6.Rachelle Amedee — Direct/Cross/Redirect/Recross
597 linesBAILIFF: Court, all rise.
BAILIFF: This court's now in session. Be seated, please.
COURT CLERK: Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
THE COURT: All right. Thank you. Commonwealth can call your next witness, please.
MS. BUCKINGHAM: Your Honor, Commonwealth would call Rachelle Amedee.
BAILIFF: Good morning. Stand right here and raise your right hand to the clerk, please.
RACHELLE AMEDEE: I do.
THE COURT: Hey, good morning.
RACHELLE AMEDEE: Good morning.
MS. BUCKINGHAM: May I inquire?
THE COURT: Yes, counsel. Please.
MS. BUCKINGHAM: Thank you. Good morning.
RACHELLE AMEDEE: Morning.
MS. BUCKINGHAM: Could you please tell the jurors your first and last name?
RACHELLE AMEDEE: Rachelle Amedee.
MS. BUCKINGHAM: Do you mind spelling your first name for the record?
RACHELLE AMEDEE: R-A-C-H-E-L-L-E. Last name is A-M-E-D-E-E.
MS. BUCKINGHAM: Thank you. And how are you employed? What do you do for work?
RACHELLE AMEDEE: I'm a nurse at Brigham and Women's Hospital. Oh. The trauma surgical ICU.
MS. BUCKINGHAM: How long have you been a nurse?
RACHELLE AMEDEE: Almost twenty-seven years.
MS. BUCKINGHAM: And can you tell us a little bit about your educational background?
RACHELLE AMEDEE: I have a bachelor's in nursing from Salem State University.
MS. BUCKINGHAM: And how long have you worked at Brigham and Women's?
RACHELLE AMEDEE: Mm, twenty years this week.
MS. BUCKINGHAM: And which unit did you say you worked in?
RACHELLE AMEDEE: The trauma surgical ICU.
MS. BUCKINGHAM: How long have you worked in that unit at Brigham?
RACHELLE AMEDEE: Eight years.
MS. BUCKINGHAM: Going back to January of 2023, were you working in that same unit?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And what was the shift that you normally worked?
RACHELLE AMEDEE: I worked the night shift, which is 7:00 PM to 7:00 AM.
MS. BUCKINGHAM: And do you... What was your schedule like for any given week? Did you work back to back shifts or...?
RACHELLE AMEDEE: I can sometimes work back to back shifts.
MS. BUCKINGHAM: Okay. But you always worked the night shift?
RACHELLE AMEDEE: The night shift.
MS. BUCKINGHAM: Okay. I'm gonna draw your attention to a particular patient that you had some interaction with in January of 2023, and that was Lindsay Clancy. Do you recall treating her?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And was she in that trauma surgical intensive care unit?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Do you remember the first time you interacted with her?
RACHELLE AMEDEE: Yes. I got a-
MS. BUCKINGHAM: And would that have been on the first night she was there on January 24th?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: How did she come to your unit at the Brigham?
RACHELLE AMEDEE: She came from the emergency room, went to MRI, then came to the ICU to me.
MS. BUCKINGHAM: And were you aware that she had been seen at a local hospital?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: In Weymouth, the South Shore Hospital?
RACHELLE AMEDEE: South Shore. Yep.
MS. BUCKINGHAM: Okay. While you were treating her on that first night, were you the main nurse assigned to her care?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And what were your responsibilities as the nurse assigned to her care on that first night?
RACHELLE AMEDEE: First night, she was intubated, came to me intubated. We had to maintain her blood pressure at a certain number. Just care, regular nursing care.
MS. BUCKINGHAM: Okay. And were you aware that she was on what's called a one-to-one?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: What does that mean?
RACHELLE AMEDEE: That means patient usually can't be left alone, and also depending... you always have to have somebody outside the room with... sort of monitor the patient.
MS. BUCKINGHAM: And is that because that patient has been identified as a potential suicide risk?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Okay. Now on that, the 24th into the early morning hours of the 25th, was there a particular event that you were witness to for this particular patient?
RACHELLE AMEDEE: She coded.
MS. BUCKINGHAM: What does that mean?
RACHELLE AMEDEE: Means her blood pressure dropped. For her, it meant her blood pressure dropped, and it wasn't sustainable with life.
MS. BUCKINGHAM: So what did you do when her blood pressure fell and she coded?
RACHELLE AMEDEE: We started CPR. We did compressions.
MS. BUCKINGHAM: And this event occurred approximately at 3:30 in the morning, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Was she eventually stabilized after that code?
RACHELLE AMEDEE: She was.
MS. BUCKINGHAM: And did they do something as far as intervention to try to maintain her blood pressure?
