Chapter 1: What historical context is provided about ketamine's use?
True Story Media. If you're an elder millennial like me, you may remember a time when ketamine was mostly known by its street name, Special K. Otherwise known as a substance you are not even tempted by after that one time that your friend's cousin got stuck in a K-hole and hallucinated in a hall closet for an entire night and freaked everyone out.
But ketamine has gotten a bit of a makeover in recent years after the FDA's 2019 green light for intranasal ketamine has helped fuel thousands of ketamine clinics across the United States. And a large number of clinical studies are currently exploring the drug for treatment-resistant depression and other conditions.
But despite some genuinely promising research, ketamine has been trending again more recently for less positive reasons, as it was responsible for the death of beloved actor Matthew Perry in October of 2023, and is also responsible for some of whatever the hell is going on with Elon Musk. Ketamine is also a big part of this story.
You see enough of these patients, you know how they deteriorate and nothing is working. Surgery doesn't work. Drugs don't work. Neuroblocks don't work. And you do this one thing and it works.
One of my enduring questions about the public reception of the Kowalski story is how on earth they managed to tell this story in such a way that it seemed fine and normal to give a nine-year-old girl so much ketamine.
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Chapter 2: How did Maya Kowalski's treatment with Dr. Kirkpatrick begin?
But even though the lunch and drinks were provided in the appropriate intervals, Timo could not be without the shoes of a passing traveler. He was just a dog in the favorite place in the stroller. We take care of the journey. You decide how you use it. VR. On a joint journey.
On September 23rd, 2015, after being told by doctors from three separate hospitals, including a pain specialist with expertise in CRPS, that Maya Kowalski did not have CRPS, but was suffering from a conversion disorder, Beata Kowalski took Maya to see Dr. Anthony Kirkpatrick.
So let's go over your history just a little bit, okay? Approximately three months ago, you started having some pain down in your feet here, okay? Here's what's important to understand is that there is no particular injury we can attribute this to, okay? Also, another thing that's important to note is that with that, she knows different fluctuating temperatures between the two sites.
In other words, sometimes one side would be colder, sometimes one side would be warmer. And sometimes one would be more red than the other, but it would flip-flop back and forth.
Dr. Anthony Kirkpatrick is an anesthesiologist and self-described expert in CRPS. As we learned at trial, his credentials are a little questionable. Here he is being cross-examined by attorney Howard Hunter.
Not board certified?
No.
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Chapter 3: What controversial practices were involved in Maya's ketamine treatments?
Not board certified in either anesthesiology or pediatric? Correct. You've never been board certified in anything?
No.
Correct. And Dr. Gerpatrick readily acknowledged his outlier status, again from his cross-examination.
You had a patient in front of you who dozens, literally dozens of other doctors had seen and treated at length. And you were the first one making a diagnosis of CRPS, correct?
Correct. But for Beata Kowalski, Dr. Kirkpatrick was a godsend. The day after their first visit on September 23rd, Beata emailed Dr. Kirkpatrick to thank him for giving us supporting evidence and the diagnosis. Supporting evidence because, of course, Beata had already reported to a doctor that Maya had CRPS, as Howard Hunter mentioned in court.
Incidentally... You were the first one to diagnose CRPS? Yes, sir.
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Chapter 4: What were the outcomes of Maya's initial ketamine infusions?
On September 23rd, 2015? Yes, sir. How do you suppose it was that the mother thought that was the current diagnosis a week before?
Dr. Kirkpatrick admitted that he didn't know where that diagnosis had come from. In this same email, Beata also discusses scheduling Maya for her first ketamine infusion and asks about laser and stem cell treatments for her daughter. Beata signs her email XOXO. As he appears to do with many of his patients, Dr. Kirkpatrick recorded videos of his evaluations of Maya.
And these are frankly strange to watch. As we discussed in the last episode, Maya's alleged condition, complex regional pain syndrome, is, well, regional. And it's a condition that begins with some kind of injury. Yet in Dr. Kirkpatrick's evaluation of a wheelchair-bound Maya, he's asking her about pain everywhere, from her cheeks to her shoulders to her feet and the skin on the top of her thigh.
Okay, excellent. Good job. Now, the next thing we're going to do here, Maya, is you see how we've got you marked here? I want you to close your eyes. Bring your little trousers back a little bit. That a girl. Mm-hmm.
Reading Dr. Kirkpatrick's depositions and watching his testimony, it's tough to wrap your brain around how he justifies giving Maya this diagnosis, which he describes as severe and progressive in her case.
He says in a deposition that while CRPS is usually triggered by an injury, that quote, often we don't know what causes it in children because they're quote, not good record keepers on account of how much they're quote, bouncing around. Which, sure, they are, but as a mom of a seven-year-old and a three-year-old, I can tell you that children are not especially stoic when they hurt themselves.
It is, in fact, usually an entire opera. Anyway, according to Beata, Maya's CRPS symptoms allegedly began with an asthma attack. which even Kirkpatrick says there's no known connection with. And yet right away, in the first appointment, Beata gets the CRPS diagnosis she's been looking for, and they're off to their races scheduling a four-day-long ketamine infusion.
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Chapter 5: How did Dr. Kirkpatrick justify his diagnosis of CRPS for Maya?
Here, Beata asks Dr. Kirkpatrick about the side effects.
How, in her case, how... bad is it going to be and how long will the short memory loss last? Yeah, good question. We want the short-term memory to be really bad, really bad. But her long-term memory should be intact. So if I ask her to remember, you know, if she can remember me telling her that her mom has got a visitor, a visitor, you know what I'm talking about, mom? Yes.
