Preview
FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016
NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022
Exhibit 2
FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016
NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022
Draft 1/19/17, 11:26a. m.
Re: Kausner v. Cappuccino
BBPF File No. 6646
9/5/15 11 A.M. TO 12 NOON SATURDAY VIA PHONE (20 Minutes)
TAPED TELEPHONE CALL
WITH CHERYL KAUSNER AND DR. CAPPUCCINO
DR. C: doing?
CK: Ah, better Dr. Cappuccino.
DR. C: I was told by Dr. Kowalski that he is eatmg, drinking, up and
moving all his parts the way he's supposed to.
CK: Well not the way he's supposed to but at least they're
movmg.
DR. C: What, what are his deficits, well you know, he told me that he
was told when he was called by Dr. Levy to come in and
evaluate him I'm not really sure what kind of went on at this
point because you know Dr. Levy did tell me that he had Dr.
Dimopoulos put him to work and Dr. Kowalski told me that
he came m and helped to do the work.
CK: There was Dr. Kowalski, Dr. Pollina, Dr. Dimopoulos was
there, uh, those three had come out and spoken to us after the
first surgery for the decompression ofthe spinal cord andthen
Dr. Levy took him, I believe it was the next morning, back to
angio...
DR. C: Yes, that I knew he put a stent in
CK: Two. He said that the aneurysm had increased, there was a
larger cut that the, the size of the cut had increased, the tear
had increased and it took two stents back to back and then
some pack... - some mesh - and that it was gomg to take
approximately three weeks to grow over and heal andthey've
got him on blood thinners.
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DR. C: Well, it's almost impossible to believe because his MR
angiogram which is a currently sophisticated study showed
nothing. It read as completely normal ..
CK: Well what...
DR. C: At Eastern Niagara Hospital.
CK: At Eastern Niagara, when I spoke with Eric, he told me that
the MRA showed that the blood vessels were patent andthat
the MRI showed uh, I forget the word he wanted to use - he
used, if it was a mass or a soft tissue mass that was putting
some pressure on and it looked like ...
DR. C: On the left side ofthe cord. They, they couldn't tell on the
MRI whether that was the packing material or a hematoma.
That's, that's what they said.
CK: Well, yeah, what, ah yeah what Eric had told me, he said it's,
that it was possible. He says usually that the packing is
absorbed by the body but if he had some bleeding that the
packing could absorb the blood, get the hematoma or
whatever. And he was decompensating and I don't know
why no one called me during the night when he lost the
ability to use his left side. That can happen . ..
DR. C: No one called?
CK: That happened overnight.
DR. C: No one called me either.
CK: I never got a phone call and you know I didn't know that -1
mean, they're telling me that the artery was knicked during
the first surgery when you hadhim, that the artery was cut
then and that was very clearly shown on the angiogram.
DR. C: See now that would have been shown on -1 can't tell you for
sure but, you know, you should, did they give you a copy of
his MRA and his, um, his MRI when you left to go to Gates
Circle?
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CK: Uh yes. That was placed in his records and they did - they
were looking for it - and they did fmd it. Now Dr. Pollina
and Dr. Levy both told me that, you know, the cut in the
artery took place during the first surgery.
DR. C: Well, I can't see how that's true becausethat would have to
be - um that would be documented very clearly on the MRA
which you have a copy. I,..
CK: Okay.
DR. C: I wouldn't rule out anything but the MRA um ...
CK: All I know .. .
DR. C: which showed completely normal vertebral arteries.
CK: Okay. All I, all I know is no one called me during the night
when he was decompensating because I would have, I would
- before I left that night and Eric called me it was, I believe,
ah-eady after visiting hours and I refused to leave and the
nursing supervisor came in and asked me to leave, told me
that I could not stay. He hadbeendecompensating all day
and I, no one had done a neuro check until that evening when
I started screaming and demanding that we do an MRI, MRA,
whatever needed to be done, that somebody contact you and
we get the neuro stuff in the work because I thought he was
stroking. To me he looked like it was the begimiing stages of
a sfroke ...