RACHELLE AMEDEE: We increased her pressors. We added two more pressors. She was already on two. They placed chest tubes and started what we call a massive blood transfusion to protocol.
MS. BUCKINGHAM: And did this all occur in the trauma surgical intensive care unit, or did she have to be taken to a different unit?
RACHELLE AMEDEE: No, it all occurred in our room.
MS. BUCKINGHAM: And other than medical staff that were treating her that particular night, did you observe anybody else present?
RACHELLE AMEDEE: She had two police officers outside the room.
MS. BUCKINGHAM: Okay. And so did they remain outside the room for the duration?
RACHELLE AMEDEE: Always outside the room, yes.
MS. BUCKINGHAM: As far as your interaction with the patient on that particular night shift, was she responsive at all during-
MS. BUCKINGHAM: ... the time that you saw her?
MS. BUCKINGHAM: And with intubation, you mentioned she was intubated, is a patient often sedated in order to maintain intubation?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Why is that?
RACHELLE AMEDEE: Helps them not fight the vent and breathe better and make sure that they're comfortable.
MS. BUCKINGHAM: And what does sedation do to an individual?
RACHELLE AMEDEE: You're calmer. You're sleeping.
MS. BUCKINGHAM: Makes them more relaxed?
RACHELLE AMEDEE: Relaxed, yeah.
MS. BUCKINGHAM: Other than that night, that first night, the 24th into the 25th, did you have the occasion to treat this patient at other points within that week?
RACHELLE AMEDEE: Yes. I have.
MS. BUCKINGHAM: And gonna draw your attention to January 26th of 2023. Do you recall interacting with her on that day?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And is it fair to say that on the 26th she was still intubated?
RACHELLE AMEDEE: She was.
MS. BUCKINGHAM: And under sedation?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Well, during this time period on the 26th, was she arousable, meaning could you initiate some communication with her?
RACHELLE AMEDEE: Some, yes.
MS. BUCKINGHAM: And were you able to kind of give her commands in order to care for her that she was able to follow?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And when I say able to follow, obviously—
RACHELLE AMEDEE: Simple, yeah, commands.
MS. BUCKINGHAM: What kinds of comm—
RACHELLE AMEDEE: Like, can you squeeze my hand? Can you wiggle your toes? Just basic, a neuro check to just make sure she's alert and she's able to follow, understand what you're saying to her.
MS. BUCKINGHAM: And for this particular patient, you're aware that she presented with a spinal injury, correct?
RACHELLE AMEDEE: Correct.
MS. BUCKINGHAM: And so movement of the lower extremities was not something that she did?
RACHELLE AMEDEE: Correct.
MS. BUCKINGHAM: But did you observe her to move her head around and move her arms around?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Now, you also had the occasion to treat her in the overnight shift of January 28th of 2023, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And during that time, she was also still intubated?
RACHELLE AMEDEE: I believe so. I don't... I'm not sure. I've had her both intubated and—
MS. BUCKINGHAM: Okay. While she was still intubated, did you have a system that you could use to communicate with her?
RACHELLE AMEDEE: Yes. Board. We have a whiteboard or clear board that sometimes patients can write on.
MS. BUCKINGHAM: Did you observe her to utilize that whiteboard to write on it?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And at this point, when she's writing on the board, she's now, her eyes are open, and she's responsive?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And she's able to tell you how she's feeling, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And fair to say she used that whiteboard to tell you she was confused and that she couldn't feel her lower extremities?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And do you recall her complaining of having pain?
RACHELLE AMEDEE: I don't recall.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: During this time period on the 28th, do you recall whether the patient was placed into restraints?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And why was that?
RACHELLE AMEDEE: Well, we restrain all patients that are intubated for safety.
MS. BUCKINGHAM: And why?
RACHELLE AMEDEE: So they don't pull out the tube or pull out any lines that they have.
MS. BUCKINGHAM: Okay. And so they're not at that level of sedation anymore where they're just completely asleep, there is danger that they could move and cause damage to—
RACHELLE AMEDEE: Medical equipment out of the way.
MS. BUCKINGHAM: Okay. And so in this case, as far as the restraints go, fair to say that they were soft restraints?
RACHELLE AMEDEE: Soft, yeah.
MS. BUCKINGHAM: And what does that look like for a patient?
RACHELLE AMEDEE: Meaning?
MS. BUCKINGHAM: Well, like, what does a soft restraint look like—
RACHELLE AMEDEE: A soft restraint—
MS. BUCKINGHAM: ...for those that don't know?
RACHELLE AMEDEE: It's like maybe I would say a cushion restraint, and then it's tied to the sides of the bed.