What did I just remember about you? What did I just tell you I saw in your mother? What did I see? A visitor. A visitor. You know what that is, don't you? See, so I do pick on moms, too, don't I? See, she remembered that, but when she's on the ketamine, I don't want her to remember that. But if I ask you, what country do you live in, you can tell me what country. United States. Perfect, perfect.
Now, it's not unheard of to use ketamine in treating CRPS, as Dr. Elliot Crane, the pediatric pain specialist we heard from in the last episode, explains on the stand.
Chapter 6: What were the implications of labeling Maya as terminal?
And it's something that we reserve for refractory cases that we cannot make better after a full court press, which would be intensive physical therapy every day for weeks, typically 10 or 12 weeks, psychotherapy every day for the same period of time, and using all the drugs that we have on the shelf that are to some degree effective in CRPS.
However, Dr. Crane emphasized that ketamine is used as a last resort for refractory pain or pain that won't resolve any other way and is used at a very low dose. So it's possible that a child with CRPS might need to receive some type of ketamine treatment at some point.
However, as a reminder, three hospitals, Johns Hopkins All Children's, Lurie's Children's in Chicago and Tampa General had all evaluated Maya and determined that she was suffering from a conversion disorder. And interestingly, the standard of care for conversion disorder is the same as that for CRPS, physical and occupational therapy and psychotherapy.
But that was not Dr. Kirkpatrick's way of doing things. He's in the business of ketamine. And less than two weeks after her first visit, Maya was back in his office for a four day ketamine infusion.
Now, are you ready to do some testing? Do two vertical fingers in your mouth and tell me you still have that pain under your eye, and if so, if it's the same or if it's decreased. Go ahead, tell me. It's the same. It didn't improve? Can you open your mouth better now? What do you think?
It hurts a lot more when I open my mouth.
Well, I know, I know, but we're talking about how it compared to where it was before we gave you the ketamine, okay? It's about the same. Yeah, all right. If it's difficult to tell, it's difficult to tell.
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Chapter 7: How did the blog posts reflect Maya's condition during treatment?
There are a number of moments like this in these videos, where Maya is saying one thing, and rather than accepting her assessment, that her pain is the same as it was before the pricey ketamine infusion, Kirkpatrick overrides it in real time. These videos, which were posted on Dr. Kirkpatrick's website, are frankly disturbing.
One features Maya coming out of one of her ketamine infusions, and she's very clearly in a state of distress and disorientation. And Dr. Kirkpatrick is just really something. This is an exchange from a later video.
Okay, all right. I have a question for you. You ready?
Yes.
Do you have a boyfriend? Do you? Do you have a boyfriend? People want to know. Talk about putting somebody on the spot, huh?
I can tell you that if a doctor shoved a camera in my daughter's face and asked her this, that would be the last time I set foot in his office. The efficacy and necessity of the ketamine that Maya received over the year that followed her diagnosis was a big point of contention at trial.
According to Beata and Dr. Kirkpatrick, as well as Jack Kowalski and his legal team, ketamine was necessary to help Maya. But the exhaustive medical records, as well as Beata's own emails and blog posts, tell a markedly different story. On October 23rd, one month after her CRPS diagnosis from Dr. Kirkpatrick, and about a week after her first ketamine infusion, the tone of Beata's blog turns dire.
She writes, again as Maya, quote, End quote. This notion of Maya being suicidal comes up in a later Kirkpatrick video from a follow-up visit where Beata and Jack Kowalski are both present, and which is once again filmed, as Dr. Kirkpatrick put it, to help other kids.
And Maya, I think you made the point that you just didn't really want to continue, did you? No. You'd rather be in a coma than continue the way what life was going for you, right? Am I correct on that? Maya did say several times that she would rather be in a coma or die than live like that.
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Chapter 8: What led to Maya's hospitalization at Johns Hopkins All Children’s Hospital?
In a November 2nd email, the day of her follow-up with Kirkpatrick, Beata asks about giving Maya fentanyl. Beata also frequently asked Dr. Kirkpatrick to step in with others, including asking him to speak to John Schott about labeling Maya as terminal, which did eventually make it onto one of her prescriptions.
She also asked Dr. Kirkpatrick to intervene with Maya's GI doctors to request that Maya be put on TPN, or intravenous tube feeds. In a pre-trial deposition, the pharmacist John Schott said he only added the terminal label to Maya's prescription after a phone call with Dr. Kirkpatrick.
Dr. Kirkpatrick didn't have much of an answer for this on the stand, other than to say that it was outside of his scope to label a patient as terminal. Dr. Kirkpatrick maintained that he didn't authorize pharmacist John Schott's notation that Maya was terminally ill.
Kirkpatrick also noted in an email to Beata that when asked for a second prescription from another pharmacist with a terminal label, that he wasn't willing to do it because it was beyond the scope of his practice. However, he didn't seem to shy away from the idea that Maya was at risk of death. Here he is in the Netflix film explaining an exchange he had with Beata.
So I warned her in all medical probability that Maya would die a slow, painful death.
The specter of Maya's death is consistent on Beata's blog. On November 4th, she writes, Every day is the same as the one prior or worse. I'm losing hope and I often ask God to let me die because I cannot handle this anymore. This is not fair. I don't want to live this way anymore. I would rather die.
Thank you.
I am slowly but surely replacing so much of my wardrobe with luxury, high quality staples from Quince. So I've raved about Quince's incredible cashmere and cotton sweaters and their outerwear, but they are adding new categories all the time and I really wanted to mix it up. So I tried a few new things in my last order. First, I dipped into the jewelry.
I got myself a very chic gold open contour cuff and It is gorgeous, and it came in a very cute little jewelry box, which made it feel extra special. So if you are looking for a little Valentine's Day gift for someone, 10 out of 10 recommend. I also noticed at the top of the year that my workout gear was all looking a little grimy. So I treated myself to some leggings and tops from Quince.
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