CASE STUDY # JD-57:

Patient is 53 year old male relatively large in size (6'2", 280 lbs.) with apparent solid character and integrity. He illustrates an above average intelligence with College training in Business and Engineering. He is currently self employed in the field of Promotional Advertising and has been so since 1993.

Veteran: Patient is a proud Veteran of the U.S. Army - HHB 3rd/3rd FA, 194th Armor Division (Sgt. E-5/Section Chief-Fire Direction Control) and honorably discharged. During his service, he was very accomplished which led to meeting General Donn Starry (Commanding Genera/U.S. Armed Forces) along with Israeli Generals for his section’s development and improvement of weapons systems. His FDC section was also featured in Army Times Magazine for these developments. Other notable achievements include: NCO Academy/Honor Graduate, Top Secret Security Clearance - responsible for decoding one part of two part code for obtaining firing solution of 8" nuclear round, NCOIC for grading Reserve Artillery Battalion to ARTEP standards (determining if combat ready), one of the primary developers of new weapons firing system which saved the government financially. The system was employed by Israel and later accredited for saving allied soldiers lives (Israel and Egypt were in heavy conflict at the time). Veteran also earned numerous awards for Battalion Soldier of the Month and Battalion NCO of the Month.

Family/Support: Patient has completely isolated himself over the majority of the past 8 years. He is divorced with children and grandchildren but has no contact with them. He has indicated that he has no friends and can not allow anyone near him in his current condition. The patient has very low self esteem and advises that he can not stand to be around himself . He does not even recognize himself or his current existence. His only friend and relative is his 74 year old mother with whom he usually speaks with briefly a few times a week. The patient expresses that a great deal of his shame comes from not being able to support his Mother. He is very willing and capable to earn an adequate income and expresses extreme self hatred for not being able to even leave his room for the vast majority of the time. The patient constantly dwells on his situation while feeling completely helpless. The patient seems to have requested help in every way possible and all has been ignored. The patient also believes that the few times that he has gotten the medical providers attention, he is treated very rudely and the treatment has been altered to inflict further mental anguish rather than provide adequate treatment.

Medical: The patient has had several injuries and surgeries:
A) Accidental injury to right wrist severing artery and severe nerve damage. Only artery was repaired in ER setting. B) Accidental injury to little finger on right hand which severed flexor tendon. No immediate medical treatment sought. C) Intentional injury to left arm which severed main artery with substantial muscle deterioration and ulnar nerve damage. Artery was repaired in ER setting and patient was on life support in Intensive Care for 3 days. D) Accidental fall on icy cement step crushed disc in right lower back and patient could not walk without assistance for weeks. Medical treatment consisted of diagnosis only at Med-Surg facility. E) Patient re-injured lower back in severe fall (60 ft.) while skydiving and the parachute collapsed early. Medical treatment in ER setting only which indicated aggravated disc, hairline foot fracture and possible loosening of internal organs from impact. Patient again could not walk without assistance for weeks. F) Surgery performed on his left arm to re-route the ulnar nerve. The surgery was apparently successful with no complications. G) Several damaging and unsuccessful surgeries (5 procedures) attempting to restore movement to finger with tendon grafting. H) Patient has incurred several concussions after being beaten and was hospitalized due to head trauma on two occasions. I) Patient was shot in the leg with a small caliber bullet and advises that the injury was superficial and he did not wait for medical treatment.

Mental/Suicidal Tendencies: The patient has had bouts of serious depression most of his life which normally subsided after 3-5 days. The patient executed at least two serious suicide attempts: A) After a long stretch of anxiety and extreme stress the patient took approximately 100 phenobarbital. By the time EMTs found him, he had no measurable vital signs and was unconscious. His heart rate and respiratory stopped again several times in the ambulance and EMTs continued emergency CPR. The ER was able to establish a heart beat and breathing once again and stabilized the patient with charcoal and pumping out of the stomach. The patient stayed in the hospital several days and then checked out against medical advice. B) Upon a short period of high anxiety, the patient “snapped” in response to a false allegation and without forethought cut his left arm to the bone with a large serrated knife (see item C. under “Medical” above). Both suicide attempts were instantaneous with little or no forethought just prior to action although during a periods of extreme stress and depression.
The patient can not sleep well and averages 3-5 hours of sleep after 20-40 hours of insomnia. He has symptoms of extreme anxiety and frequent panic attacks. He was hoping to see a mental health provider to assist with medications to relieve the anxiety and sleep disorder but it was postponed by the provider.

Medications/Substance: The patient has admittedly experimented with marijuana in social settings when he was much younger (over 20 years ago) with no pattern or frequency. Once the patient took a couple of puffs of marijuana (2006) recommended by a friend for constant nausea. This has been the only instance of this type of behavior for approximately 20 years. The patient was forthcoming with medical providers after this single incident and did not attempt to deny nor avoid drug testing. Patient also volunteered that he briefly used cocaine experimentally which was introduced to him by his then current girlfriend in 1992. He removed himself from the girlfriend and substance after approximately 3 months of on and off recreational use and indicates he has not taken the substance since nor had any desire to.