RACHELLE AMEDEE: So it's all the way around your wrist.
MS. BUCKINGHAM: Okay. At some point, by the end of that shift, you recall that she was extubated?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Can you tell us what extubation is?
RACHELLE AMEDEE: That means you remove the tube. You usually stop all sedation.
MS. BUCKINGHAM: Okay. And were you able to make observations of the patient once she was extubated?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Did her presentation change at all from your previous interactions with her?
MS. BUCKINGHAM: Okay. Did you have the occasion to treat her again on January 30th?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And again, at that point she has already been extubated? And are you able to then make an assessment of her without the tube and about her orientation and her alertness?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Is that something that you kinda do each and every shift?
RACHELLE AMEDEE: Every shift, yeah.
MS. BUCKINGHAM: Was she still on sedation medication at that time?
MS. BUCKINGHAM: And what was your observations of the patient's demeanor now that she is extubated?
RACHELLE AMEDEE: She's flat. No emotion either way.
MS. BUCKINGHAM: And is that fairly consistent with what your observations of—were of her during the course of your time treating her?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: How about being alert and oriented? Did you observe her to be alert and oriented?
RACHELLE AMEDEE: She was.
MS. BUCKINGHAM: Okay. And did you observe her to identify sleep as an ongoing issue?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And so as part of the plan for treating her, did you address the sleep?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And how did you guys address sleep?
RACHELLE AMEDEE: The plan was to start the first sleeping medication for her. I don't remember exactly which one, and then wait a couple hours, see if it worked, and if not, try another medication.
MS. BUCKINGHAM: Okay. And this actually occurred over the course of a few days, correct?
RACHELLE AMEDEE: Few days. Yeah.
MS. BUCKINGHAM: During the time when you observed her to be flat, as far as her affect goes, did you also observe her to be cooperative?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Meaning she followed your directions?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Did you treat her or were you the overnight nurse for her on February 2nd, you recall?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Okay. On this particular night, February 2nd, do you remember her making a particular request of you or ask you for something specific?
RACHELLE AMEDEE: I think that was the night she wanted to reach out to her lawyer.
MS. BUCKINGHAM: Okay. And did you note that in your nursing notes?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Why did you note that particular request?
MR. REDDINGTON: Objection.
THE COURT: Can I see counsel?
THE COURT: Yeah, counsel, go ahead.
MS. BUCKINGHAM: Thank you. So on this particular night, the 2nd, she made a request of you for her lawyer, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Was that something she had asked you before?
MS. BUCKINGHAM: And so, did you think it was something worth noting?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Why would you note something like that?
RACHELLE AMEDEE: 'Cause that was the first time she referred to anything going on with the case or whatever.
MS. BUCKINGHAM: Okay. And so you had the occasion after she was extubated to have some casual conversation with her, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Okay. And this was not a conversation you'd had before?
MS. BUCKINGHAM: What did you do when she made that request? What was your response?
RACHELLE AMEDEE: I sent what we call a consult to the social worker in order to coordinate reaching out to her lawyer.
MS. BUCKINGHAM: Okay. In any of the shifts that you had been caring for this particular patient, did you see anyone besides medical staff and the law enforcement that were outside of the room come in and speak with her?
MS. BUCKINGHAM: Were you aware that she was not to have visitors?
RACHELLE AMEDEE: Yes. I was told the first night.
MS. BUCKINGHAM: And is that something that you've seen before in your work as a nurse when there are police on site?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Were you present at one point when some troopers came in to take photographs of her?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And were you in the room when they took the photographs?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Do you recall assisting them in viewing the injuries to her wrists and her neck?
RACHELLE AMEDEE: I don't know if I... I don't remember assisting.
MS. BUCKINGHAM: Okay. But you were present in-
RACHELLE AMEDEE: I was present, like, in the room with her.
MS. BUCKINGHAM: And fair to say, your contact ended with this patient on February 3rd when she was transferred off of the trauma surgical ICU unit?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Just have one moment.
RACHELLE AMEDEE: Sure.
MS. BUCKINGHAM: Now, you were not the only nurse to treat her on the night shift, correct?
RACHELLE AMEDEE: Correct.
MS. BUCKINGHAM: So on days that you didn't work, another nurse treated her?
RACHELLE AMEDEE: Exactly.
MS. BUCKINGHAM: And were you familiar with the nurse who was generally assigned to treat her during the day?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And who was that?
RACHELLE AMEDEE: Meghan Collins.
MS. BUCKINGHAM: Meghan Collins?
RACHELLE AMEDEE: Mm-hmm.
