Tuesday, January 8, 2008

2008. Apartheid Addington Hospital, 1988, Fraser's Neuropsychological Assessment

Fraser was mending, but I trekked to Durban once a month from Koffiefontien to see Fraser. Fifteen months after Fraser's Verulam road accident, Addington's psychiatrist Dr. Luiz neoropsychologically assessed Fraser thus:

"...awkward, jerky gait, loud booming voice,... unaware of either. [Fraser's walking and talking was normal before Fraser's iatrogenic Neuroleptic Malignant Syndrome - NMS].

...rigid, contracted right hand and wrist... incapable of any movement... displays unrealistic expectations of recovery of use of this hand. [Fraser's right hand was normal before NMS].

Movements of his left hand are slow and jerky... has difficulty changing from one movement to another, showing tendency to perseverate... Sometimes has difficulty initiating movements, thus demonstrating a degree of inertia in the motor system. [Fraser's left hand and body movements were normal after his coma and before hospital NMS. Fraser wandered Durban beachfront for a month before NMS].

Although Fraser appears to understand and is able to repeat verbal instructions to act, he has some difficulty in carrying them out accurately. Although his initial attempts are accurate, he soon begins to repeat in stereotype fashion.

On presentation of tactile stimuli, he is able to describe aspects of the object at hand, but has difficulty integrating the clues to form a gestalt.

...demonstrates a fairly persistent confusion of left and right, thus experiencing difficulties with visuospatial coordination tasks and finding himself disorientated. [Maybe Dr. Luiz had this problem too. See below].

...approach to tasks is impulsive and involves random trial and error attempts. [So what?]

...experiences difficulties in finding appropriate names for objects, thus demonstrating a degree of amnestic aphasia.

Although Fraser demonstrates fair concentration and attention, he frequently loses the gist of complex instructions and short stories, thus reflecting a general disturbance on mnestic processes... loss of programmed forms of activity and cannot create an intention to remember... displays retrograde and anterograde memory deficits and also has problems with remote memory. [Like the rest of us. Writing used huge amounts of my memory energy. There were many things I'd forgotten in my life, and I'm not brain-damaged. My long -term-memories were associated with emotional events. Everyday routines were forgotten. Fraser's long-term-memory improved over the years after his brain-damage].

...functional deficits described above, are in keeping with right sided fronto-parieto temporal damage... [left sided!] some deficits in the corresponding left [right!] cerebral areas perhaps due to contra-coup injury... displays many of the classic personality problems following frontal lobe damage. [Dr. Luiz mixed up Fraser's left and right brain injuries!]

...totally unrealistic expectations regarding future recovery and function.

...loss of ability for appropriate self-appraisal and appropriate planning.

...filthy hair and fingernails at both appointments, thus leading me to doubt his ability to adequately care for his physical and health needs.

...although Fraser apparently made significant improvements during the last year, he still requires a supervised and structured environment. If this were provided, Fraser may manage a sheltered employment situation, but is unlikely to manage adequately in the open labour market." Sheltered employment meant slave labour for exploitative contractors.

It took me weeks of letter writing before Dr. Luiz produced the assessment. I was too naive to realize the assessment just softened me up for Fraser's certification and "rehabilitation" horrors which would follow.

Dr. Luiz played Blame The Patient, which would continue for many years. Dr. Luiz didn't mention NMS. Dr. Luiz's demeaning, pedantic tests failed to show Fraser's emotional and social behaviour, nor how Fraser would function in daily living situations. Dr. Luiz didn't say how Fraser would be rehabilitated. Anyone looking at Fraser would've seen the left side of his forehead was bashed, covered in raw scars. I wondered how true the assessment was, given such a gross error. The filthy hair comment indicated Addington Hospital's negligence. If Fraser was dirty and in a state of neglect, then Dr. Luiz's team of doctors and nurses were negligent.

While Dr. Luiz tried duping me with misinformation and lying by omission, SA States-of-Terror continued, with many killings in KwaZulu-Natal. Psychiatrists did what they liked in apartheid SA, protected by the 1973 Mental Health Act. Dr. Luiz's deceit was that nowhere in the assessment did he mention iatrogenic NMS, which wrecked Fraser's physical movements, right hand, both Achilles tendons, and walking and running for the rest of Fraser's life. The damage iatrogenic NMS and wheelchair fall did to Frasers' brain only Dr. Luiz, his team of doctors and God knew?

Copyright Mark JS Esslemont.

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