DR. C: Yes, I know.
CK: And you know, that's when, and then they, it was like two or
three hours, bef- and I was getting no results and they said it
probably won't be read until tomorrow morning and I said
this is an ICU, how is that not possible and they gave me a
hard time about calling the doc and then that's when Eric
called me andtold me, you know, that in everything in his
mind looked okay and when he started decompensating
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r-
during the night nobody called me because I would have, I
would have demanded that he be flown immediately.
DR. C: No and nobody contacted me either when I checked in m the
first thing in the morning and ah he is getting weaker. I said
okay, checked it out immediately and said he's got to go for
the angiogram. Sent him for that angiogram. The, um, we, I
knew, the evening, I don't know what had occurred overnight
and nobody said anything to me and that's when I, I had
known already that the MRA read on both sides, right and
left, fheywere completely normal. There was little bit of
what they felt was the packing, he didn't feel like it was a
hematoma, at least at that point. And 1 asked him as you did
and questioned him they said well this is a little bit, a little bit
more discoloration, pressure on the left side that 1 woidd like
to see but he said it doesn't look like something that's
expanding so T said okay I'll see how he does overnight and
my intention was possibly to send him for an angiogram in
the, in the morning.. .
CK: Okay. Well let - when I came in and I talked to you around, I
guess it was, when visiting hours started, you were on the
phone. I think that was around 11 o'clock, we'd, we had this
discussion about getting him over to the Vascular Center. At
that point he hadnothing on his left side. His right side, his
right arm was still the way it was in the hospital, he hadvery
little movement, couldn't make a full bicep curl. By the time
we left he couldn't sit up in the chair. He, he couldn't sit up
in the bed, he was just slumped right over. He...
DR. C: that was the morning that he was carted, he
went to Buffalo General
CK: Yes.
DR. C: they, you know, so, again, that was
the decompensation that occurred overnight, I wasn't notified
imtil the morning, which was when I activated immediately to
get him to uh ...
CK: Okay.
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DR. C- Gates Vascular, you have, were not m yet I said as soon as
she gets in I want to speak to her, touch base with her.
CK: Yes, you were, right, you were on the phone with her when I
walked through the door.
DR. C: Correct. And I was hoping to ..
CK: Cause I was trying to get in before that and they would not
allow me in undl 1 1.
DR. C: Yes.
CK: But, you know, either here nor there, he's here when he -1
just spoke with Dr. Kowalski and Pollina and Dr. Shakir and
apparendy as ofright now he is - his nerves are starting to
fire which yesterday morning they gave me very little hope
that his nerves were going to fire and that he would get -
regain anything useful because when they did their MRI there
was nothing, there was - they showed damage on the spinal
cord and he could talk but, and flex his right hand, but
absolutely nothing on the left side and they didn't think he
was going to get anything back. Now this mommg they are a
little bit more encouraging because he is moving a little bit.
He ate -1 have, I just came out ofthere a little while ago -
just a few minutes ago, they have him up in a recliner. He
can move all four exti-emities, the left arm he can move a little
bit better than the right. The right he can make a fist. He
cannot do that with the left arm. Right leg he can kick out
and wiggle his toes. Left he can move a little bit, nothing
significant at this point.
DR. C: Really, because Dr. Kowalski's report rated all ofhis motors
at 4 over 5 which is almost normal and his left deltoids and
biceps 3 plus over 5...
CK. See now, yes ...
DR. C: He didn't say anything
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CK: Yes, I mean he is getting - like I said, he can, he was
checking deltoids and but, like I said, Tom can't bring his
right arm all the way up to do a complete bicep curl. He can't
lift his ami. Instead he, what he does is he looks like a stroke
patient. He kind oftilts over to the left side to tiy to swing
his arm up.
DR. C: Right, right, right.
