Posted by Lieutenant Commander Pilar O’Keefe (Head Nurse) in Reez Office - Otana’s results

Posted by Lieutenant Allison Scott (Pediatrics/Assistant Chief Medical Officer) in Reez Office - Otana’s results

Posted by Lieutenant Commander Jonathan Reez (Chief of Psychiatry) in Reez Office - Otana’s results
Posted by… suppressed (1) by the Post Ghost! 👻
Snip
Ally sat across from Jonathan in his office waiting for Pilar and Derek to arrive. The head nurse had asked the pair to look at her daughter. Ally, being the only pediatrician on the crew, handled the majority of the children’s cases. It was times like this however she hated her job. Bad news was never easy to give especially when it was dealing with someone else’s child. Children held the hopes and the dreams of a parent all wrapped up in a tiny blanket. Every parent dreamt of a life for their child filled with love, friends, family, a career, and accomplishments showing their child was not only important to them but to society. Holding a baby for the first time the world was again an adventure two people shared knowing they could experience all the things they loved but this time watching it through the eyes of someone new. That was when things went according to plan.

When the future deviated from this idealized dream it was like a death. The death of the dream that could have been. The future was no longer a rosy horizon of possibilities but a narrow path where every turn took you into a set of murky woods you could almost see out of but not quite. It was Ally and Jonathan’s job to show Derek and Pilar the new path their family would be traveling upon. The road would not be easy but Scott and Reez had to impart, before the couple left, that their daughter would always have to be held to a higher standard. The dreams and expectations Derek and Pilar had for Otana could still be met, albeit in different versions at times, as long as their expectations were high. While her future was not the same bright highway the rest of the parents on the Ogawa faced, Otana’s path was almost more special. It was a journey she would take with her parents holding her hands to guide her into the amazing person she would become.

Lt. Ally Scott medical

Pilar and Derek arrived at Reez’s office and Otana pushed the chime and the trio waited for admittance to the office. Pilar had already braced she and Derek for the potential information that they may receive. She knew something was wrong and she hoped that they were ready to deal with whatever it actually was.

Head Nurse

“Here we go,” Ally said hearing the first set of chimes. “Now be clinical but not heartless. Answer questions with honesty but try not to sound fatalistic or unapproachable. Imagine this is you on the other side of the table when you deliver the news okay,” she told Jonathan with a serious expression. “This is Pilar and Derek and we are about to crush their world so be gentle but be ready for them not to hear a word we say when we present the report.”

Jonathan looked at Ally with a credulous look as she spoke. “You are cute at times…” he said with a wink, which was the only true sign of affection as he looked up at the door.

“Come in,” Ally said in a formal tone hearing the chimes. She looked back at Jonathan realizing they were in his office and not hers. Sorry she mouthed taking a deep breath. She had to get over her nervousness. This was not the first time she had delivered bad new. It was just the first time she had given it to a member of her crew. There was no way she could be as clinical as she ever would when they were on a mission helping a stranger.

Lt. Ally Scott medical

As the doors opened Jonathan looked at the couple. “Alison has told me I shouldn’t be heartless, fatalistic, or unapproachable… so who wants muffins?” he asked them all as he looked over at Ally but then smiled ever so softly back at Pilar and her husband. “Seriously I have some really yummy ones you might like… coffee and tea as well? It’s best to be comfortable, we may be here awhile but trust me there is some silver linings as we go on.” he said softly, while at first the tone might have seen mocking it quickly changed. He was sincere and soft as he looked at them all as he nodded for them all to come in deeper into his office.

Reez, CoP

“Arsehole,” Ally mouthed to Jonathan. She knew he was only trying to lighten the mood and poke fun at her in a friendly fashion. Jonathan had an entire career of breaking news to people that was hard and difficult. His way was not hers but Ally was just starting her career. Part of her envied the laid back approach yet the other half wondered if laid back was too laid back. Taking a deep breath she focused on what was important at this second: The O’Keefe family.

Pilar cocked her head to one side and simply nodded “Tea and a muffin would be wonderful.” She said as she looked at Derrick, Otana headed to the toys that were in the room without greeting anyone else in the room. Pilar took a seat and looked at Ally and Jon, her face unreadable, Derrick on the other hand looked concerned “So what have you all found?” He asked skipping the pleasantries.

Head Nurse

“Maybe we can go over the report together,” Ally suggested reaching across the table for a PaDD. Pilar was more than capable of understanding what the report said but in Ally’s experience, people tended to zone when given the initial diagnosis in a bad situation. At least reading it might help deliver the bad news and they could couple the worst sections with the positives verbally. Ally looked at Jon to take over the meeting.

Lt. Ally Scott, medical

“So, how has she been in the last 48 hours?” Jonathan asked the pair, wanting to know more about Otana before they delved too far into this report.

Reez, CoP

Pilar sighed “She has had several meltdowns and temper tantrums.” She said “Especially when she is transitioning to different activities.” Pilar said “She’s not sleeping really well and will wake up and wander around our quarters.” She added “Otherwise, she’s been acting pretty normal.”

Head Nurse

Jonathan looked over at Ally as he glanced away from the couple. There could be some medications for this, but that would solve the problem. Not that this was something that could potentially be solved easily. It wasn’t something she could just be fixed with a wave of a tricorder and a hypo.

