Thomas Jefferson University Hospital
Emergency Room Admission Report
Date of Admission: Friday, February 9th, 2024
Time of Admission: 8:12 PM
Patient Information:
* Name: Jane Doe (Unidentified)
* Age: 14 years (approximated)
* Gender: Female
Chief Complaint:
Unconscious female, approximately 14 years old, with multiple traumatic injuries, suspected superpowered individual with regeneration factor. Possible radiation exposure.
History of Present Illness:
Patient was brought in by two individuals who refused to give patient’s name. Reported to be caught in a recent shootout between local gangs and the NSRA near Reading Terminal Market. Witnesses indicated a pre-existing regeneration factor and recommended testing for radiation exposure. No further history available.
Initial Assessment:
* Vital Signs: Heart rate elevated, blood pressure low, respiratory rate shallow, temperature normal.
* Physical Examination: Gunshot wound observed in the abdominal area with full penetration, severe burns on hands, face, and neck, multiple lacerations and bruises, signs of multiple broken bones.
* Neurological Status: Unconscious, no response to verbal stimuli, pupils reactive to light.
* Mouth Examination: Presence of numerous sharp, pointed teeth, indicative of superhuman abilities.
* Radiation Exposure Assessment: Radiation detector readings indicated elevated levels, confirming suspected radiation exposure.
Immediate Interventions:
* Initiated IV fluids and administered anti-radiation medication (Prussian Blue and Potassium Iodide).
* Applied emergency wound dressings to gunshot wound and burn areas.
* Administered broad-spectrum antibiotics and pain management medication.
* Prepared for immediate radiological assessment and CT scan.
* Notified on-call trauma surgeon and radiologist for urgent consultation.
* Placed on cardiac monitor and administered supplemental oxygen.
Diagnostic Tests Ordered:
* Full-body X-rays and CT scan.
* Complete blood count (CBC), Comprehensive Metabolic Panel (CMP).
* Radiation dosimetry test.
* Coagulation profile.
Preliminary Diagnosis:
* Acute radiation sickness (ARS).
* Gunshot wound to the abdomen (non-fatal trajectory).
* Second to third-degree burns on exposed skin areas.
* Multiple non-displaced fractures.
* Suspected superhuman regeneration ability.
Plan and Recommendations:
* Immediate surgery required for gunshot wound exploration and possible internal repair.
* Transfer to Intensive Care Unit (ICU) post-surgery for close monitoring.
* Continuous monitoring for signs of ARS progression.
* Consultation with radiation sickness specialist.
* Further evaluation of regeneration ability by a superhuman physiology expert.
Attending ER Physician:
Dr. Emily Chen, MD
ER Physician ID: EC-47291
Notes on Unusual Presentation:
* Rapid healing observed in some superficial lacerations upon admission.
* Atypical dental structure (shark-like teeth) suggesting superhuman status.
* Admitted under Jane Doe due to lack of identification and guardianship information.
* Friends who brought in the patient did not provide their names and left promptly after ensuring patient’s admission.
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Thomas Jefferson University Hospital
Radiation Exposure Report
Patient: Jane Doe
Date: February 9th, 2024
Time: 8:34 PM
Clinical Summary:
Patient admitted with severe radiation exposure and multiple traumatic injuries. Patient is unconscious with occasional vocalizations.
Radiation Exposure Assessment:
* Estimated Exposure: >10 Grays (Gy). This level of exposure is indicative of acute radiation syndrome (ARS) with a high probability of mortality without aggressive treatment.
* Source of Exposure: Unknown high-radiation source near Reading Terminal Market.
* Comment: Where did the patient encounter such high radiation levels? Possibly industrial or accidental exposure. Her chance of survival is extremely slim, even with a regeneration factor.
Clinical Observations and Complications:
1. Skin: Patient exhibits accelerated skin shedding and regrowth, indicative of severe radiation burns. This rapid turnover is complicating wound care and topical treatment.