CK: Uh the left arm, as I said, is moving but not it - he can
achially lift that arm if he is lying in bed he can lift that up to
his head but he doesn't have very good grip strength but he is
moving his fingers. Left leg, I, it, since that was the last thing
to decompensate. I kind of thought that was going to be the
first we were going to see back but I don't see anything
significant. He can't wiggle his toes, he can't kick his leg
out, he can move it a little bit. He's getting much more
motion out of the right leg than he is the left. That was, you
know, as of, just a few minutes ago. I was in there with him
when they were doing neuro checks and I was getting real
happy and very excited and Dr. Kowalski told me well don't
get too excited, he says we're still in the Neuro ICU. And he
said ...
DR. C: Okay...
CK: you have to give me ...
DR. C: Hejust told me that he was out of the ICU.
CK: No he has orders, he has orders to go to the step down unit
today. There is nothing available in the step down unit at this
point. So, they're not in any hurry to move him out but they
said the biggest significant difference between the neuro ICU
and the neuro step down unit is that they are not going to be
waking him up every hour to do neuro checks, it will be every
two hours and I'll be able to stay with him a little bit longer,
in fact most ofthe day, unless they're working with him
which I'm sure they're going to be working with him a lot.
But as of yet he has not been moved. He is in neuro ICU bed
13. So that's where we stand. At 6 o'clock last night after
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the extubation at 3:30, 6 o'clock last night, he had an episode
of SVT, possible atrial fibrillation, I really couldn't see the
printout and what's on the monitor was poor, but he had a rate
that went up to 180s, his arterial line was reading 184 over
118, um they thought that they were going to have to
reintubate him, they were looking at swelling, they ended up
giving Lopressor to break it and he has been good since. He's
on room air, and he's takmg some, a ftill liquid diet right now.
Of course, you know, he has to have somebody feed it to him
but at least he's taking it. He's getting some nutrition. So,
that's where it stands as ofright now. And I was told that he
was on blood thinners because ofthe stent. It's going to take
five to six weeks, oh I'm sony, 10 to 12 weeks before he can
come off the blood thinners. And Dr. Kowalski was telling
me he was going to need another surgery that went
posteriorly to complete cage up the cervical. Because they
had to take apart and take out one of the vertebrae, I wanted
to say, I wanna say it was C5 or C6, to completely remove the
hematoma that was there. They said it was too large to get
out any other way. So these are the reports that I am getting.
DR. C: Yeah. I'm not quite getting the same thmg but you know,
I'm, it's, interestingly enough I'll be looking at the, which is
the first angiogram that I, that I looked and then I saw the one
you said had a right angle on it, it was completely nonnal.
CK. Okay.
DR. C: Completely normal. So I'm, I'm very very confused.
CK: What, what Dr. Levy was showing me how the artery kind of
snakes up. He showed me an area that - and you know,
maybe it's normal, I don't know but he said the way it was
pushed out, it to me it looked like the artery was going at a
right angle. He told me that that was one ofthe major arteries
that fed the brain and that you could see, you know, over here
was, you know, and he was pointing on it, was the
compression that was going on to the spinal cord. So, I mean,
I, I don't know how ...
DR. C: ... the compression that was on the spinal cord .. .
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CK: they said was a ...
DR. C: it was a, it was a hemostatic agent. There is no doubt about
that. That's what- on the, on the angiogram, it's, it's not
something that you can, you can't see the compression on the
spinal cord itselfbecause that's not what it's looking at, it's
focused on, on the artery itself...
CK. Right. So, I don't know ...
DR. C: ... and on the new MRI, the second MRI that was donebefore
he even left Lockport, that showed some compression on the
left side andthat was the same day, it was done in the
afternoon of the day that we were together and then ....
CK: Right
DR. C: ... and his left side was normal. So, you know, that may very
well be ...
CK: Yes, it says, yes somethmg happened over night
DR. C: Yep. ...
CK: ... obviously.