MS. BUCKINGHAM: And is it fair to say that with the law enforcement presence and this patient's particular situation, the amount of medical staff that were treating her on a regular basis was fairly limited?
RACHELLE AMEDEE: Correct.
MS. BUCKINGHAM: Meaning it was the same people all the time?
RACHELLE AMEDEE: Yes. Mm-hmm.
MS. BUCKINGHAM: Okay. Thank you.
THE COURT: All right. Attorney Reddington.
MR. REDDINGTON: Morning.
RACHELLE AMEDEE: Morning.
MR. REDDINGTON: First of all, you have the certified copies of the records from Brigham and Women's Hospital. I'd like to mark these as exhibits.
THE COURT: All right. Commonwealth, any objection?
MS. SPRAGUE: We... Do we have those? I actually have those on a disc. I was gonna put the disc in instead of—
MR. REDDINGTON: I'd prefer the paper copies.
MS. SPRAGUE: ...all the paper.
THE COURT: Why don't we put both, why don't we put both in?
MR. REDDINGTON: Sure.
MS. SPRAGUE: Sure.
THE COURT: We can do A and B.
COURT REPORTER: 141A and B.
MR. REDDINGTON: All right.
THE COURT: Thank you.
MR. REDDINGTON: Now, let's talk about a lawyer first, since that was the last that they asked you about. And correct me if I'm wrong on any of these dates or facts. She was admitted on the 24th of January. Is that correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And do you have a memory as to approximately what time was it in the evening?
RACHELLE AMEDEE: Well, she got to the ICU. It was around 3:00.
MR. REDDINGTON: Okay. You're very soft-spoken.
RACHELLE AMEDEE: Sorry.
MR. REDDINGTON: If you can just keep your voice up so all the jurors can hear you.
RACHELLE AMEDEE: She got to the ICU around 3:00 AM.
MR. REDDINGTON: Thank you. And she came by MedFlight?
RACHELLE AMEDEE: She came to me from MRI.
MR. REDDINGTON: And MRI obviously would be when you're taking the pictures—
RACHELLE AMEDEE: Picture, yeah.
MR. REDDINGTON: ...and that would be on the 24th of January in the early morning hours, correct?
RACHELLE AMEDEE: I think it went into the 25th.
MR. REDDINGTON: Into the 25th?
RACHELLE AMEDEE: I think so.
MR. REDDINGTON: Counsel asked you about the whiteboard that she would write on. And I think it was, again, if I'm wrong, correct me, was it January 28th that she used for the first time the whiteboard to communicate?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And the whiteboard basically is just a whiteboard—
RACHELLE AMEDEE: Yeah.
MR. REDDINGTON: ...and you write on it.
RACHELLE AMEDEE: Erasable.
MR. REDDINGTON: And she was not able to speak because she was intubated, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And she was in the restraints that you've described as well, right?
RACHELLE AMEDEE: Right.
MR. REDDINGTON: Moving forward, January 28th, 29, 30, into February 1st, February 2nd, it was on February 2nd that counsel asked you about her asking to reach out to her lawyer, correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And do you know who her lawyer was at that time?
MR. REDDINGTON: Had you seen him before?
MR. REDDINGTON: Did you know, is his name Attorney Gelb?
MR. REDDINGTON: Make any reference to you?
MR. REDDINGTON: Do you know that, whether or not she had conversation with Attorney Gelb regarding her status as being under arrest by the numerous police that were guarding the room?
RACHELLE AMEDEE: I don't.
MR. REDDINGTON: Do you know whether or not she was ever able to talk to Attorney Gelb, or did you refer her to the social worker people?
RACHELLE AMEDEE: I've put in a consult for the social worker.
MR. REDDINGTON: Okay. Thank you. When she was admitted on the 24th, would you agree that she was in a state of cardiac arrest shortly thereafter?
RACHELLE AMEDEE: Shortly after arriving to me.
MR. REDDINGTON: So I'm looking at the medical records that have been introduced for the jurors, and I'm referencing on page 18, if I may.
MR. REDDINGTON: Now,
MR. REDDINGTON: This is one page of, I don't know, 400 pages of medical records.
THE COURT: Can you see that?
MR. REDDINGTON: Looking at this, does it indicate the… It said SICU course.
RACHELLE AMEDEE: Surgical ICU.
MR. REDDINGTON: I'm sorry?
RACHELLE AMEDEE: Surgical ICU.
MR. REDDINGTON: Okay. And that makes reference to the fact that shortly after arriving in the ICU, the patient had a cardiac arrest. Is that fair?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Were you there then?
RACHELLE AMEDEE: I was.