* Comment: Skin regeneration is unusually fast, complicating decontamination and treatment. Layers of shed skin accumulating in bandages. Estimated 3 grams of skin flakes already accumulated - how is her body keeping up?
2. Bone Spur-Like Growths: Small, bone-like projections observed, possibly related to accelerated regeneration factor in response to radiation damage.
* Comment: Growth patterns are atypical and require further investigation.
3. Hematological Effects: CBC indicates leukopenia and thrombocytopenia, consistent with ARS.
* Comment: Blood counts are being monitored closely for further decline.
4. Neurological Status: Patient remains unconscious; neurological responses to stimuli are limited. EEG monitoring recommended.
* Comment: Concern for potential neurological or nervous damage due to high radiation exposure.
5. Gastrointestinal Symptoms: Patient has shown signs of severe nausea and vomiting prior to admission.
* Comment: Gastrointestinal ARS likely; monitoring for further symptoms such as diarrhea and abdominal pain.
Initial Treatment and Management:
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1. Decontamination: Completed upon admission. All clothing removed and patient washed to reduce external contamination.
2. Supportive Care: IV fluids initiated for hydration and electrolyte balance. Antiemetics administered for nausea.
3. Radiation-Specific Treatment:
* Potassium Iodide administered for thyroid protection.
* Prussian Blue given for internal decontamination (to bind cesium and thallium).
4. Pain Management: Analgesics administered for pain control.
5. Hematopoietic Support: Administration of granulocyte colony-stimulating factor (G-CSF) to stimulate white blood cell production. Transfusion support prepared for anticipated anemia and thrombocytopenia.
Plan:
* Continuous monitoring in ICU setting.
* Hematological support as needed based on blood counts.
* Regular skin assessment and care to manage rapid shedding.
* Neurological monitoring and EEG.
* Preparing for surgical intervention for concurrent traumatic injuries post-stabilization.
Attending Physician: Dr. Laura Kim, MD, Radiation Oncology
Radiologist: Dr. Aaron Patel, MD
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When I dream, it's usually not a pleasant place. There's a lot of things in here that I don't tell my counselor at school about because I don't really want her to worry. I know there's, like, a mandate, that they have to tell someone if I have thoughts of suicide or hurting myself or others. And I really don't want to cause anyone trouble like that.
I don't want to hurt myself. I don't want to hurt others. I don't enjoy experiencing or giving pain, but a part of me recognizes that everything before now has felt not real. Like the pain I collect and inflict is the only thing anchoring me here. Like I've been asleep my whole life and it's only once I began to encounter violence, real violence, the kind that makes your skin curl and scares your mom, that I began to wake up.
I dream about my home a lot. My bedroom. Battlefields that Pop-Pop Moe told me about, his dad, my great grandfather, fighting in World War II. They didn't have superheroes or supervillains back then. I mean, they did. They did have Superman and then they had Spider-Man and all the rest but they weren't real. Not like I am.
My arms hurt. Am I asleep right now? I try to make a noise with my throat and nothing comes out.
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Surgical Report: Jane Doe
Date of Surgery: February 9th, 2024
Time of Surgery Commencement: 10:00 PM
Time of Surgery Conclusion: 6:00 AM (February 10th, 2024)
Note: Times are approximate.
Surgical Team:
* Chief Surgeon: Dr. Rebecca Stein, MD, Trauma Surgery
* Assistant Surgeon: Dr. Marcus Young, MD, Orthopedic Surgery
* Radiologist: Dr. Aaron Patel, MD
* Anesthesiologist: Dr. Emily Larson, MD
* Nursing Team Lead: Sarah Thompson, RN
* Surgical Residents: Dr. Lisa Nguyen, Dr. Omar Rivera
Timeline and Procedures:
10:00 PM - 11:30 PM: Exploratory Surgery and Gunshot Wound Treatment
* Initial exploratory laparotomy performed to assess and repair internal damage from the gunshot wound.