“We can start with a course of stimulants like Adderal or Methylphenidate to treat her outbursts and other behaviors. The success rate using these to control impulsivity and to increase focus is about 80%. I would caution the use of aripiprazole or risperidone for now because the side effects are hard to control. If we need to look into their use we can but I would prefer to try Methylphenidate in a low dose such as 2mg twice daily. If we need more we can increase the dosage of that later,” Ally suggested. She was not one to treat with meds as a first option but if Otana was not able to focus then behavioral therapy would be pointless. If she could not attend to the lesson being taught how could she ever learn it?

Turning to Derek, Ally explained the medication. Pilar knew everything Ally was stating but at times when doctors started talking it could leave others to think they were using a different language. “Of all the drugs we are talking about Methyplenidate has the least amount of side effects which can include mood changes, feeling irritable, sleep problems, fast heart rate, loss of appetite, stomach pain or headache. We can monitor Otana closely for these side effects. Pilar would easily be able to tell us if it is working or not. I am going to suggest this paired with behavioral supports by a counselor. It is my plan to wean her off the meds as soon as possible and replace it completely with behavioral therapy. As to the sleeping issues, it is my hope that the less anxiety Otana feels, the easier it will be to improve her sleeping habit.”

Lt. Allison Scott medical

“What are you using to calm her down?” he asked them, wondering what methods they had to bring her back down when she got agitated since she was not on medication at the moment.

Reez, CoP

Pilar looked at Jon “We still use swaddling when she is really upset.” Derrick looked at Pilar “When she is with me and has a meltdown, I will just hold her tight and sing to her.” He added “When she is not overly upset, I will give her a snack and some water and that helps her calm down sometimes.” Derrick said “We try to keep a log of when she has behaviors so that we can see if there is a pattern to what is going on.”

Head Nurse

Jonathan glanced over at Ally, she was also a child development specialist and perhaps more so than him. He knew all the tactics but he never wanted to go into something without her saying in fields where she held strength in.

Reez, CoP

“Have you tried a communication board,” Ally suggested “The meltdown is probably due to her not having a functional way to communicate her wants and her frustration is demonstrated by the outburst. The communication board will not stop her from speaking but maybe aid in the ability for her to communicate using pictures as visual cues for what she may be experiencing a word retrieval issue for. We have several types but I am thinking Proloquo2go is the best program. I can set it up and train you n its use,” Ally offered. “It is one of my options in my report. Shall we go over the report,” Ally suggested?

Lt. Ally Scott medical

Pilar looked at Derek “That sounds like a good idea using the communication board.” She said and then looked at Ally “Go ahead with the report?” She said she had already prepared herself for the worst and she had also tried to prepare Derek for the influx of information. It was a lot to take in especially since Otana was their only daughter.

Head Nurse

Ally took a deep breath and looked at Jon. They had agreed she would present it and he would field any questions that Derek and Pilar would have. Since there could be a lot Ally was happy that section would be directed to Jonathan. Sliding a PaDD over to them, there were three files marked.

https://imgur.com/OANAvWB
https://imgur.com/UMy04a3
https://imgur.com/gOtqtyu

The report was self-explanatory so Ally just hit the highlights. “Otana presented with a mild traumatic brain injury to her Frontal and Temporal lobes. The Frontal lobe lesion is what is impacting her communication, executive functions, memory and attention/impulsivity. The Temporal lobe lesions is affecting her auditory processing and the ability to control her emotions. As you know both of these injuries are permanent and can not be repaired. The good side is due to Otana’s age and the plasticity of her brain, with enough therapy and specialized education, she has the possibility of regaining most if not all of the function back. It will be a long road but we do have options. Otana’s traumatic brain injuries will impact her daily living skills. Applied Behavioral Analysis or ABA therapy is recommended to work on her ability to complete tasks and improve scholastic performance. ABA will increase her ability to process language and increase her communication skills. Academically skills should be broken down to smaller steps with teach-reteach sessions as warranted until her skills are independently achieved. Home and school should employ the use of visual supports such as times and visual displays to ease the anxiety associated with transitions and increase Otana’s ability to predict changing events in her environment.” Ally’s tone was neutral and matter of fact. She was relaying information and not to the point of interpreting it.

Taking a deep breath after flooding them with facts she changed wheels and tried to gauge how well the couple was following it. Looking up Ally took a moment to judge the parent’s eyes for comprehension. Some parents had a glassy look that meant their brain was being overwhelmed by the sheer amount of information. Other parents had a blank look that meant the report could have been in Romulan for as much as they understood of it. A few parents over the years broke down crying devastated that their world was now torn in half and never able to be reassembled. Starfleet medical trained people to be stoic and detached when the need called for it but when it touched your loved ones. When the news was about the only people in the universe one cared for, an individual’s reaction was unpredictable. Ally was happy Jonathan was here to help her friends through this if they needed to. There was one last piece of information Ally could share. “Pilar I can’t imagine what is going on in your mind right now but know that you are not alone okay,” Ally reached out her hand towards Pilar. “Otana’s rate of learning may be impacted but it is difficult to predict how the injury will present during her formative years. I am not going to give up on her. Jonathan is not giving up on her. No one is giving up on here,” Ally said firmly and waited for the parents to reply.

Lt. Ally Scott medical