DR. C: Probably the, the hematoma bleed, that hematoma or the, and
the anti packing, the anti hemostatics keeps absorbing every
little bit of anything that's in the area and it looks like he's
swollen there. Whether it's a blood hematoma or a
hematoma, the packing, it's the same thing. It canpush on
the cord which is what it's doing ....
CK: Right.
DR. C: ... you know, when, you know, when we left the operating
room he was completely clean and dry and you know, there
was a lot ofbony resection, the bone spurs and everything,
my impression was those were oozing which is why we left
the drain in ....
8
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CK: right
DR. C: ... remember he hadthe drainin there.
CK: That's nght.
DR. C: So, I'm still kind of at a loss as to how it all came to pass.
What's important to me, the most important thing, is that he,
you know, is turning up andhe is gettmg better andthere is
more movement....
CK: Me too.
DR. C: He was definitely decompensating on Thursday morning,
that's for sure, or overnight Thursday night...
CK: I- and said- I mean, I, I, I guess, one of the things that had
bothered me was right from the get go he could, he was
complainmg that he could not hit the pain pump. He was in
so much pain but he couldn't manipulate it. He could feel it
but he couldn't manipulate his fingers to push the pam pump.
And I kept reporting that to the nurses and you know, they'd,
they looked at me and say well if he's complaining ofpain
just hit, hit the button. You can do that. You can't overdose
him.
DR. C: Yep. And I don't
CK: Right, and I...
DR. C: I don't know what they were telling you but why they weren't
tellmg me that he was saying he couldn't hit the pain pump.
That's the odd thing. God only knows.
CK: I don't know but he's getting better. Will you be in to see
him?
DR. C: I will be in to see him tomorrow morning first thing. I'm just
dropping off a child at college in ..
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CK: Understood.
DR. C: ... I'm sorry?
CK: I said I understood. Dr. Levy told me that you hadpersonal
commitinents. I had two children. I understand.
DR. C: This is my fifth of sixth offtocollege. I'll be back in tonight
and I'll be visiting with him probably tomorrow late morning,
early afternoon after getting the Sunday morning routine
taken care of. But I'm just hoping that hopefully Dr.
Levy or one of those will be there so I can see the second set
of angio because it's hard for me to believe that uh, you
know, the, also that these were not done Thursday on
Wednesday afternoon there was no aneurysm, no
abnormalities at all so then an aneurysm gets read down there
and then again on the second angios that somehow the
aneurysm expanded massively and that's why he had to stent
and do this or do that. So,
CK: Yes. I, I mean . .
DR. C: I'm at a loss because some ofthis doesn't make any sense
anatomically
CK: Yeah, well, I, like I said, I'm not radiologist, and I've no
radiology experience, and they're trying to point things out.
They may as well be telling me that they were looking at
craters on the moon for what I know.
DR. C: No, I appreciate that. I appreciate that.
CK: You know, I just, I just know what they were telling me and
what you were saying and what they were saying were two
different things and it's very different when you're on the
other side of the bed as you know.
DR. C: There's no doubt about that. Having been a patient myself
recently, there's no doubt that that's possibly the case here.
You know, I mean it's difficult when, you know, when you're
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a zombie in the bed as a patient yourself practicing
medicine, you know that having worked in the ICU . ..
CK: Oh absolutely. My brain has shut down and it is, things are
getting confused for me because everything is happening so
quickly and I'm on a rollercoaster. You know, from he's
gonnabejust fine to he's not going to survive the surgery, to
he's not going to have anything to getting some movement.
So, I'm very pleased that he's getting something back.
DR. C: YeahI think that over time having seensimilar episodes that
having seen spinal cordjust like the kid from the Bills who
was a complete quadriplegic and he completely 100%
recovered. So, if they, if it comes back but obviously it takes
a little bit of time.
CK: Obviously. Okay. I will look, I will look forward to talking
DR. C: ... hospital - yes, will you be in the hospital tomorrow?
