, they aren’t ready to be extubated (have their breathing tubes removed) because they can’t be depended upon to clear their throat, cough, etc. And as long as a person has a breathing tube, they need to stay sedated because the breathing (and feeding) tubes are very uncomfortable and may trigger a gag reflex. JP goes back on sedation.

1 PM Jeremy and Raymond go to the 79th Precinct and to the accident scene. Jeremy picked up a copy of the initial accident report at the precinct. Christy Raymond, and Jeremy visited the scene of the accident. Christy took pictures from various perspectives.

~2:45 PM JP goes down for an angiogram to check on whether there’s a blockage in her carotid artery, the big artery that runs up the side of the neck bringing oxygenated blood to the head and neck.

~4 PM Update from doctors: Everything in her brain looks really good. The bruises on her brain have already peaked and are beginning to heal—this is occurring earlier than the average of three–four days. Docs will remove sedation again Thursday AM to check command following, etc., and are hopeful that they will be able to remove breathing tube sometime Thursday or Friday. After they take out the tubes and pressure monitor they will do an MRI which will give more information about the long-term prognosis, but until then the only available information about neuro functioning comes from things like the commands that are being given.

~5:30 PM Christy and Jeremy took pictures of Jillian in her bed.

Dr. Elliott will be on all night. Dr. Elliott showed images from the CT scans and the CTA (CT Angiogram) which show no further clotting. The CT showed the skull fracture, which extends from the outer corner of her left eye deep into her head right next to the carotid artery, which is why the doctors were concerned that the fracture might have disturbed the carotid artery. Very, very slight midline shift to the right.

Thursday, August 14

8 AM Doctors remove sedation and Jillian coughs, so they resume sedation for a while. When they remove it again a few minutes later, she is still unresponsive to commands. The doctors reiterate that this is not a cause for concern; her brain has been through a lot and still needs to heal before it’s ready to regain consciousness.

On another CT scan later this morning, everything looks fine.

3 PM Doctors removed the monitor off the top of her head that was the main data source of her intracranial pressure (ICP). The main reason for this is because her CAT scans have been consistently coming back "clean." Jillian’s mom Ingrid affectionately called the monitor a “top-knot” or “a Martian fashion statement.” Those who have seen Jillian can tell you that it looked like a looped tube sitting on the top of her head.

Doctors also removed one of the drains that was on the left side of her head.

She is being gradually, bit by bit, taken off of the sedative.

She is probably not coming off the respirator until Monday.

Doctors continue to hold the perspective that it is still very early in her process to expect more than what we’re already getting from her.

-Erika Hand and Sara Marcus