Upgrade to Pro — share decks privately, control downloads, hide ads and more …

Case File: Annemarie Ludford Garvey 1 - Intro

Ann
November 21, 2022

Case File: Annemarie Ludford Garvey 1 - Intro

We will rewrite this later, but for now, the following is the Introduction to our book, "Case File: Who is Anne - Understanding the Meaning of Life, Her Purpose, and How She Makes Sense of Their World." As of 1-2-23, it is up to page 420 of 500. Please keep coming back!

Ann

November 21, 2022
Tweet

More Decks by Ann

Other Decks in Education

Transcript

  1. Case File: Who is Anne - Understanding the Meaning of Life, Her
    Purpose, and How She Makes Sense of Their World
    Patient location: In their home at Sandwich, Illinois a small farming town sixty miles
    SW of Chicago.
    Before the initiation of today's documented service, the patient or patient guardian verbally
    consented to virtual/remote treatment. The topics discussed are the assessment & plan in this
    note. This telehealth visit performed was physically located at Provider-Based Clinic
    Mental Status Exam
    Appearance: casually dressed, glasses, good grooming, and hygiene and overweight ~280 lbs.
    Behavior: cooperative (pleasant), fair eye contact and good eye contact
    Speech: fluent, normal rate, tone, quantity, and volume
    Language: fluent, appropriate
    Mood: "feeling depressed", dysthymic, euthymic, frustrated
    Affect: full-range, mood congruent, appropriate, and reactive
    Thought Process: goal directed and linear
    Thought Content - denies suicidal ideation (SI) and homicidal Ideation (HI), no psychotic
    symptoms
    Perceptions: no disturbances reported
    Cognition: not assessed

    View full-size slide

  2. Insight: good, age appropriate
    Judgment: good, age appropriate
    Reliability: dependable
    Current Risk Assessment
    Homicide Risk Factors: No
    Last Suicide C-SSRS Screening: Date: Screening Found 8/9/2022
    Results: Calculated C-SSRS Suicidal Ideation Severity: Moderate Risk
    (8/9/2022 1:25 PM)
    Assessment/Plan
    1. Recurrent major depressive disorder, in partial remission (CMS/HCC)
    Overview:
    Patient (pt) has had depressive symptoms (sx) since childhood connected to trauma. Had multiple
    psych admissions for SI +/- attempts by overdose. Last admission (+SI attempt) in 2003 following
    death of her father.
    Plan:
    - Continue current medications. Reviewed expected benefit and side effects (SE). Pt verbalized
    understanding.
    - Continue video visits given distance from her home and difficulty getting out of the house.
    - Reinforced activities that aid in grounding. Online journal assisting with daily structure.
    - Continue behavioral activation for depressive sx – staying active with daily journal/schedule,
    blocked time for projects.
    - Continue email as needed. Pt will call/write to writer (Dr. Robert Marvin) with updates as
    needed.
    2. Dissociative identity disorder (DID) (CMS/HCC)
    Overview:
    Diagnosed when she was in her twenties. Significant past trauma - physical, verbal, emotional,
    sexual - from several family members. Reports approximately twenty alters ranging from infant to
    current age. Refers to herself as "we." Has been in therapy since late twenties. Considerable

    View full-size slide

  3. number of inpatient admissions, twenty plus when younger. Last admission was 2003 following
    death of father. She has continued with medications and outpatient therapy. She has made
    noteworthy progress in therapy with daily schedules (using online tools), affect
    regulation/tolerance, and interpersonal interactions.
    Plan:
    - Continue intent-to-treat (IT) – focus on productivity (online projects), structuring time,
    improving coping skills, improving internal communication, processing of trauma, medical health,
    finances, family interactions and productivity.
    - Reinforced safety plan.
    - Will continue with structured Cognitive Behavioral Therapy (CBT) components as can work into
    schedule/sessions.
    - Continue to frame activities - balancing goals of therapy, personal/family goals.
    3. Posttraumatic stress disorder (PTSD)
    Overview:
    See DID overview. Ongoing interpersonal and internal triggers.
    Assessment & Plan (A/P):
    See DID A/P.
    Education Provided
    The client has received other psychoeducation client/family education during today's session and
    verbalized understanding of education and/or training.
    Education/Instructions given to: Client
    Barriers to learning: None
    Content: Refer to note above
    Evaluation/Outcome: Verbalized understanding
    Current Health Issues:
    Mental health Problems:
    Dissociative Identity Disorder (DID)
    Severe Depression w/Suicidal Ideations - in Partial Remission