CK: I will. Ifyou tell me whattime you're going to behere I will
make sure that I'm here.
DR. C: WhatI'll do is, whenI start heading out ofLockport, I will
ring, ring you on this number...
CK: That's fine.
DR. C:
CK: Excellent. Thank you so very much doctor.
DR. C: Alright. Have a good day.
CK: You too. Bye bye.
11
Preview
FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 Exhibit 2 FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 Draft 1/19/17, 11:26a. m. Re: Kausner v. Cappuccino BBPF File No. 6646 9/5/15 11 A.M. TO 12 NOON SATURDAY VIA PHONE (20 Minutes) TAPED TELEPHONE CALL WITH CHERYL KAUSNER AND DR. CAPPUCCINO DR. C: doing? CK: Ah, better Dr. Cappuccino. DR. C: I was told by Dr. Kowalski that he is eatmg, drinking, up and moving all his parts the way he's supposed to. CK: Well not the way he's supposed to but at least they're movmg. DR. C: What, what are his deficits, well you know, he told me that he was told when he was called by Dr. Levy to come in and evaluate him I'm not really sure what kind of went on at this point because you know Dr. Levy did tell me that he had Dr. Dimopoulos put him to work and Dr. Kowalski told me that he came m and helped to do the work. CK: There was Dr. Kowalski, Dr. Pollina, Dr. Dimopoulos was there, uh, those three had come out and spoken to us after the first surgery for the decompression ofthe spinal cord andthen Dr. Levy took him, I believe it was the next morning, back to angio... DR. C: Yes, that I knew he put a stent in CK: Two. He said that the aneurysm had increased, there was a larger cut that the, the size of the cut had increased, the tear had increased and it took two stents back to back and then some pack... - some mesh - and that it was gomg to take approximately three weeks to grow over and heal andthey've got him on blood thinners. FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF '\. DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 n DR. C: Well, it's almost impossible to believe because his MR angiogram which is a currently sophisticated study showed nothing. It read as completely normal .. CK: Well what... DR. C: At Eastern Niagara Hospital. CK: At Eastern Niagara, when I spoke with Eric, he told me that the MRA showed that the blood vessels were patent andthat the MRI showed uh, I forget the word he wanted to use - he used, if it was a mass or a soft tissue mass that was putting some pressure on and it looked like ... DR. C: On the left side ofthe cord. They, they couldn't tell on the MRI whether that was the packing material or a hematoma. That's, that's what they said. CK: Well, yeah, what, ah yeah what Eric had told me, he said it's, that it was possible. He says usually that the packing is absorbed by the body but if he had some bleeding that the packing could absorb the blood, get the hematoma or whatever. And he was decompensating and I don't know why no one called me during the night when he lost the ability to use his left side. That can happen . .. DR. C: No one called? CK: That happened overnight. DR. C: No one called me either. CK: I never got a phone call and you know I didn't know that -1 mean, they're telling me that the artery was knicked during the first surgery when you hadhim, that the artery was cut then and that was very clearly shown on the angiogram. DR. C: See now that would have been shown on -1 can't tell you for sure but, you know, you should, did they give you a copy of his MRA and his, um, his MRI when you left to go to Gates Circle? FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 n CK: Uh yes. That was placed in his records and they did - they were looking for it - and they did fmd it. Now Dr. Pollina and Dr. Levy both told me that, you know, the cut in the artery took place during the first surgery. DR. C: Well, I can't see how that's true becausethat would have to be - um that would be documented very clearly on the MRA which you have a copy. I,.. CK: Okay. DR. C: I wouldn't rule out anything but the MRA um ... CK: All I know .. . DR. C: which showed completely normal vertebral arteries. CK: Okay. All I, all I know is no one called me during the night when he was decompensating because I would have, I would - before I left that night and Eric called me it was, I believe, ah-eady after visiting hours and I refused to leave and the nursing supervisor came in and asked me to leave, told me that I could not stay. He hadbeendecompensating all day and I, no one had done a neuro check until that evening when I started screaming and demanding that we do an MRI, MRA, whatever needed to be done, that somebody contact you and we get the neuro stuff in the work