Excerpts From Mrn

FOUNDATION MEDICAL DEPARTMENT
SECURITY CLEARANCE LEVEL 3:

ACCESS GRANTED (11.3.2.50.01)

Initial Impression/Plan
On ██/██/20██, an individual fitting the description of a 45-year-old Hispanic man who directly encountered SCP-XXXX on ██/██/19██ and who experienced an unimpeded ABE (pre-enclosure) was reported to local authorities at 17°57′43″S 122°14′10″E (Western Australia). The individual, named █████ █████, was discovered alone in a field belonging to local farmers.

Mr. █████ was not clothed and showed pronounced, disfiguring swelling of the limbs, face, and chest. It was later estimated he carried an additional 5 liters of abnormal fluid in his tissues. He had no known prior medical conditions which could produce these symptoms. He could not speak as a result of angioedema¹, however, he was able to vocalize his distress in a primitive manner, thereby alerting the locals to his presence.

Upon being confirmed through dental records as a missing individual from SCP-XXXX, witnesses were treated with appropriate amnestic agents, and the abductee was evacuated to our service for further workup. Radiological data, interpretations, and excerpts from relevant medical documentation can be accessed under medical record number ████████████, dates ██/██/20██ - ██/██/20██. (See below.)

██/██/20██ 1543
MICU Progress Note:

The patient’s vital signs were stable upon admission to our unit. Medical treatment began with intravenous diuretics to pull off the accumulation of fluid in the patient’s tissues. Diuresis was abnormal in that the patient’s urine was measured at a high specific gravity and contained serum-level percentages of red blood cells despite normal kidney function. Ultrasonography suggested the signature of the remaining fluid to be a nonshadowing, echogenic sludge. Orthopedic services were consulted to tap a site of the fluid collection. The serology reports are pending.

██/██/20██ 0623,
MICU Progress Note:

No acute events overnight. Patient's ventilations improving, spontaneous breathing trial with cessation of sedatives today; will extubate if bloodwork allows. Edema is resolving, hematocrit² and vital signs stable.

██/██/20██ 1843,
MICU Progress Note:

Extubated yesterday to supplemental oxygen. Patient is not oriented to time, place, or person; speech is defined by echopraxia³. Psychiatric services consulted, we appreciate their recommendations.

██/██/20██ 2002
Psychiatric Consult Note:
Assessment and Plan - Mr. █████ was referred to us for complaints of repeated vocal utterances without apparent meaning after successful extubation on ██/██/██. An interpreter provided by the facility is present. Upon initial exam, the patient is lying supine and comfortably in a hospital bed. No conjugate gaze, eyes are widened with dilated pupils despite the cessation of epinephrine and norepinephrine drips yesterday. The patient is continually speaking the phrase, "So beautiful," (per interpreter), which is repeated at a high volume with audible strain on the vocal cords. We suggest frequent neurovascular checks, anxiolytics⁴, low-dose SSRIs⁵, as well as continual staff re-orientation to time, place, and person. Will follow daily, we appreciate the consult.

██/██/20██ 0514
Death Note

Admission Information Summary:
- Admitted ██/██/20██
- Admitted to: MICU
- Length of Stay: 4 days
- Admitting physician: Dr. J Meyers, MD
- Referring physician for admission: N/A
- Supervising physician: Dr. J Meyers, MD
- Admitting diagnosis: [EXPUNGED]

Death Summary:
- Date/Time of Expiration: 0254
- Manner: Unnatural Cause
- Physician Declaring: Dr. J Meyers, MD
- Preliminary cause of death: Acute exsanguination
- Secondary cause of death: [EXPUNGED]
- Free-Text Notes:
Patient experienced acute-onset tonic-clonic seizure-like signs and symptoms, which eventually were
accompanied by apparent disseminated intravascular coagulation (DIC) refractory to standard
interventions.
- Organ donor: Yes
- Donor status honored?: No; circumstances prohibit
- Autopsy ordered?: Yes
- Assigns notified: [REDACTED]

██/██/20██ 0714
MICU Progress Note:
At approximately 0013, pt was found by unit orderly convulsing in bed, experiencing a possible seizure. Analysis of the rounding logs suggest the event had at that time been occurring 35 minutes at maximum. 2 amps of bicarbonate, 4 mg of midazolam administered via peripheral IV. Seizure persisted, another 4 mg of midazolam administered. Blood was observed to precipitate from facial orifices by RN staff member, STAT⁶ labs displayed markedly low hemoglobin, hematocrit, platelets and fibrinogen, with elevated D-dimer⁷ at 12,000 ng/mL. Code blue called. Bleeding resistant to emergency administration of coagulation factors including fresh frozen plasma, platelets, and cryoprecipitate, as well as 12 units of packed red blood cells. Hypotension persisted despite the re-initiation of previous IV vasopressors. Acute, severe facial, abdominal, and extremity swelling noted. Exophthalmos noted with subsequent proptosis bilaterally⁸. Attending physician, Dr. J Meyers, MD ended the code blue at 0254.

██/██/20██ 1354
Autopsy Report:

The cadaver has been adequately prepped with a cholorhexadine gluconate bath. I was present, scrubbed, and attentive during the extent of the examination along with my advanced practice provider, █████ █████████ , CRNP.

There is sustained and severe edema of the entire body. Palpation reveals the material responsible for swelling to be semi-solid. There are several [DATA EXPUNGED] across the body, which appear to be carved into the subdermal and osseous tissues to mimic, amongst many items, the figure of [EXPUNGED]. The patient had no known episodes or history of self-mutilation nor had contact with any item of capable of producing the damage observed. The record does not document any previously noted lesions or burns upon the patient at the time of admission. The sequence of pictograms suggests a clear narrative, the interpretation and reproduction of which is beyond the scope of this autopsy.

Livor mortis⁹ is greatly exaggerated. All adipose, connective, and parenchymal tissues have been saturated with partially coagulated blood, possibly secondary to loss of oncotic pressures between the vasculature and epithelial membranes in conjunction with the administered blood products at the time of death. Global thromboembolectomy¹⁰ performed. Samples were saved in vitro within 1000mL of 0.9% normal saline at 23 degrees Celsius at █████ on Floor █.
…
The cause of death is hypotension and cardiac arrest in the setting of acute exsanguination secondary to DIC. However, how the patient suffered the condition in such an acute manner is indeterminable. Possible pathophysiologies may include chemical-induced acute liver toxicity secondary to an intolerable medication started while in recovery (recently began a Palliative regimen, drug reaction history unknown). Given the extraordinary circumstances preceding the patient's arrival to our service, [DATA EXPUNGED] secondary to [EXPUNGED] is a more likely albeit less-medical explanation.

I attest that the above document reflects myself and my colleagues' professional conclusions and recommendations.

Electronic signature:

_
█████████ █████████ CRNP.

_
████████████ MD, PhD

-End of Report-

Footnotes

1. Swelling of the tissues around the face and throat.

2. The percentage of red blood cells in the blood.

3. Meaningless repetition or imitation of the movements of others as a symptom of psychiatric disorder.

4. Medications that reduce anxiety.

5. Selective-serotonin reuptake inhibitors are drugs that are used as antidepressants.

6. From the Latin word statim, which means “instantly” or “immediately.

7. Test used in the presence of an inappropriate blood clot; normal value is below 500 ng/mL.

8. The patient's eyes were pressed through the orbits until they were no longer continuous with the skull.

9. The discoloration of the skin due to the pooling of blood in the dependent parts of the body following death.

10. A procedure to surgically remove an inappropriate blood clot from the blood vessels.