MR. REDDINGTON: And when it says the etiology of the arrest, she got two rounds of CPR before obtaining ROSC. Can you tell me, please, what is CPR, two rounds, and what is ROSC?
RACHELLE AMEDEE: Meaning we did chest compressions. She was already intubated, so she was getting oxygen.
MR. REDDINGTON: Okay. And then bilateral chest tubes were placed in her body?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Does that mean from both sides?
RACHELLE AMEDEE: Both sides.
MR. REDDINGTON: Okay. And they, that punctures through the chest into what? The lungs?
RACHELLE AMEDEE: The lungs.
MR. REDDINGTON: Okay. Let's go with the lungs. And when they placed the chest tubes, at this point, shortly after admission, there was 100 to 300 ccs of blood from each chest tube? What does that mean?
RACHELLE AMEDEE: That's the output they got once they put the chest tube—
MR. REDDINGTON: Sorry. Again, just can you keep your voice up?
RACHELLE AMEDEE: That's the output they got once they put the chest tube in.
MR. REDDINGTON: Okay. So when they put the chest tube in, it drained 100 to 300 ccs of blood. Is that correct?
RACHELLE AMEDEE: Correct.
MR. REDDINGTON: And then after that, again, shortly after admission to the hospital, coming from South Shore Hospital, she then got a massive transfusion protocol, which you told us about, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And what does that mean?
RACHELLE AMEDEE: Means she gets… We have a protocol that with blood, depending blood products.
MR. REDDINGTON: Okay.
RACHELLE AMEDEE: She gets infused rapidly.
MR. REDDINGTON: And was there a notice, shortly after arrival to the ICU, she was being turned and had 30 ccs of clear fluid that came out of her nose. Is that right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And what is that? Is that, was there a suspicion that that was what's called CSF?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And what is CSF?
RACHELLE AMEDEE: It's spinal fluid.
MR. REDDINGTON: Okay. Going to the next page, which would be 19. Does it indicate, again, on there… If I can just bring this up a little bit better. So she now has noted acute blood loss, anemia, right? What does that mean?
RACHELLE AMEDEE: She has a low blood count.
MR. REDDINGTON: And do you know what happened to the blood or any idea?
RACHELLE AMEDEE: I do not.
MR. REDDINGTON: So she had very low… Lost a lot of blood, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And she had anemia. That would be what? Low blood or something?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And she required multiple transfusions immediately following her arrest, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And when it says arrest, does that mean arrest by the police or does that mean the cardiac—
RACHELLE AMEDEE: Yeah.
MR. REDDINGTON: … I wanna make sure that's clear. It's cardiac arrest, nothing to do with the police, okay. And she had massive—required multiple transfusions, and you were there for that, correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Were you aware of the extent of the… After you had the X-ray, not X-rays. After you had the MRIs and the CAT scans, were you aware as her, the lead nurse or treating nurse as to what the extent of her injuries were?
RACHELLE AMEDEE: At that point, I don't believe so.
MR. REDDINGTON: All right. At some point did you become aware of that?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Okay. So, and again, I've got the records, you don't, so let me do it this way just to make it easy. Do you remember that she had a burst fracture of C1?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And what does that mean?
RACHELLE AMEDEE: Means a cerebral fracture.
MR. REDDINGTON: That'd be up here? So this is the cervical spine—
RACHELLE AMEDEE: Cervical.
MR. REDDINGTON: … Up here.
RACHELLE AMEDEE: Mm-hmm.
MR. REDDINGTON: And then T5 and T6.
RACHELLE AMEDEE: Mm-hmm.
MR. REDDINGTON: There was a transection.
RACHELLE AMEDEE: Thoracic.
MR. REDDINGTON: What does that mean?
RACHELLE AMEDEE: Thoracic.
MR. REDDINGTON: Okay.
RACHELLE AMEDEE: On the spine.
MR. REDDINGTON: So it would be down here.
RACHELLE AMEDEE: Yeah.
MR. REDDINGTON: And when it says transection, what does that mean?
RACHELLE AMEDEE: It's severed.
MR. REDDINGTON: And then T, 1, 2, 3, 4 also were injured as well, right?
RACHELLE AMEDEE: Mm-hmm.
MR. REDDINGTON: What is neurogenic shock? What does that mean? If you know.
RACHELLE AMEDEE: Neurogenic shock?
MR. REDDINGTON: Sorry. Yeah, neurogenic shock. It just makes reference on, uh—
RACHELLE AMEDEE: These are not my notes, so I can't really—
MR. REDDINGTON: That's fine. I understand.