* Removal of bullet fragments and damaged tissue, suturing of internal lacerations.
* Continuous monitoring of vital signs and adaptation of anesthesia due to unusual physiology.
11:30 PM - 1:00 AM: Internal Microwave Injury Treatment
* Application of localized cooling techniques to affected internal areas.
* Minimally invasive procedures to assess and manage damage to fat deposits, muscle, and internal organs.
* Comment: Microwave injuries present as deep tissue burns, complicating internal assessment. Damage to fat and muscle is severe.
1:00 AM - 2:30 AM: Management of Bone Spurs and Unusual Regenerative Response
* Careful surgical removal of accessible and problematic bone spurs, particularly those impeding organ function or wound closure.
* Application of hemostatic agents to manage bleeding from spur removal sites.
2:30 AM - 4:00 AM: Fracture Management and External Burns
* Reduction and immobilization of fractured ankle and other small fractures.
* Application of advanced dressings to manage rapid skin shedding and radiation burns.
* Comment: Extremely high rate of skin regeneration and shedding, leading to accumulation beneath splints.
4:00 AM - 6:00 AM: Final Assessment and Wound Closure
* Thorough internal and external assessment for any remaining critical issues.
* Closure of all surgical incisions, ensuring no compression on rapidly regenerating areas.
* Application of non-adhesive, breathable dressings where appropriate.
* Preparation for transfer to ICU for post-operative monitoring.
Post-Surgical Plan:
* Continuous monitoring in ICU.
* Regular reassessment of wound healing and management of skin shedding.
* Ongoing pain management and nutritional support.
* Hematological support and monitoring for radiation sickness progression.
Summary: The surgery was complex and extended due to the patient's unique regenerative abilities and the severity of her injuries. The team successfully managed the gunshot wound, internal burns, bone spurs, and fractures. The patient's rapid skin regeneration posed a significant challenge, particularly in managing wound care and immobilization of fractures. Post-operative care will require close monitoring and adaptation to her superhuman physiology.
Signed:
Dr. Rebecca Stein, MD
Chief Surgeon
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Mama?
Papa?
Pop-Pop?
Where are you?
It's warm and itchy here. I don't like it. Can someone turn the fan on?
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Date: February 12th, 2024, 8:22 PM
From: Dr. Rebecca Stein, Chief Surgeon
To: [Recipient List: Medical Staff]
Subject: Update on Jane Doe (Sam Small) Case
Dear Team,
I wanted to provide an update on our Jane Doe case. As you're aware, Jane has been in a coma since her admission on February 9th due to severe radiation exposure and multiple injuries, including a gunshot wound and internal burns.
Earlier today, two individuals identifying themselves as Benjamin and Rachel Small arrived, providing identification and proof of guardianship for 'Jane Doe', indicating her to be their daughter, Samantha Small. The Smalls are, as you might expect, distraught but cooperative. They have been briefed on Samantha's condition and the complexities of her care.
Despite the extreme severity of her condition, we've observed a remarkable rate of healing, consistent with her reported superhuman regeneration abilities. However, we're closely monitoring for any complications arising from the rapid regeneration and the high levels of radiation she was exposed to. For those unaware, Samantha was exposed to approximately 10 Grays of radiation during the Reading Terminal Market shootings through an unknown source - 8 Grays represents a sufficient dosage of radiation to result in lethal outcomes for more than 99% of full grown adults.
Her continued survival is remarkable, and the Smalls have agreed to allow us to share details of her case as a study regarding the interactions between superhumans with regeneration factors and acute radiation syndrome, so long as PII is appropriately scrubbed. Please do your best to ensure that the Smalls, especially Samantha, are as comfortable here during their stay as possible.
We appreciate your continued dedication to Samantha's care during this challenging time.
Best,
Dr. Rebecca Stein