because I thought he was stroking. To me he looked like it was the begimiing stages of a sfroke ... DR. C: Yes, I know. CK: And you know, that's when, and then they, it was like two or three hours, bef- and I was getting no results and they said it probably won't be read until tomorrow morning and I said this is an ICU, how is that not possible and they gave me a hard time about calling the doc and then that's when Eric called me andtold me, you know, that in everything in his mind looked okay and when he started decompensating FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 r- during the night nobody called me because I would have, I would have demanded that he be flown immediately. DR. C: No and nobody contacted me either when I checked in m the first thing in the morning and ah he is getting weaker. I said okay, checked it out immediately and said he's got to go for the angiogram. Sent him for that angiogram. The, um, we, I knew, the evening, I don't know what had occurred overnight and nobody said anything to me and that's when I, I had known already that the MRA read on both sides, right and left, fheywere completely normal. There was little bit of what they felt was the packing, he didn't feel like it was a hematoma, at least at that point. And 1 asked him as you did and questioned him they said well this is a little bit, a little bit more discoloration, pressure on the left side that 1 woidd like to see but he said it doesn't look like something that's expanding so T said okay I'll see how he does overnight and my intention was possibly to send him for an angiogram in the, in the morning.. . CK: Okay. Well let - when I came in and I talked to you around, I guess it was, when visiting hours started, you were on the phone. I think that was around 11 o'clock, we'd, we had this discussion about getting him over to the Vascular Center. At that point he hadnothing on his left side. His right side, his right arm was still the way it was in the hospital, he hadvery little movement, couldn't make a full bicep curl. By the time we left he couldn't sit up in the chair. He, he couldn't sit up in the bed, he was just slumped right over. He... DR. C: that was the morning that he was carted, he went to Buffalo General CK: Yes. DR. C: they, you know, so, again, that was the decompensation that occurred overnight, I wasn't notified imtil the morning, which was when I activated immediately to get him to uh ... CK: Okay. 4 FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 DR. C- Gates Vascular, you have, were not m yet I said as soon as she gets in I want to speak to her, touch base with her. CK: Yes, you were, right, you were on the phone with her when I walked through the door. DR. C: Correct. And I was hoping to .. CK: Cause I was trying to get in before that and they would not allow me in undl 1 1. DR. C: Yes. CK: But, you know, either here nor there, he's here when he -1 just spoke with Dr. Kowalski and Pollina and Dr. Shakir and apparendy as ofright now he is - his nerves are starting to fire which yesterday morning they gave me very little hope that his nerves were going to fire and that he would get - regain anything useful because when they did their MRI there was nothing, there was - they showed damage on the spinal cord and he could talk but, and flex his right hand, but absolutely nothing on the left side and they didn't think he was going to get anything back. Now this mommg they are a little bit more encouraging because he is moving a little bit. He ate -1 have, I just came out ofthere a little while ago - just a few minutes ago, they have him up in a recliner. He can move all four exti-emities, the left arm he can move a little bit better than the right. The right he can make a fist. He cannot do that with the left arm. Right leg he can kick out and wiggle his toes. Left he can move a little bit, nothing significant at this point. DR. C: Really, because Dr. Kowalski's report rated all ofhis motors at 4 over 5 which is almost normal and his left deltoids and biceps 3 plus over 5... CK. See now, yes ... DR. C: He didn't say anything FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 r CK: Yes, I mean he is getting - like I said, he can, he was checking deltoids and but, like I said, Tom can't bring his right arm all the way up to do a complete bicep curl. He can't lift his ami. Instead he, what he does is he looks like a stroke patient. He kind oftilts over to the left side to tiy to swing his arm up. DR. C: Right, right, right. CK: Uh the left arm, as I said, is moving but not it - he can achially lift that arm if he is lying in bed he can lift that