MR. REDDINGTON: And this would be on page 65. Do you recall reviewing the documentation as to the, what's captioned present illness in the records? Did you know that she was presenting as a transfer from South Shore Hospital?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Did you know that she was, that under present illness in the history would be that she's a 30, 32-year-old female with history significant for postpartum depression. Did you know that?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And did you know that, after the fall with the C1 burst fracture and the complex transection of T5 and T6, she also had rib fracture, correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: On page 66, that would make reference to the timeframe, going into the 25th. On the 25th that she was reacting to painful stimuli, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And that basically means that she's not conscious, if you will, but she's able to react to—
RACHELLE AMEDEE: If you cause pain.
MR. REDDINGTON: Yeah. Okay.
MR. REDDINGTON: There's a notation of a contusion, laceration, and crushing of the thyroid with thyroidal edema. What does that mean?
RACHELLE AMEDEE: She has swelling, I'm assuming, around her thyroid.
MR. REDDINGTON: Okay. And that is—
RACHELLE AMEDEE: Again, this is not my scope—
MR. REDDINGTON: Okay.
RACHELLE AMEDEE: … Of practice, so.
MR. REDDINGTON: Okay. On page 70, the same evening, making reference to the fact that, in addition to the injuries to the spine, that she also had the rib fractures and was currently in shock. Do you remember that she was in shock?
MR. REDDINGTON: Yes, no?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Okay. Would you agree, or do you recall that there's a notation that this patient is critically ill, and noting that she has postpartum psychosis on page 72?
MS. BUCKINGHAM: Objection.
THE COURT: Can I see, counsel.
MR. REDDINGTON: Sorry. When you're treating a patient, one of the things you try to do is to know what their total body and emotional condition is, what they've been dealing with, and what injuries they have, right?
RACHELLE AMEDEE: We get a rundown or history of the patient.
MR. REDDINGTON: Sure. And as it goes into the end of January, and she had been communicating on the whiteboard, you were aware at that point why she was in the hospital, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: You knew where she came from, South Shore Hospital, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And you knew that there had been discussion about postpartum psychosis. Isn't that right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Okay. And do you recall that... And this would be on... May I approach you under the witness?
THE COURT: You may.
MR. REDDINGTON: Thank you.
THE COURT: You could maybe, if you could show counsel. Wait.
MR. REDDINGTON: I want the date and the time.
MR. REDDINGTON: Okay. And the lawyer, the legal team.
MR. REDDINGTON: So I'm just showing you one page from the medical record. Can you tell me approximately what date is this page from?
RACHELLE AMEDEE: One twenty-five.
MR. REDDINGTON: January 25.
THE COURT: If I can ask you if you keep your voice, at least speak in the microphone.
RACHELLE AMEDEE: Oh, sorry. Yeah.
THE COURT: Thank you.
RACHELLE AMEDEE: January 25th.
MR. REDDINGTON: Okay. And does it say what time?
RACHELLE AMEDEE: Nine AM. Nine O three AM.
MR. REDDINGTON: All right. Can I see that for a second? Thank you. And looking at that,
MR. REDDINGTON: Do you recall on that date, you had been working with her the night before, correct?
RACHELLE AMEDEE: Correct.
MR. REDDINGTON: Where it indicates that the patient is under arrest, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And there were police officers at her bedside, right?
RACHELLE AMEDEE: Outside the room.
MR. REDDINGTON: Well, it says at her bedside on the record, doesn't it?
RACHELLE AMEDEE: In the record, but I'm saying they-
MR. REDDINGTON: So the night before-
RACHELLE AMEDEE: They were outside her room.
MR. REDDINGTON: ... outside the room. You were not there during the day, apparently, right?
RACHELLE AMEDEE: Correct.
MR. REDDINGTON: Okay. And there's a difference from you guys as far as your medical records if the police officer is at the bedside as opposed to sitting in a chair in the hallway outside the room.
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Okay. So indicating police officer at her bedside, we will involve the social work and legal teams, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Okay.
MR. REDDINGTON: And again, on page seventy-two, there's a reference to CSF leak, and that's significant. It says significant amount of fluid coming from her nose. Do you have any memory of observing that in your treatment?
RACHELLE AMEDEE: I did.
MR. REDDINGTON: Okay. And then of course, there was the code event that you've already described for us. There's the hundred to three hundred CCs of blood coming from the tubes, and then it makes reference to, on page seventy-four, to massive transfusion protocol. Is that like a medical term, or is that somebody—
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: ...describing it, or?
RACHELLE AMEDEE: It's a medical. Like, it's a protocol that we have at the hospital.
MR. REDDINGTON: Okay.
MR. REDDINGTON: And on page seventy-five, did you make reference to or did you observe the injuries, for example, to her wrist?