    View full-size slide

  4. Posttraumatic Stress Disorder (PTSD)
    Physical Health Problems:
    Diabetes
    Diabetic Nerve Disorder
    Severe Obesity
    High Cholesterol or Triglycerides
    Fatty Liver
    History of Bleeding Ulcers
    Underactive Thyroid
    Chronic Kidney Disease (3A)
    Sleep Apnea
    Dizziness
    Heart Disease Due to Blocked Artery
    Nonobstructive Atherosclerosis of Coronary Artery
    Chronic Bilateral Low Back Pain
    Degenerative Arthritis – Lumbar (L) – Sacrum (S) (Bilateral Facet Arthropathy)
    Subluxation at L3-4 and L1-2 with Flexion/Extension
    Vascular calcification with postop change in the pelvis.
    Disk Bulging L1 – S1
    Varying Degrees of Stenoses Including Severe Spinal Canal Stenosis at L4-L5 and
    Moderate Spinal Canal Stenosis at L3-L4
    ## Current Medications
    Please review your medications and verify that the list is up to date. **Call 911 if you have an
    emergency.**
    ### methylphenidate 20 MG tablet
    Commonly known as: RITALIN
    Take one tablet (20 mg total) by mouth three times a day.
    ### Escitalopram 20 MG tablet

    View full-size slide

  5. Commonly known as: LEXAPRO
    Take two tablets (40 mg total) by mouth one time each day.
    ### gabapentin 300 MG capsule
    Commonly known as: NEURONTIN
    Take two capsules (600 mg total) by mouth four times a day.
    ### buPROPion SR 150 MG 12 hr. tablet
    Commonly known as: WELLBUTRIN SR
    Take one tablet (150 mg total) by mouth three times a day.
    ### risperiDONE 2 MG tablet
    Commonly known as: RisperDAL
    Take one tablet (2 mg total) by mouth every night.
    ### busPIRone 15 MG tablet
    Commonly known as: BUSPAR
    Take one tablet (15 mg total) by mouth four times a day.
    ### calcium carbonate-vitamin D 600-200 MG-UNIT tablet
    Take one tablet by mouth daily.
    ### Vitamin D (Ergocalciferol) 50 mcg (2,000 units) capsule
    Take one capsule by mouth daily. (patient notified to take 2600 units daily via OTC supplements)
    ### Vitamin B-12 CR 1000 MCG Tablet CR
    Take one tablet by mouth daily.
    ### Nitroglycerin 0.4 MG sublingual tablet
    Commonly known as: NITROSTAT
    Place one tablet under the tongue every five minutes as needed for Chest pain. DO NOT EXCEED A TOTAL
    OF 3 DOSES IN 15 MINUTES
    ### isosorbide mononitrate 30 MG 24 hr. tablet
    Commonly known as: IMDUR
    Take one tablet by mouth daily.
    ### albuterol 108 (90 Base) MCG/ACT inhaler
    Inhale two puffs into the lungs every four hours as needed for Shortness of Breath or Wheezing.

    View full-size slide

  6. ### Insulin Glargine (1 Unit Dial) 300 UNIT/ML pen-injector
    Commonly known as: TOUJEO SOLOSTAR
    Inject 54 Units into the skin daily.
    ### FreeStyle Libre 14 Day Sensor Misc.
    One every 14 days.
    ### Ozempic (0.25 or 0.5 MG/DOSE) (1.34 mg/ml) 0.25 or 0.5 MG/DOSE injection
    Generic name: semaglutide(0.25 or 0.5 mg/DOSE)
    INJECT 0.5 MG SUBCUTANEOUSLY ONCE A WEEK (EVERY 7 DAYS)
    ### acetaminophen-codeine 300-30 MG per tablet
    Commonly known as: TYLENOL NO.3
    Take one tablet by mouth at bedtime as needed for Pain.
    ### ranolazine 500 MG 12 hr. tablet
    Commonly known as: Ranexa
    Take one tablet by mouth in the morning and one tablet before bedtime.
    ### levothyroxine 125 MCG tablet
    Take one tablet by mouth daily.
    ### metformin 1000 MG tablet
    Commonly known as: GLUCOPHAGE
    Take one tablet by mouth two times daily.
    ### pantoprazole 40 MG tablet
    Commonly known as: PROTONIX
    Take one tablet by mouth daily.
    ### atorvastatin 40 MG tablet
    Commonly known as: LIPITOR
    Take one tablet by mouth nightly.
    ### Pen Needles 32G X 4 MM Misc.
    Use once daily with Toujeo.
    ### aspirin 81 MG chewable tablet
    Chew 81 mg by mouth daily.