The patient has been prescribed several different antidepressants since the age of 25 and most often quit taking the medications when his situation appeared to be getting better. He has not taken any other medications for any substantial length of time and has often refused pain medications assuming his pain was temporary and would lessen with healing. Nothing in the patient’s medical history suggest that he has ever abused prescription medications in any way. Also, nothing in the Patients history indicates that he is a “pill hunter” or has requested any medications for purposes other than what the medications are intended for. The patient states that he was prescribed xanax which did little to help and often seemed to make him more anxious. He indicated that he has no medication to help with the extreme anxiety but is afraid to request medication after the way he is being humiliated and falsely labeled for having to continue to plead for adequate pain medications.

The patient has been prescribed opiate pain medications for approximately 5 years and medical records indicate no signs of abuse or addiction. Up until September, 2010 the patient attempted to make the medications last even though tolerance required a higher dosage to be effective. The patient also advises that he does not take additional medication once the pain is not distracting and has never incurred any cravings for the medication. He did admit that he had significant fear from experiencing the severe withdrawal symptoms again and that this problem intensified pain drastically.

The patient admits to previously using alcohol, sometime in excess. Use was mostly in social environments on weekends and sometimes led to binges of 1-2 days. Patient began tapering his alcohol consumption in 1998 and lost his desire for alcohol completely by around 2004. The patient states that he has drank less than 12 beers total during the last several years and does not currently crave alcohol and/or any other substance. He also indicated that he would enjoy being able to set on his deck and enjoy a “six-pack” but due to his loss of taste for alcohol and current medications, he can not do so.

History Continued - 2002 to current:

The medical records show several surgeries and procedures in 2002 and 2003 which were unsuccessful due to the physicians unwillingness to provide proper communications. This lack of communications led to all of the surgeries and procedures being a great waste of time and resources as well as inflicting undue pain and mental anguish on the patient. The surgeries and neglect by the attending physicians placed the patient in much worse condition mentally and physically than he experienced prior to the surgeries. Medical records confirm these facts in which the physicians offered an apology to offset their series of mistakes and intentional neglect

Since 2003, the patient began experiencing extreme pain from the surgeries and began to withdraw from work and social activities. The chronic depression compounded and the patients life changed drastically by 2004. By this time his earning capabilities had diminished greatly and his isolation increased rapidly.

The patient can not understand why he can not force himself to perform even the smallest of tasks as he had been able to most of his life. He was very hesitant to seek medical treatment for the extreme pain and mental disorder due to his previous treatment and loss of trust in his medical providers. Once he was able to force himself to seek help, opiate pain medications were prescribed and he was sent to a different facility for further treatment. Surgery was performed on the patients left arm and the ulnar nerve re-routed although the extreme pain in his right hand and mental problems went untreated..

The patient then endured several years on pain medications which were losing there effect and continued to further distance himself from everyone. By 2009, the patient had completely isolated himself and was spending as much as 90% of his time in a 10' x 10' room in overwhelming fear, pain and anguish (often not bathing for weeks and laying in his own feces). The patient had re-financed his home three times since 2002 to survive financially since his earning capacity had almost completely diminished.

In 2009, upon the patient starting to believe that he was going insane, the patient forced himself to again seek medical attention. The patient was under extreme duress just leaving his room and making the appointment but was able to do so. Once the patient was able to see a mental health provider, he briefly described to her the isolation, overwhelming fear and feeling of insanity. The mental health provider promptly replied in a condescending tone, “well, you made it here didn’t you?”. The patient then just hung his head in disbelief with a tightness in his head that blurred his vision. The patient left and returned home to run to his room in attempt to find a safe place of comfort and did not return to mental health for appointments.

The pain medications had decreased in effectiveness for quite some time although the patient was hesitant to request additional medications. Eventually the pain was too severe to keep ignoring and his Primary Care provider was advised of the situation which was initially ignored. The patient did not insist and continued to just “exist” while having no apparent quality of life. Suicidal thoughts became more frequent for the patient along with overwhelming fear and extreme isolation. Finally the primary care provider recognized the need to increase the pain medications. The physician made several attempts to properly increase the pain medication and was denied every time by the administration with absolutely no explanation. The primary care provider could only instruct the patient to re-fill his pain medications as early as possible to make up for the necessary increase. The primary care provider expressed his frustrations with the administration although there were nothing else he could do.

By September, 2010, the patient could not tolerate the pain without adjustment of his medications. The patients requests were continually ignored except for medical assistants and nurses to quickly threaten the patient in lieu of the medications “contract”. The medical records indicate that the patient had done nothing wrong and that the primary care provider had requested an increase in medications several times. These threats added greatly to the patients already extreme anxiety and stress. The patient attempted to contact mental health for assistance and continued to plead with providers to review his history and increase the medications. Mental Health did assist in the patient getting a supplement although the primary care providers continued to ignore the situation entirely. The patient was now faced with suffering severe withdrawal symptoms along with the on-going chronic pain. This same behavior went on for months while the patient suffered needlessly on many different levels.