RACHELLE AMEDEE: I observed.
MR. REDDINGTON: Yes. And would you agree with me, page seventy-five of the medical record, indicating if it says RUE. What does RUE mean? Do you know?
RACHELLE AMEDEE: Oh, right upper extremity.
MR. REDDINGTON: Right upper extremity. Three point five centimeter deep laceration. Volar aspect of wrist. Can you tell me what is the volar aspect of the wrist?
MR. REDDINGTON: I just don't know.
RACHELLE AMEDEE: I'm not sure what that's referring to.
MR. REDDINGTON: Okay. That's all right. That's fine. Would you agree that there was noted a three point five centimeter deep laceration on her wrist?
RACHELLE AMEDEE: I can't say because I didn't measure. This is somebody else's note, so.
MR. REDDINGTON: Well, when you looked at her, did you observe with your own eyes and your own experience that she had a deep laceration on the—
RACHELLE AMEDEE: She had a laceration, yes.
MR. REDDINGTON: You can't say it's deep or not?
RACHELLE AMEDEE: I can't say. I didn't—
MR. REDDINGTON: Do you wanna say it was superficial?
RACHELLE AMEDEE: I can't say that either.
MR. REDDINGTON: So when you looked at the laceration on her wrist—
RACHELLE AMEDEE: Yeah.
MR. REDDINGTON: ...you can't tell us if you would agree that it was a deep laceration?
RACHELLE AMEDEE: I really didn't get to assess it at the time when she arrived, so.
MR. REDDINGTON: LUE, underneath that, left upper extremity apparently, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: Two-centimeter deep laceration, again, on the volar aspect of the wrist. You did see laceration on the left, right?
RACHELLE AMEDEE: Yeah, she had dressings.
MR. REDDINGTON: Okay.
MR. REDDINGTON: And when she was admitted, she had the core temperature of 82 degrees, is that correct?
RACHELLE AMEDEE: If that's what's noted.
MR. REDDINGTON: All right. Do you remember, did they use a Bair Claw or something like that? What is it they call it? They put the—
RACHELLE AMEDEE: A Bair Hugger.
MR. REDDINGTON: Bair Hugger. They put a Bair Hugger blanket on them. And when I say them, I mean people that have a low—
RACHELLE AMEDEE: Low temperature, to warm them up.
MR. REDDINGTON: It hopefully raises the temp, right?
RACHELLE AMEDEE: Temperature, yeah.
MR. REDDINGTON: And then if it has warm intravenous IVF, that would be inj- putting warm saline in the body?
RACHELLE AMEDEE: Yes, through an IV.
MR. REDDINGTON: All right. All with an effort to try to get the temperature up, right?
RACHELLE AMEDEE: Up, yeah.
MR. REDDINGTON: And her core temperature was 82 degrees even after she was at the South Shore Hospital, and underneath the Bair thing and all that, and still 80?
RACHELLE AMEDEE: If that's what's noted.
MR. REDDINGTON: Yeah.
RACHELLE AMEDEE: Again, that's not my note.
MR. REDDINGTON: That's pretty low, isn't it?
RACHELLE AMEDEE: It is.
MR. REDDINGTON: And you made reference to pressors. I'm sorry. Can you—
RACHELLE AMEDEE: Pressors.
MR. REDDINGTON: ... tell me what's—
RACHELLE AMEDEE: Blood pressure medication to bring up the blood pressure.
MR. REDDINGTON: Okay.
MR. REDDINGTON: On January 26th she was still intubated, is that right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And she was under sedation, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And then you referenced January 29th, 29th, January 28th, overnight shift she was still intubated, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And January 28th is when she first started utilizing the whiteboard, is that correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: But she was intubated, yes?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: She was restrained to the bed—
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: ... yes, and had the tube was still in her mouth, and she was writing on a whiteboard on the 28th of January, correct?
RACHELLE AMEDEE: She was able to, yes.
MR. REDDINGTON: January 30th she was extubated as the district attorney asked you, right?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: So, at that point was she able to talk, like, you know, talk?
RACHELLE AMEDEE: Talk.
MR. REDDINGTON: Okay. And then on February 2nd is when she used the— she asked about wanting to reach out to her attorney, is that correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: But you had no knowledge as to her mother and father getting an attorney for her while she was in custody with the police all around her?
MR. REDDINGTON: Okay. And you tried to help her out as best you could, right?
RACHELLE AMEDEE: Yeah, to coordinate. It's harder at night to—
MR. REDDINGTON: Sure.
RACHELLE AMEDEE: ... you know, so I wanted to pass it on.
MR. REDDINGTON: And finally, she was not able to have visitors per order of the police, is that correct?