    View full-size slide

  7. Core Part(s)
    **Annemarie – Annemarie/Anne** (birth to age 16) core part keeper of our soul, often depressed and
    fantasizes death and suicide, anxious and tense, most responsible for over-weight, had a good
    relationship to paternal grandmother, becomes overwhelmed, sensitive to noise, secretive, easily
    disappointed, centered on self and her privacy, likes to sit, or lay very still, has abuse nightmares, slow,
    has trouble leaving house
    Oldest Adults - Leadership
    **Jesse** – (eighteen years to ageless) first truly independent part, left for school and travel to Norway,
    sense of power and purpose, idealist, adventurer, sprite and relies on Marie, role definer, self-reliant,
    sense of a broader humanity, guides our future and ambitions including the writing, loves to make
    things by hand, watches over Sarah and Henry
    **Ayn** – (seventeen years to 52 years) created to present best “integrated” part, registered for
    college, writing/some editing, team leader, best mixed of all the parts together, counselor, early interest
    in psychology and human development, will discuss internal parts with Corey, smooth over system
    presentation to a public world, finds it easy and fulfilling to take care of people
    **Kate** – (sixteen years to 52 years) created to capstone formal intellectual needs of high school and
    college, leadership roles, writing/heavy editing, boss role, commanding, decision-maker, holds higher
    expectations, likes to take vacations, pragmatic, chief financial officer, goal setter, and watches over
    Anniemi, non-sexual
    **Ann** – (fourteen years to 52 years) created to negotiate high school socially and emotionally,
    somewhat needy, holds lower expectations, Mom, wife, patience, but more unsure of herself,
    unconditional love and understanding (especially when frustrated), wants a home and to be married,
    nurturer, feels guilty for not being good enough or deserving, handled parents and marital separation
    and divorce
    Middle-Ages
    **Kelsie** – (twelve years to 38 years) created to help things that were going wrong, nervous, work gas
    station manages light bookkeeping, cash register, payroll and customers, endurance, and giftedness,
    oversaw mental illnesses obsessive, anxious, compulsive, night owl, hardest worker, natural intellectual
    ability, service orientated, in charge of CARF accreditation

    View full-size slide

  8. **Jamie** – (eleven years 45 years) created as a response to early sexual cues with same age kids, some
    of the writing/organizing, stats, least amount of trust for outside world, charts etc. helps with younger
    parts when they are dealing with outside world, dry humor, will help Kate with money tasks, easily
    annoyed, she is bi-sexual, toughest of us, was athletic before weight gain and smoking
    Corey and Marie – The two are most Knowledgeable of Our Multiple System – Corey Writes the Most –
    and If she has System Questions, she asks Marie who has ALL the answers. She is our sense of
    consciousness, but she is not an external part like all the other parts – A LOT of Editors
    **Corey** – (ten years to 42 years) responded to depressive withdrawn years after the “real” Sarah
    died, will do basic journalistic writing, serious, first babysitter, can get overwhelmed and confused, most
    introverted, relies on Marie, likes to summarize, thinks often about hiring help, asks questions, and loves
    cuddling on rainy days with friend or book
    **Sarah** – (eight years 32 years) held first spontaneous school/scout friendship but friend Sarah died,
    holds our faith, happiness, and humor, creative, watches younger parts while older parts are working,
    keeps health and safety balanced, playful, is sunny and loves the outdoors, loves the recorder and
    singing, most imaginative, likes to take pictures
    **Lissa** – (seven years to 25 years) receiver of “punishments,” does not talk, very isolated, and shows
    signs of neglect, responsible for interest in learning, and does a lot of research, books, and library,
    biggest reader, very curious and loves to learn, tied with Ann for wanting house, plays and enjoys music,
    enjoys especially the piano, will feed Corey lists, likes going out to eat with the Casies, loves to drive, will
    use self-destruction to get system to hospital rather than take a chance on suicidal behavior
    **Henry** – (six years to 32 years) our early “runner” to avoid abuse and later cross-country skier, non-
    sexual, only male in system, idea man and seeks solutions, assists Sarah with the younger parts needs
    and protection, likes to fix things, competent, steps in to help with housework, does computer
    uploading, downloading and a variety of the more complex computer processes, is athletic like Jamie,
    seems to maintain age of oldest “external” son
    **Anniemi** – (five years to 30 years) formal “front” part shown to early school in response to
    problems with the Casies handling kindergarten, church, and home, nervous about the need to be good,
    not bad, ombudsman, deals with fairness and compromise, negotiations, and complaints, sometimes
    stutters, tries to study, and help, but sometimes it seems with blinders on. Often starts and stops
    projects out of confusion, is forgetful, easily assumes position of rejection, feels devoted to Sr. Tess and
    is close to Dear Heart (Annemarie), sometimes suicidal, memory of childhood stories

