L48 Anthro 3283 Chapter Notes - Chapter 11: Disseminated Intravascular Coagulation, Septic Shock, Childrens Hospital
Fadiman Ch. 11 (140-153)
• November 25, 1986 – Lia had a big seizure, worst she has every had; on the verge of
death; was asphyxiating; her 16th admission to MCMC
• Neil had been afraid for months that this day would come; the usual problems only worse
this time; he was upset when telling Ann this
• Everyone assumed she has the same thing wrong with her, only worse; like every test
since Lia’s return home from foster care, it showed her parents gave the meds
• Unusual signs – high temperature, diarrhea, and a very low platelet count; the last 2 were
noted without comment on her chart
• A 20-minute spout of epilepticus is considered to be life threatening; Lia seized
continuously for almost 2 hours; when she stopped she was unconscious, though
breathing
• During the crisis, no one has said a word of explanation to her parents; they were
forbidden to enter the Emergency Room B
• Able to stop seizure, but she was still very sick; couldn’t handle her problems in the
hospital, so transferred to ICU of Valley Children’s Hospital (VCH)
• Neil wrote on progress report that the parents were spoken to and understand her critical
condition
o Parents understood something completely different; thought he sent her away
because he wanted to go on vacation and play, not because of her critical
condition; if he had stayed he would have restored her to her health like every
other time, but this time he wanted to play
• Neil very wound up from this; he thought it was going to be his fault that Lia had the
most terrible seizure of her life and that he wouldn’t be able to keep her from dying – but
he did
o he felt a certain amount of satisfaction, but also felt really sad because he didn’t
know what Lia was going to be like in the end
o thought she would not be the same
• Lia had another big seizure when arrived at hospital around midnight
• Dr. Kopacz (treated her at the other hospital) – failed to notice her sex
o American medicine at its worst and best: the patient was reduced from a girl to an
analyzable collection of symptoms, and the physician succeeded in keeping her
alive
• He diagnosed her condition is “profound shock, probably of septic origin”
o Septic shock is the result of an invasion of the circulatory system
o Mortality rate is 40-60%
• The word epilepsy was hardly on her chart, the doctors had too much to worry about
• On 11am on Thanksgiving, she crashed; as a result of the septic shock, she developed a
disorder called disseminated intravascular coagulation
o Her low platelet count at MCMC had been an early, unrecognized sign of this
• Parents did not hear of all of her procedures until they were already performed
o Her dad wasn’t there yet and didn’t sign anything
o They sucked her backbone and it disappointed him and made him sad because
that’s how they lost Lia
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