Something Was Not Right

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Dec 17, 2018, afternoon, a husband told me his wife got a stroke. Both husband and wife described the symptoms. Her entire body becomes paralyzed and her blood pressure was so high. Husband had not seen the symptoms but he endorsed her wife’s symptoms to me. The later wife told me the same. Of course, it was not the stroke but was a panic attack. Almighty did mercy on the wife and save the healthcare sources because she recovered by herself without seeing any doctor. Simply, you can teach illiterate person but you cannot teach the mind and brain of educated people. Yes, of course, Everybody needs sympathy and empathy, and sometimes mercy. So, the wife got everything that she wished to have it. Those miracles only happens in my native country.  

Roughly two weeks after the above incident, a woman brought to the hospital via EMS. The paramedic has alerted us that a woman en route to the hospital has definitive stroke symptoms. Stroke alert was paged. The patient was taken directly from an EMS stretcher to the CT scan without any delayed. The woman was alert but could not speak a word. Her eyes were trying to say something but everybody was failed to read her message. Her SBP was above 230 mmHg. After the scan, the patient was brought back to the ED. The stroke team was on their way. EKG was done which was not favoring for our best day. Pt also showed ischemia to her heart muscle. The cardiac team was alerted also. Cardiologist and Neurosurgeon both arrived at the ED. Time was clicking so we had to make a decision treating the heart or brain first. You cannot mess with the neurosurgeon. Nobody could tell the neurosurgeons what they should do or not. They are grumpy as hell. 

 The radiologist confirmed CT shows a blood clot in the brain small vessels. The clot was very small what it needs to be taken care now before it could make permanent damage to the body. Anyway, the neurosurgeon might have rested well or had a good day. Or it was that woman’s luck that the neurosurgeon suggested to the cardiologist, “Can you do angiogram while I could retrieve the clot in my OR”. The technology has changed significantly that stroke could be resolved with medication (TPA) and retrieval of clot directly. Not all the neurosurgeons are trained to do the retrieval of the clot. Little bit mistake could end up as permanent damage to the brain.  Starting the patient on TPA and performing the angiogram was not a best practice either.

Anyway, the patient was sent to the OR with implied consent for the procedure because there was no family present. The hospital record reveals the patient’s previous visit which helped the ED staff to locate her family. The chaplain also came when the stroke alert was paged. There were two number listed for the next of kin to inform if is emergency only. Both numbers were international last digit 80, and 79 because the woman was an immigrant. The chaplain tried multiple times but both numbers were switched out so social worker came to do her role.  

Later, the ED staff was briefed the patient’s prognosis. Pt was suffered from both stroke and heart attack. The toxicology report was cleaned. Of course, her recent long trip had caused the pulmonary embolism which further becomes the culprit for both stroke and heart attack at the same time. The woman made marked recovery and was released home within 3 days. The social worker had played a significant role in helping the woman after recovery. It was a joint hard work of three teams who had provided the woman timely manner treatment to prevent disability and of course mortality.  

Learning or teaching point is: seek medical attention right away when you develop shortness of breath, chest pain, or leg pain after a long trip. Control your blood pressure with exercise or DASH diet, or get anti-hypertensive drugs if diet and exercise fail. The blood clots could travel from the leg to the chest, then to your vital organ heart and brain. Risk factors for pulmonary embolism: prolonged sitting and standing for more than 5 hours, birth control pills, recent surgery, cancer treatment, coagulopathy disorders or HRT (hormone replacement therapy).  

The woman had ignored all those risk factors and she also was non-compliance with her high blood pressure medication. Her stress level had contributed to the marked elevation of blood pressure. Later, the woman had sent us, “Thank You” letter. I wonder if the Almighty was with her all the time to support her. The real stroke and heart attack had happened exactly at the same time but the woman’s eyes were trying to tell us something. Her eyes were looking toward the door as she waited for somebody. We were happy for the happy endings but sometimes It comes to my brain, “well, did we provide the best and optimal care or holistic care to the patient or we missed something important aspect of the care: sympathy and empathy”.  Something was missing in this case which often comes in my mind.

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