    View full-size slide

  9. Youngest
    **KC** – (four years to 10 years) twin to Casey, rejected sexual abuse as wrong/bad, watches over body
    systems (hunger, tired, pain, washroom, and medications) with Casey, but is more negative and realistic,
    gets frustrated and angry easy, favorite word is no, collusive, loves ice cream, helpful, feels shame, over
    responsible for her age, first guardian over early relationships, stopped hugs and kisses from family
    members, system’s buoy, or thermometer
    **Casey** – (four years to 10 years) twin to KC, accepted sexual abuse as self being wanted, watches
    over body systems (hunger, tired, pain, washroom and medications) with KC, but is more positive and
    imaginative, usually a porter/portal to meet the youngest parts, naive, talkative, cries easily, loves
    cookies and will steal food, gets tired faster than others, helpful, feels glee, error on the side of
    cautiousness, played with neighborhood kids
    **Anna** – (two and a half years to six years) senses danger, holds severe pain, physically abused, Hides
    face, rocking, and non-communicative, will hide, curls up like Mimi, but usually guided by Marie, has a
    sense of mystery, inquisitive, held early relationship with paternal grandmother (non-abusive)
    **Marie** – (two to ageless) –internal self-helper, sense of knowledge, consciousness, understands
    switches, internal answers, and history, never is out by self, but is evident in our rocking, and knows
    internal needs of system
    **Gracie** – (one and a half years to five years) severe manipulation of genitals makes our body rigid,
    easily paralyzed and catatonic, hyperventilates, fear, will close our system (cause minds to disconnect),
    makes guttural sounds from her throat, weary and fearful, played with neighbor Carol Ann
    **Crystal** – (eight months to four years) inability to breathe, startles, thrashes, autistic, choked by
    ejaculations, smothered due to screaming, seizure-like, is hyper-alert
    **Mimi** – (three months to three years), inability to hold consciousness, sleepy, calmed by massages,
    given alcohol to body parts to suckle on and keep quiet
    **Embry** – (0-0 months), the only part of us that died at birth. Was Mimi’s twin. Responsible for the
    Ann’s system of devotion and dedication. We do things in her name. She buried (as a symbol) in
    1992(3) near the old tank at Bunker Prairie Park, in MN where we cross-country skied in high school.

    View full-size slide

  10. Introduction
    Mental Status Exam
    Assessments/Plans
    1. Recurrent major depressive disorder, in partial remission
    2. Dissociative Identity Disorder
    3. Posttraumatic stress disorder
    Current Health Issues
    Mental health problems
    Physical health problems
    Current Medications
    Core Parts
    Table of Contents
    Chapter 1
    ## 2022-08-25 - Evidence 1A – Utilizing Supportive Therapy
    ## 2022-08-26 - Evidence 1B – Testing Out New Journal System
    ## 2022-08-27 - Evidence 1C – Nihit Is an Ever-Stewing Pot
    ## Two-Week Note to Dr. Marvin – Evidence 1D – Catch You up
    ## 2022-08-28 - Evidence 1E – Let Us Think About What It Means
    ## 2022-08-29 - Evidence 1F – Certain Writing Spiral
    ## 2022-08-30 - Evidence 1G – On Schedule To Be On Schedule
    Chapter 2
    ## 2022-08-30 - Evidence 2A – Feeling Relief and Feeling Positive
    ## 2022-08-31 - Evidence 2B – Could Be Our Quiet Time
    ## 2022-09-01 - Evidence 2C – Needing To Take Care of Self
    Chapter 3
    ## 2022-09-01 - Evidence 3A - As To Medical Conditions
    ## 2022-09-02 - Evidence 3B – Giving Us a Fighting Chance
    ## 2022-09-03 - Evidence 3C – Let Us Get Things Done
    ## 2022-09-04 - Evidence 3D – It Is OK, We Can Do This

