Clinical Consultation
Jacob sustained a serious and nearly fatal traumatic brain injury in September of 2004 after falling 18 feet onto a concrete surface. He was taken to Marin General Hospital, spent the first nine days in a coma, and the next four weeks in full-time intensive care. After his eight-month hospital stay, Jacob finally came home in a wheelchair, only to begin a long course of mental and physical rehabilitation.
Dr. Richard Mendius, one of the attending physicians and surgeons at Marin General Hospital, was Jacob’s neurologist during his eight months there.
Dr. Mendius concluded early on that Jacob’s condition was “non-restorable and non-rehabable”, as documented in the attached note. (Link to note)
While Catherine was spending 12-14 hours daily at Jacob’s hospital bedside, Dr. Mendius reminded her many times of Jacob’s limitations. Dr. Mendius recently wrote the prescription for Jacob’s wheel chair and is still involved in his care.
Jacob is only able to walk short distances. He gets tired fairly soon, and is afraid of losing his balance and falling. The wheel chair gives him greater self-confidence as well as support.
When Jacob fell, he not only fractured his skull, but also his neck vertebrae C6, C7, thoracic T1 and T9, and 3 ribs on the left side of body. It is of utmost importance that Jacob does not fall again, especially on his neck, as it was badly damaged and is very fragile. His neck still does cause him pain at times, so it is important he has a pillow for support while he sleeps.
The extensive damage to Jacob’s right frontal lobe (please see the attached CT scan) causes specific behavior problems involving decision-making, judgment, and other executive functions.
He typically has great difficulty tolerating frustration or over-stimulation, which can lead to feelings of agitation, and sometimes to yelling, cursing, and other types of vocal outbursts. Jacob may say things that formerly he might have only thought, or act with the emotional immaturity of a young child.
Jacob will suffer from mood swings, anxiety, sleep disturbances and depression. He may be filled with nervous tension, scream at his mother, and wake up more during the night. With sleep deprivation, he may show more depression, irritability, and anxiety.
In addition, Jacob may become confused, make a bad decision or act impulsively, leading to behaviors such as failing to understand subtle environmental cues. He may not be able to process information or understand situations accurately due to the damage in his frontal and temporal lobes.
He may show diminished cognitive skills with which to perceive, understand, plan, and communicate appropriately. His inability to do simple tasks only increases his frustration.
Jacob developed considerable physical problems due to his severe traumatic brain injury. The tracheotomy incision was made too high so that he has difficulty swallowing. In the past, he has choked on his own saliva several times per hour. Preferably, he should be in a 90 degree sitting position while eating and drinking to prevent him from choking, aspirating food or fluids, and asphyxiating. Even though Jacob has learned to eat regular foods and drink regular liquids, carbonated drinks are not suitable for Jacob. In addition, it is advisable that someone keeps an eye on him during eating periods.
Jacob also contracted Hepatitis C while in the prison system. His liver enzymes are very high, and he needs constant fluids to keep it properly cleansed. He is not getting any further medical treatment for his hepatitis ailment.
Jacob’s Traumatic Brain Injury
Jacob was originally diagnosed with ‘schizophrenia’ back in the year 1990. Many years later, in 2004 he sustained a grave traumatic brain injury; a large part of his right side frontal lobe was damaged and appears to be missing. This gave Jacob a medical disability in addition to his mental ailment, and made him a different person.
Anger is a very common problem after brain injuries. In Jacob’s case, his problem with anger had several causes acting in combination. He was, and sometimes still is, angry about his injury per se and the problems that have come with it, such as his disabilities and the loss of being able to do certain things, playing basketball and being able to walk on his own, just to name some.
People unfamiliar with the person or with brain injury are often too quick to assume that personality alone is to blame, and this is the reason that in Jacob’s case his brain injury has been and still is being totally denied by Marin County, as it has been equally treated by Sonoma County.
Jacob has also developed ‘impulsivity as a direct effect of the damage to his brain. To describe it in more detail, there are parts of Jacob’s brain that normally have inhibited angry feelings and behavior, they have been damaged and do not do their jobs as well. As a result, Jacob’s anger threshold has been lowered so that he becomes angry more easily and more intensely. It can be said that impulsive anger is directly due to brain injury when:
- Angry feelings come and go relatively suddenly!
- Anger episodes are in response to minor events!
- Anger is made worse by psychological stress such as fatigue, pain and low blood sugar.
- Anger is also created by placing the patient in a wrong environment.
- Jacob’s anger is also created by persons that do not understand brain injuries!
- When Jacob is not properly attended to, his anger outbursts may, and on many occasions have been, interpreted as acts of potential violence, he has been medically restrained as well as having been put in four point restraints and his medical jacket gets notations of ‘Jacob has committed violence’ again, when his attendants or care givers at the time are not familiar with his true ailment, namely his traumatic brain injury.
At this time, in order for Jacob to have any kind of future and orderly life he is in need of a personal and full-time attendant.
When he leaves his home, he is unable to cross busy streets by himself; he forgets to look left and right before proceeding to cross the street.
Jacob suffers from OCD as a result of his brain injury, to give an example; he will drink coca cola not one but several!
Jacob still suffers from disphagia!
He will choke when drinking improperly, if left unattended or when he is upset or while someone talks to him while he drinks!
Jacob has a severely impaired judgment!
Jacob suffers from cognitive impairment! He has memory deficits and confabulation.
He has a very short term memory, and forgets things constantly!
Jacob has communication impairments! He has a very rigid way of thinking! He gets fatigued easily and gets frustrated easily.
Jacob suffers from high cholesterol that is not currently addressed; he frequently gets low blood sugar which is not being monitored.
He needs to eat at least 4 times per day, and if that is not attended to, he becomes very frustrated.
Jacob’s teeth hurt and will need work, no one is addressing that problem.
His teeth have been a problem which has not been dealt with or even discussed with Michael Sintef, since Jacob will only tell his mother, i.e. me, if and when he is in pain. This is due to his brain injury fear.
Jacob suffers from Hepatitis C and will need to be attended to frequently.
Jacob sustained a gravely traumatic brain injury.
Everyone involved in Jacob’s case has photos that document Jacob’s hospitalization, as well as 2 copies of CT scans of his brain.
They show that a large portion of his right frontal lobe is missing, which has left him with the following disabilities:
- Jacob can only think in the present! He cannot think about the past or future! He is unable to plan ahead!
- Jacob can only think of one thing at a time!
- Jacob cannot form intent!
- Jacob cannot focus with emotional intensity. He does not get upset, although at times he becomes frustrated.
- Jacob can barely walk! When he does, he has no stability or balance! He only walks a few steps at a time!
- Jacob will not venture into the community on his own. He is wheelchair bound, and stays close to me.
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