up to his head but he doesn't have very good grip strength but he is moving his fingers. Left leg, I, it, since that was the last thing to decompensate. I kind of thought that was going to be the first we were going to see back but I don't see anything significant. He can't wiggle his toes, he can't kick his leg out, he can move it a little bit. He's getting much more motion out of the right leg than he is the left. That was, you know, as of, just a few minutes ago. I was in there with him when they were doing neuro checks and I was getting real happy and very excited and Dr. Kowalski told me well don't get too excited, he says we're still in the Neuro ICU. And he said ... DR. C: Okay... CK: you have to give me ... DR. C: Hejust told me that he was out of the ICU. CK: No he has orders, he has orders to go to the step down unit today. There is nothing available in the step down unit at this point. So, they're not in any hurry to move him out but they said the biggest significant difference between the neuro ICU and the neuro step down unit is that they are not going to be waking him up every hour to do neuro checks, it will be every two hours and I'll be able to stay with him a little bit longer, in fact most ofthe day, unless they're working with him which I'm sure they're going to be working with him a lot. But as of yet he has not been moved. He is in neuro ICU bed 13. So that's where we stand. At 6 o'clock last night after FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 r the extubation at 3:30, 6 o'clock last night, he had an episode of SVT, possible atrial fibrillation, I really couldn't see the printout and what's on the monitor was poor, but he had a rate that went up to 180s, his arterial line was reading 184 over 118, um they thought that they were going to have to reintubate him, they were looking at swelling, they ended up giving Lopressor to break it and he has been good since. He's on room air, and he's takmg some, a ftill liquid diet right now. Of course, you know, he has to have somebody feed it to him but at least he's taking it. He's getting some nutrition. So, that's where it stands as ofright now. And I was told that he was on blood thinners because ofthe stent. It's going to take five to six weeks, oh I'm sony, 10 to 12 weeks before he can come off the blood thinners. And Dr. Kowalski was telling me he was going to need another surgery that went posteriorly to complete cage up the cervical. Because they had to take apart and take out one of the vertebrae, I wanted to say, I wanna say it was C5 or C6, to completely remove the hematoma that was there. They said it was too large to get out any other way. So these are the reports that I am getting. DR. C: Yeah. I'm not quite getting the same thmg but you know, I'm, it's, interestingly enough I'll be looking at the, which is the first angiogram that I, that I looked and then I saw the one you said had a right angle on it, it was completely nonnal. CK. Okay. DR. C: Completely normal. So I'm, I'm very very confused. CK: What, what Dr. Levy was showing me how the artery kind of snakes up. He showed me an area that - and you know, maybe it's normal, I don't know but he said the way it was pushed out, it to me it looked like the artery was going at a right angle. He told me that that was one ofthe major arteries that fed the brain and that you could see, you know, over here was, you know, and he was pointing on it, was the compression that was going on to the spinal cord. So, I mean, I, I don't know how ... DR. C: ... the compression that was on the spinal cord .. . 7 FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 CK: they said was a ... DR. C: it was a, it was a hemostatic agent. There is no doubt about that. That's what- on the, on the angiogram, it's, it's not something that you can, you can't see the compression on the spinal cord itselfbecause that's not what it's looking at, it's focused on, on the artery itself... CK. Right. So, I don't know ... DR. C: ... and on the new MRI, the second MRI that was donebefore he even left Lockport, that showed some compression on the left side andthat was the same day, it was done in the afternoon of the day that we were together and then .... CK: Right DR. C: ... and his left side was normal. So, you know, that may very well be ... CK: Yes, it says, yes somethmg happened over night DR. C: Yep. ... CK: ... obviously. DR. C: Probably the, the hematoma bleed, that hematoma or the, and the anti packing, the anti hemostatics keeps absorbing every little bit of anything that's in the area and it looks like he's swollen there. Whether it's a blood hematoma or a hematoma, the packing, it's the same thing. It canpush on the cord which is what it's doing .... CK: Right. DR. C: ... you know, when, you know, when we left the operating room he was completely clean and dry and you know, there was a lot ofbony resection, the bone spurs and everything, my impression was those were oozing which is why we left the drain in .... 