In December, 2010, the patient was experiencing additional severe pain in his lower back (most likely due to the injuries previously described in “Medical” D) & E) above). The patient continued to be ignored and have to suffer through the pain, withdrawal symptoms and mental anguish although he consistently pleaded for medical care through numerous telephone calls and faxes. At this point the patient indicated that suicide was a constant thought and he felt that he was being put in a position that there were no other choices.


Months later in February, 2011 a meeting was scheduled to provide proper pain management (the medical necessity for medication adjustment had been justified and recommended by the patient’s primary care physician for approximately 6 months and were totally ignored until now). The patient was very excited and hopeful in belief that he would soon have adequate relief. Within a couple of days of the patient beginning the new medication, it was apparent that the medication prescribed was doing little more than offsetting the severe withdrawal symptoms. The medication did nothing to assist with the pain and improve the patients quality of life. The prescribing provider later sarcastically implied that the only reason he finally acknowledged the patient at all was due to a fax which indicated a copy being sent to a high ranking official.

The pain clinic was advised that the medication was not effective and again requested a change in treatment. The medications were changed once again although he could not immediately fill the new prescription. This was due to the patient being told previously to discontinue medications
prescribed by a different clinic which were destroyed and now he was requested to return them. This put the patient again in extreme pain, mental anguish and constant anxiety attacks in fear of the unbearable withdrawal symptoms and enduring more unnecessary pain.

The patient unhappily accepted his fate and requested that his provider at least provide instructions and medications that may help him with withdrawal symptoms while awaiting on his new medications to be dispensed. The written request was ignored by all medical and mental health providers which continued to further damage the patent mentally. The patient indicates that he has lost all faith and trust in the medical providers and continues to be hopeless.

The patient could not sleep and continued having anxiety attacks while still enduring the constant pain in his hand and back. The patient had appointments at the facility and expressed his discomfort and stress along with thoughts of suicide. The patient was instructed to once again visit mental health for a quick evaluation. During the mental health suicide evaluation, the provider insisted that the patient see someone in Administration and indicated that patients should not be made to suffer under these circumstances.

The patient had been awake for 2-3 days and had been at the facility for 6 hours that day. Once the patient arrived at the administrative office, he was marched down to the pain clinic and instructed to sit outside and wait with no further conversation or discussion. The patient was in extreme stress and very humiliated at this point. Once entering the medical providers office, he was treated very rudely and became confrontational. After things settled down, the physician asked the patient in a sarcastic tone, “what do you want, I have more patients that you”. The administrator quickly interrupted before the patient could reply and told the physician, “do not ask him what he wants, you are the doctor...”. She then went on to exclaim, “we are willing to treat your addiction Mr. Xxxxx !” The patient also claims that the administrative manager also openly suggested a medication which could be very harmful to the patient and could possibly affect the patient for his lifetime. This humiliated the patient extremely and he was in awe at what had just been said and just looked at the floor in amazement and shame. The physician then went on to suggest prescribing the patient a supplement of pain medication to last until his new prescription was released. The administrative manager had left the room although a nurse was still in the room with the physician and patient. Upon the physician suggesting the supplement, the nurse was obviously against it and began making extreme gestures with her eyes and body language indicating that she did not agree with the physician’s decision. The patient was then ask to wait outside for the agreed upon prescription. Once the nurse came out and gave the prescription to the patient, it had been changed again to the previous medication in which the patient had already advised was not effective and also had undesirable side effects. The patient was completely wore down mentally and very confused. He left the facility and attempted to get by on the medication prescribed.

The medication again was not effective in treating the patients pain but only prevented severe withdrawal symptoms. The patient is currently experiencing painful heaviness in his chest, anxiety attacks, severe headaches (often to the point of vomiting). The patient is also showing even deeper signs of depression and most often has resorted to turning his telephones off to further distance himself from more harm. The patient has currently broke off most communication with his mother which is his only friend and/or family he currently has. The patient has discussed thoughts of suicide with his mother in hopes of protecting her from the shock and attempting to convince her that he would be “ok” and much happier. The patient is confused about feeling that he must die and the extreme fear he has when the thoughts turn serious. He has advised mental health that this must mean that he truly wishes to live but is convinced that he can not continue to live under his current quality of life.

The patient is currently offered no means of resolve and has little hope. He also believes that the total ignorance of his situation by medical providers and administration is in attempt to manipulate the patients status and justify their false statements and extremely unethical behavior. The patient concludes in stating that he feels as if he is in shock and regardless of the outcome at this point, that his remaining life will be affected negatively due to this continued unethical and abusive behavior.


COMMUNICATION
It is crucial in every aspect of a human being’s life - It is the first thing targeted for destruction in war - It is much more important than even our Freedom Of Speech...
Our Freedom Of Speech is worthless if not acknowledged by someone who cares.

Let Freedom Ring Loudly...(and hope someone still hears it)


“God Bless America And The People Who Still Hold Her Sacred Enough To Stand For What Is Right Rather Than What Others Dictate”