    View full-size slide

  11. ## 2022-09-05 - Evidence 3E – Have You Done Your Marvin Yet
    ## 2022-09-06 - Evidence 3F – I Got a Chance to Talk
    Chapter 4
    ## 2022-09-06 - Evidence 4A – Writing Scope & Writer’s Roles
    ## 2022-09-07 - Evidence 4B – How Did That Happen
    ## 2022-09-08 - Evidence 4C – Where Were We While Listening
    ## 2022-09-09 - Evidence 4D – We Need to Remember Some Appointments
    ## 2022-09-10 - Evidence 4E – We Took A Morning Shower (shower)
    ## 2022-09-12 - Evidence 4F – Complete the Journal
    ## 2022-09-13 - Evidence 4G – Moving Past Our Earlier Morning
    Chapter 5
    ## 2022-09-13 - Evidence 5A – Another Episode of Chest Pain
    ## 2022-09-15 - Evidence 5B - Productive Journal Sections
    Chapter 6
    ## 2022-09-15 - Evidence 6A – Hanging Out With Nihit
    ## 2022-09-16 - Evidence 6B – Nihit is Being In and Out
    ## 2022-09-18 - Evidence 6C – Feeling a Little Grumpy
    ## 2022-09-19 - Evidence 6D – Seasick over Nihit
    ## 2022-09-20 - Evidence 6E – Feeling Mopey AND Cranky
    Chapter 7
    ## 2022-09-20 - Evidence 7A – Unsettled About Change in Hair
    ## 2022-09-21 - Evidence 7B – Lone Bird Out
    ## 2022-09-22 - Evidence 7C – Remembering We Smile A Lot
    ## Concept Index 9-22-22 – Evidence 7D – Internalizing/Externalizing Self & Other
    Chapter 8
    ## 2022-09-22 - Evidence 8A – Mixed to Low Feelings
    ## 2022-09-23 - Evidence 8B – Listening to Newsy-type Things
    ## 2022-09-24 - Evidence 8C – Strange Baby Meerkat Dream
    ## 2022-09-26 - Evidence 8D – Then We Got Into Trumpworld News

    View full-size slide

  12. ## 2022-09-27 - Evidence 8E – Writing Goal Ideas
    Chapter 9
    ## 2022-09-27 Evidence 9A – Busy Working on Guilded Material
    ## 2022-09-28 - Evidence 9B – Encouraging Rich Not To Be Grouchy
    ## 2022-09-29 Evidence 9C – Being Hungry & Un-Sated
    Chapter 10
    ## 2022-09-29 - Evidence 10A – Not Doing Much “Exciting”
    ## 2022-09-30 - Evidence 10B – Slept Good Even Without Rich
    ## 2022-10-02 - Evidence 10C – Took A Chance & Chores Got Done
    ## 2022-10-03 - Evidence 10D – Soft Morning with Rich
    ## 2022-10-04 - Evidence 10E – Nihit & Us Will Both Be Stressing
    Chapter 11
    ## 2022-10-04 – Evidence 11A – Dress For the Wedding
    ## 2022-10-05 – Evidence 11B – Rich in After 11PM
    Chapter 12
    ## 2022-10-06 – Evidence 12A – Feeling “A Little Unsettled”
    ## 2022-10-07 – Evidence 12B – Last Night’s Sleep Was Sound
    Chapter 13
    ## 2022-10-11 – Evidence 13A – Appointments to Nephrologist & PCP
    Chapter 14
    ## 2022-11-13 – Evidence 14A – Review of Medical Appointments
    ## 2022-10-14 – Evidence 14B – Do not Read This Nihit!
    ## 2022-10-17 – Evidence 14C – We Have Not Been Able to Recall Much
    ## 2022-10-18 – Evidence 14D – Trying To Make Things Work
    Chapter 15
    ## 2022-10-20 – Evidence 15A – Nihit Making Recommendations
    ## 2022-10-25 – Evidence 15B – Memories of Rich Moving Around
    Chapter 16
    ## 2022-10-25 – Evidence 16A – Audiology Appointment Went Well

