D-A-M-N-I-T

[J] Here's an email I just sent to the chief neurology nurse, Teresa. She is Dr. Steinberg's right-hand woman. She's not in charge of the nurses caring for Marisa, but could influence how they operate. I should also probably point out that the way the Stanford nurses are controlling Marisa's lumbar drain is one the commonly accepted practices used throughout the neurology community. It's referred to as volume control. The other common technique is referred to as pressure control. Pressure control maintains a constant drain-to-patient height. My technique uses the best of both worlds. Maybe they'll adopt my methodology and refer to it as the Rust Technique. Not likely. After reading Dr. Steinberg's official nurse orders the other day, I believe he is essentially calling for the Rust Technique. I knew he was good the day I met him. Anyway, here's my email to the chief nurse.

Teresa

When I got to the hospital this morning, I took a look at the lumbar drain. I instantly knew, before talking to anyone, that a recent height adjustment had been made and Marisa's headache pain was on the rise. I made this assessment without the use of magical powers. After talking to Marisa, I discovered that a height adjustment had been made approximately 45 minutes before my arrival. Approximately 30 minutes before my arrival Marisa's head had started to hurt and Dr. Howard came by on her morning rounds. Another adjustment was made during that time. When I arrived, I found the drain pressure-level set just below head height. I called Dr. Howard back into the room. She said that she thought a lot of fluid had drained since making her rounds ~30 minutes prior. She reset the drain to ear height. After ~5 minutes Marisa's head started to feel better. After ~30 minutes her headache pain was back to normal.

The bottom line is that both drain height, relative to the patient's head, and flow rate matter. They both need to be monitored and controlled to prevent under and over drainage. I implore you to review my latest presentation. I believe that a little education and training would reduce the risk of both under and over drainage. I also suspect that the occurrence of successful fistula closure would improve if my lumbar drain techniques were used. By the way, Marisa's drain is currently set lower than it typically has been the last few days, and she just drained at a rate of 10cc/hr over the last 45 minutes. The higher level, used over the last few days, also produced approximately 10 cc/hr. I think lower is better for fistula healing, but it's possible to go too low and induce over-drainage complications.

Thanks again for listening.

John