RACHELLE AMEDEE: Correct.
MR. REDDINGTON: Thank you very much, ma'am.
RACHELLE AMEDEE: Thank you.
THE COURT: Commonwealth, redirect.
MS. BUCKINGHAM: Miss Amedee, the first time that Ms. Clancy, the defendant, the patient, used a whiteboard with you was on January 28th, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: You're not aware of if she used that tool with other nurses on other shifts, are you?
RACHELLE AMEDEE: No. No.
MS. BUCKINGHAM: And the first time that she mentioned a lawyer on the February second, that's the first time she mentioned a lawyer to you, correct?
RACHELLE AMEDEE: Correct.
MS. BUCKINGHAM: You were asked about the trauma and the chest tube and that she lost 100 to 300 CCs of blood.
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: The transfusion came after that, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And fair to say the course of her treatment coming to Brigham was that she first came in through the emergency department, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Then she was sent for an MRI.
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And then she came to the trauma surgery, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And you're aware that she had other imaging like CT scans, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And that, especially when it came to the head CT, she didn't have any intracranial injuries or anything that required that you be focused on her head injury, correct?
RACHELLE AMEDEE: Correct.
MS. BUCKINGHAM: So it was more a cardiac issue and keeping her stable, and internal bleeding in the chest area.
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: As far as what you're aware of from other treating physicians, you're aware Dr. Anderson was one of the trauma surgeons that was treating the patient.
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And he was making assessments and giving orders to you and other nurses, fair to say?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: And are you aware that he identified in the history that this patient actually had a history of postpartum mood symptoms, not psychosis?
RACHELLE AMEDEE: I would have to look at the note. I don't remember.
MS. BUCKINGHAM: Those aren't notes that you would have written.
MS. BUCKINGHAM: And you weren't taking a full history of the patient when you were there.
RACHELLE AMEDEE: Not at the time, no.
MS. BUCKINGHAM: Okay. Were you aware that she then subsequently was fully evaluated by the psychiatric team?
RACHELLE AMEDEE: I knew she saw psych, yes.
MS. BUCKINGHAM: And were you aware that they ultimately identified that there's an inherent uncertainty in her diagnosis?
RACHELLE AMEDEE: I do not remember.
MS. BUCKINGHAM: Okay. As far as the lacerations went, in your treatment of her, again, you treated her overnight shifts for various days, correct?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Did you ever have a situation where you had to change her bandages because they were seeping?
MS. BUCKINGHAM: And are you aware that a day—
RACHELLE AMEDEE: Except for the first night, but we didn't get to that 'cause she coded.
MS. BUCKINGHAM: 'Cause she coded.
RACHELLE AMEDEE: Yeah.
MS. BUCKINGHAM: And then you're aware that the next day after, another individual, a physician's assistant, a physician's assistant, excuse me, actually came in and treated those lacerations.
RACHELLE AMEDEE: Sutured, yeah.
MS. BUCKINGHAM: As far as Dr. Anderson goes, were you aware that on January 25th he noted that the lacerations to her neck and wrists were very superficial and didn't require treatment at that time?
RACHELLE AMEDEE: I was not aware. I have... don't remember that note.
MS. BUCKINGHAM: Would you, if I showed you the record that that's in his note—
RACHELLE AMEDEE: Yeah.
MS. BUCKINGHAM: … would you agree that that's an assessment that he made?
RACHELLE AMEDEE: Yes.
MS. BUCKINGHAM: Great. And he didn't re—he didn't instruct you to do anything further with those injuries?
RACHELLE AMEDEE: Yes. Right.
MS. BUCKINGHAM: Thank you.
MR. REDDINGTON: Just very briefly.
THE COURT: Sure.
MR. REDDINGTON: District attorney asked you about the evaluation by the psych, as she put it, psychiatric teams, with a determination that there was inherent uncertainty according to the psychiatric teams. Do you know when the psychiatric teams were evaluating her?
RACHELLE AMEDEE: I don't know. It was after—during the day.
MR. REDDINGTON: Okay.
RACHELLE AMEDEE: I don't know what day, but...
MR. REDDINGTON: But in any event, I did show you on the thing over there the—where the reference was made to postpartum depression, postpartum psychosis, correct?
RACHELLE AMEDEE: Yes.
MR. REDDINGTON: And...
MR. REDDINGTON: That's all I have. Thank you, ma'am.
THE COURT: Anything further?
MS. BUCKINGHAM: No, thank you.
THE COURT: All right. Thank you, ma'am. You may sit down. Thank you.
RACHELLE AMEDEE: Thank you.
THE COURT: All right. Commonwealth.