    View full-size slide

  13. Chapter 17
    ## 2022-10-27 – Evidence 17A – Distracted Working on an Update
    ## 2022-10-28 – Evidence 17B – Let Me Know
    ## 2022-10-30 – Evidence 17C – Rich Was With Me When We Woke Up
    ## 2022-10-31 – Evidence 17D – Sweetie Time For Breakfast
    Chapter 18
    ## 2022-11-01 – Evidence 18A – Not Having Anything To Talk About
    ## 2022-11-02 – Evidence 18B – Rich Was Cooking Dinner
    ## 2022-11-03 – Evidence 18C – What Did We Talk To Dr. Marvin About
    Chapter 19
    ## 2022-11-03 – Evidence 19A – Connected Low Moods To Feelings
    ## 2022-11-04 – Evidence 19B – By the Advice of Nihit
    ## 2022-11-05 – Evidence 19C – Skimming Over Information
    ## 2022-11-08 – Evidence 19D – Dr. Marvin Will Be Out
    Chapter 20
    ## 2022-11-10 – Evidence 20A – Working Through Tech Issues
    ## 2022-11-14 – Evidence 20B – We Received Coffee Right Away
    ## 2022-11-15 – Evidence 20C – Rubbing Rich’s Arm
    Chapter 21
    ## 2022-11-15 – Evidence 21A – Updates To Nihit’s Vacation
    ## 2022-11-16 – Evidence 21B – Today Was Not Stellar
    ## 2022-11-17 – Evidence 21C – We Were Nightmarish
    Chapter 22
    ## 2022-11-17 – Evidence 22A – Feeling “Skittish” and “Stuck”
    ## 2022-11-19 – Evidence 22B – Lost the Morning Thoughts
    ## 2022-11-20 – Evidence 22C – Reading This Week’s Writing Work
    ## 2022-11-22 – Evidence 22D – We Just Did A Major Thing – Dusted
    Chapter 23
    ## 2022-11-22 – Evidence 23A – Unclear About What Supposed To Do

    View full-size slide

  14. ## 2022-11-23 – Evidence 23B – First Thing We Are Writing About
    ## 2022-11-28 – Evidence 23C – Trip, Fall, Drop
    Chapter 24
    ## 2022-11-29 – Evidence 24A – Is It Time For The C-Pap Machine
    ## 2022-11-30 – Evidence 24B – We Are Too Big To Be Comfortable
    Chapter 25
    ## 2022-12-01 – Evidence 25A – Starting To Tag
    ## 2022-12-01 – Evidence 25B – Use of Glucose Meter is Significant
    ## 2022-12-02 – Evidence 25C – Ginney To The Groomer
    Chapter 26
    ## 2022-12-06 – Evidence 26A – Stress Is Upcoming Surgery – Rich
    ## 2022-12-07 – Evidence 26B – Ginney Need To Go Out
    Chapter 27
    ## 2022-12-08 – Evidence 27A – Serious About Weight Loss – Start 291.1 lbs.
    ## 2022-12-09 – Evidence 27B – Casey In Charge
    ## 2022-12-10 – Evidence 27C – Gobsmacked
    ## 2022-12-12 – Evidence 27D – Skipped Past Confusion
    Chapter 28
    ## 2022-12-13 – Evidence 28A – Someone Catches Covid
    ## 2022-12-14 – Evidence 28B – Nurse Sarah
    ## 2022-12-15 – Evidence 28C – Jamie, Soft Underside, Hard Shell
    ## 2022-12-16 – Evidence 28D – An Hour On What
    ## 2022-12-17 - Evidence 28E – Shoot Smerconish Time
    Chapter 29
    ## 2022-12-20 – Evidence 29A – Jillian and Chris Are Here
    ## 2022-12-20 – Evidence 29B – Puppy Sitting – Christmas Shopping
    ## 2022-12-22 – Evidence 29C – Cub’s Park Puppy Sitting
    ## 2022-12-22 – Evidence 29D – Yay, Dog Patrol
    Chapter 30

    View full-size slide

  15. ## 2022-12-22 – Evidence 30A– Reviewing Progress Updates
    ## 2022-12-26 – Evidence 30B – Any Morning Starting With Coffee is Fine
    ## 2022-1-1 – Evidence 30C – A Brand New Year

    View full-size slide