8 FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 CK: right DR. C: ... remember he hadthe drainin there. CK: That's nght. DR. C: So, I'm still kind of at a loss as to how it all came to pass. What's important to me, the most important thing, is that he, you know, is turning up andhe is gettmg better andthere is more movement.... CK: Me too. DR. C: He was definitely decompensating on Thursday morning, that's for sure, or overnight Thursday night... CK: I- and said- I mean, I, I, I guess, one of the things that had bothered me was right from the get go he could, he was complainmg that he could not hit the pain pump. He was in so much pain but he couldn't manipulate it. He could feel it but he couldn't manipulate his fingers to push the pam pump. And I kept reporting that to the nurses and you know, they'd, they looked at me and say well if he's complaining ofpain just hit, hit the button. You can do that. You can't overdose him. DR. C: Yep. And I don't CK: Right, and I... DR. C: I don't know what they were telling you but why they weren't tellmg me that he was saying he couldn't hit the pain pump. That's the odd thing. God only knows. CK: I don't know but he's getting better. Will you be in to see him? DR. C: I will be in to see him tomorrow morning first thing. I'm just dropping off a child at college in .. FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 CK: Understood. DR. C: ... I'm sorry? CK: I said I understood. Dr. Levy told me that you hadpersonal commitinents. I had two children. I understand. DR. C: This is my fifth of sixth offtocollege. I'll be back in tonight and I'll be visiting with him probably tomorrow late morning, early afternoon after getting the Sunday morning routine taken care of. But I'm just hoping that hopefully Dr. Levy or one of those will be there so I can see the second set of angio because it's hard for me to believe that uh, you know, the, also that these were not done Thursday on Wednesday afternoon there was no aneurysm, no abnormalities at all so then an aneurysm gets read down there and then again on the second angios that somehow the aneurysm expanded massively and that's why he had to stent and do this or do that. So, CK: Yes. I, I mean . . DR. C: I'm at a loss because some ofthis doesn't make any sense anatomically CK: Yeah, well, I, like I said, I'm not radiologist, and I've no radiology experience, and they're trying to point things out. They may as well be telling me that they were looking at craters on the moon for what I know. DR. C: No, I appreciate that. I appreciate that. CK: You know, I just, I just know what they were telling me and what you were saying and what they were saying were two different things and it's very different when you're on the other side of the bed as you know. DR. C: There's no doubt about that. Having been a patient myself recently, there's no doubt that that's possibly the case here. You know, I mean it's difficult when, you know, when you're 10 FILED: NIAGARA COUNTY CLERK 04/04/2022 03:52 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 248 RECEIVED NYSCEF: 04/04/2022 a zombie in the bed as a patient yourself practicing medicine, you know that having worked in the ICU . .. CK: Oh absolutely. My brain has shut down and it is, things are getting confused for me because everything is happening so quickly and I'm on a rollercoaster. You know, from he's gonnabejust fine to he's not going to survive the surgery, to he's not going to have anything to getting some movement. So, I'm very pleased that he's getting something back. DR. C: YeahI think that over time having seensimilar episodes that having seen spinal cordjust like the kid from the Bills who was a complete quadriplegic and he completely 100% recovered. So, if they, if it comes back but obviously it takes a little bit of time. CK: Obviously. Okay. I will look, I will look forward to talking DR. C: ... hospital - yes, will you be in the hospital tomorrow? CK: I will. Ifyou tell me whattime you're going to behere I will make sure that I'm here. DR. C: WhatI'll do is, whenI start heading out ofLockport, I will ring, ring you on this number... CK: That's fine. DR. C: CK: Excellent. Thank you so very much doctor. DR. C: Alright. Have a good day. CK: You too. Bye bye. 11