To Hell and Back

by csi101

Set after the events of Lost Son - however, in this version, Speed survives and is recovering in hospital. It is set out as clinical notes written by the psychologist sent in to counsel Speed when he is diagnosed as suffering from Post Traumatic Stress Disorder (PTSD). As a result, it is not written as a traditional story but more as dictated notes from the counselling sessions.

1. Chapter 1

Tuesday, October 12, 2004

First consultation today with Mr Timothy James Speedle (preferred name: 'Tim').

Tim is a 31 year old male currently employed by Miami-Dade police department as a criminalist. Referred while an inpatient at Ryder Trauma Centre post gun shot wound to chest. Patient shows early symptoms of PTSD with insomnia, nightmares and generalized anxiety. Currently 22 days post admission.

Consulting physicians: Mr Jim Martin (trauma surgeon) and Dr Ridi Radinajah, (general medical).

Introductory visit with Tim today. A quiet and reserved man, he appeared reticent to contribute much to our discussion. Continuing to experience some pain and discomfort across left chest and shoulder - could be impacting general demeanor of patient. Due for discharge next week. States has 'never been in therapy' in the past and 'unsure as to what to talk about'. Conversation today centered on events of previous 2 weeks. Tim's memory of said events very limited.

Past medical history - No diagnoses of previous mental health issues. No history of illicit drug use. Social smoker/drinker. Tonsillectomy age 12 years. Motorcycle accident 2000 - fractured 2 ribs and dislocated shoulder.

Facts:

Medical -

Tim attended MacCauley Jewelers, SW 42nd Ave, Coconut Grove at approx. 1520 with his supervisor, Lieutenant Horatio Caine. Gun shots were exchanged between police and 3 assailants within the jewelry store which resulted in Tim receiving life threatening injuries. The bullet entered through the left intercostal space (4-5) and shattered on entry causing extensive damage to the upper lobe of his left lung and a partial tear to his pulmonary vein. Tim was airlifted to Ryder and underwent immediate emergency surgery to remove a portion of his upper left lobe and suturing of his pulmonary vein. There was significant blood loss requiring 15 units of packed cells in total and resulting in cardiac arrest on two separate occasions - each time successful resuscitation with a combination of CPR and cardioversion. Post surgery, Tim spent 3 days in an induced coma in ICU before sedation was weaned and he regained consciousness. He has unreliable memories of familiar voices during this time. He spent a total of 11 days in the intensive care unit before being transferred to General Ward 5A. Intercostal catheters were removed day 6. Morphine infusion weaned day 7. Pain currently managed with combination of codeine plus paracetamol and occasional pethidine. Physical therapy commenced during ICU stay and continued on ward.

Family - Very limited familial support. Tim has been estranged from parents and younger brother for past 12 years. Patient reluctant to discuss details of estrangement during today's session and anxiety levels noticeably increased when subject of family arose. States he has friends in Miami who 'are his family now'. On further questioning, nominates colleague Dr Alexx Woods and her husband, Dr Joe Woods, as close friends and it is apparent he regards them as pseudo parents. He displays genuine affection when talking about their influence on him and it is clear they are a constant presence in his personal life. Both have been frequent visitors throughout his hospital admission. On general discussion, it appears Tim has also assigned a pseudo parental role to his supervisor, Lieutenant Caine. The manner in which he describes their relationship makes it very clear he holds Lt Caine's advice in high stead and relies on his guidance and support heavily. Lt Caine has also had a strong presence at the hospital during the past 3 weeks. On further questioning about his 'Miami family', Tim became visibly uncomfortable and requested the topic be changed. To follow up on this in future sessions.

General - Tim has clear memories of the moments prior to the shooting taking place and limited memories from the moment of being shot through to waking in the intensive care unit. He states his last memories were walking into the jewelry store and looking through a glass partition wall into the rear of the store. On further questioning, he has vague 'snippets' of being on the floor and not being able move and a 'white heat' which radiated from his chest through his entire left side. He has some vague memories of familiar voices and states he 'could hear them talking but couldn't open [his] eyes'. He states he believes in hindsight that the voices belonged to his friends Drs Alexx and Joe Woods. He has memories of waking in the intensive care unit, however on further discussion, it appears these memories may have been from at least 24 hours post regaining consciousness. Tim states he has been having 'some trouble' sleeping lately and wakes several times during the night. He doesn't remember having specific nightmares but states he often feels 'panicked' when he first wakes. Nursing staff have confirmed he has often been unsettled during sleep and wakes in cold sweats and often emotional. Nursing staff also confirm he has requested Dr Alexx Woods be contacted on two separate occasions and she has been required to come to the hospital to settle him when his anxiety has not abated quickly. Tim states that he is very keen to go home and believes he will be able to manage independently on discharge.

Plan: Commenced on sertraline 25mg daily and review in 4 weeks. Alprazolam 0.25-0.5mg daily prn for acute anxiety episode and for insomnia if required. Highlighted addictive qualities and reinforced need for compliance. Arranged follow up appointment for Friday.