In the morning of August 9, 2011, F-40 went to the emergency department at an area hospital with a severe headache of recent onset. The initial CT scan showed an “[a]neurysm arising from the distal left middle cerebral artery at its trifurcation.” The patient was transferred to another hospital for a cerebral angiogram in order to get a better picture of the aneurysm to make a decision regarding the method of excluding it from the blood circulation, i.e., clipping vs. coiling.
Following the angiogram, the patient underwent an endovascular coil embolization of the intracranial ruptured aneurysm. The post-procedure CT scan showed “extensive subarachnoid blood especially on the left with accumulation most prominently in the left parietal lobe…There is no midline shift [and] diffuse cerebral edema.”
The patient returned to baseline and the patient spoke with her husband in recovery while awaiting transfer to the intensive care unit ("ICU"). The patient's husband left the hospital to go home to say "Hi" to the kids, to "tell them the great news, and get back to the hospital." The couple's children were 2, 4, and 9 at that time.
While in the ICU, the patient was noted to be able to move all four extremities, but began to have focal neurological deficits, namely, her right side is weaker than left. Later, the hospital nursing staff documented changes in handgrip strength (moderate on right; strong on left) where it was previously strong bilaterally. Further, the nursing staff documented that the patient’s speech was slurred. The case was being managed by an off-site consultant. However, the hospital staff, in the face of these changes never sought out the intensivist, also know as a critical care physician, to assess F-40's deteriorating condition.
As time progressed, according to her husband, he became quite alarmed as this wife’s snoring gradually became more strained where it began sounding less and less like snoring and more like strained breathing. An inability to control breathing or protect one’s airway is one of the symptoms of increased intracranial pressure.
Hours after the first evidence of focal neurologic deficits, a CT was, finally, ordered that showed a left frontal subarachnoid hemorrhage ("SAH") that was causing a midline shift (4mm) that was not seen on any earlier CT scan. In the morning of August 10, 2011, the patient underwent placement of a ventricular drain and, later, left decompressive craniectomy (and evacuation of left intracerebral hematoma). The patient, later, died.