The patient was seriously injured at a mass shooting outside the MGM Mandalay Bay Hotel in Las Vegas, Nevada. He experienced what was initially diagnosed as only a gunshot wound to the left posterior para-spinal tissues. Because surgical removal of the bullet was considered too risky, the receiving hospital discharged the patient to home without treatment and without a care plan.
Many months after his injury, the patient experienced symptoms which had not been accurately diagnosed or properly treated. After he found conventional “talk therapies” totally ineffective, the patient presented to Dr. Parker. She correctly diagnosed and treated the patient’s latent, severe PTSD. Treatment and illness assessment and management did not end there, however. Dr. Parker determined that the patient’s PTSD was the cause of other, downstream, medical consequences which had gone unnoticed until the patient came to her for care. These included chronic tachycardia, chronic hypertension, and an ocular infarction, none of which would likely have been detectable by a traditional mental health provider. In contrast, the detection of downstream medical sequelae of PTSD is a principal focus of Dr. Parker’s care as an illness and medical traumatologist. She referred the patient to cardiology for proper continuing treatment of his cardio-vascular conditions and advised the patient’s opthamologist of the existence of ongoing PTSD-related hypertensive condition which endangered the patient’s ocular pressure, and which might compromise his vision in the future.
This was still not the end of Dr. Parker’s care and follow-up. While conducting a regular therapeutic session with the patient, Dr. Parker was alert to a new presenting symptom. The patient (who was shot on the left side), complained of severe pain and loss of function on the right side. The patient merely mentioned it in passing, but it nevertheless caught the careful attention of Dr. Parker, as being potentially significant. Owing to her extensive training in medical assessment, she recognized the medical significance of pain and impairment that is experienced on the side of the body opposite from the side of injury. She immediately contacted an eminent ortho-neuro medical colleague, who agreed that on the basis of this symptom, a full exam was called for. Dr. Parker made the referral and necessary arrangements to ensure that the patient was seen by this out-of-state physician, who determined that peripheral nerves were being severed. She also constructed an array of radiologic imaging, never before viewed in a comparative format by any of the patient’s prior providers. This imaging suggested that bullet fragments were actively migrating in the patient’s tissues, close to vital organs – yet another undiagnosed condition.
On the basis of her traumatological and imaging report, in conjunction with the physician’s ortho-neuro report, Dr. Parker took one further step and successfully referred the patient’s case for review by an internationally acclaimed nuclear neurologist. Thanks to this consult, it was determined that the patient was not only experiencing ongoing bullet fragmentary migration leading to shearing of peripheral nerves but furthermore, had actually sustained a concussive contralateral wave injury within the spinal cord itself. What was initially misdiagnosed as a soft tissue gunshot injury proved to be something far more serious, thanks to the persistence of a traumatologist dedicated to meticulous patient assessment and integrative medical referral. Today, thanks to these efforts, the patient knows the true nature of his physical injury and how best to manage it. And following a completed course of treatment with Dr. Parker, his PTSD is no longer chronic but rather, in remission.