Dr. Kube: Neighbors, neurologist help get patient quick treatment for stroke symptoms
Mary came to the emergency department (ED) on a snowy winter night by ambulance from her home. She was widowed and lived alone, but she had neighbors who would check in on her daily and make sure she had groceries and food to eat. Mary had a dog that she would walk down the street to the corner and back twice a day. One of Mary’s neighbors, Melissa, had picked up groceries for her in the late afternoon on her way home from work and helped her put them away. She headed home as Mary started preparing herself dinner.
The snow had started to fall in the late afternoon and there was a light dusting on the sidewalk by dinner time. Mary’s other neighbor, Jane, kept checking out her front window expecting to see Mary out walking her dog, as she normally took the dog for her evening walk around dinner time. Jane wondered if Mary was hesitant to walk in the snow, so she went over to check if Mary wanted her to walk her dog for her.
Jane knocked on the door several times and Mary did not answer. She used her key to enter the house and found Mary sitting at her kitchen table with her dinner in front of her and her dog sitting at her feet. She asked Mary if she was okay and immediately knew something was wrong. The right side of Mary’s face was droopy, and she was slurring her speech when she tried to speak. She also noticed that Mary was not able to use her right arm. Jane immediately called 911.
Paramedics arrived within minutes and quickly assessed Mary. Jane called Melissa to ask her if Mary had been ok that afternoon when she brought her groceries. She confirmed that Mary had been normal just an hour before Jane had let herself into Mary’s house. This information was very important to know as the stroke treatment depends on exactly how long the stroke symptoms have been present.
Jane was assisted onto the ambulance cot and the paramedics quickly checked her blood sugar and vital signs. They asked Jane if she had any further information about Mary since Mary could not communicate well because of her slurred speech. She knew Mary had a small folder with her medical forms in it and she got it from Mary’s purse and handed it to one of the paramedics.
I was waiting to see Mary when she arrived in the ED, and we took her directly to get a CT scan of her brain. She was immediately seen by our stroke team, which includes a neurologist who evaluated Mary in conjunction with me. I had my ED social worker try to get ahold of Mary’s family, who could help make medical decisions for Mary. We looked through the paperwork Mary had in her purse, which listed her brother as her emergency contact and power of attorney.
The initial CT scan of Mary’s brain did not show any signs of bleeding or other acute findings, which is not uncommon when someone is in the initial stages of a stroke. The neurologist explained to Mary that she was having a stroke and that there was a medication we could use to break up the clot in her brain that was causing her symptoms. He explained to her that in the best case, this medication could reverse her symptoms, and in the worst case, it could cause catastrophic bleeding that could be life-threatening. Mary seemed to understand as she shook her head when the neurologist asked if she understood the risks of the medication as he explained it to her. Unfortunately, her speech was still slurred, and she couldn’t formulate her words to answer him.
We tried to reach Mary’s brother several times in hopes that we could discuss our proposed treatment for Mary and get his permission, but he did not answer. Mary did not have any other family members. Jane and Melissa came to the ED to be with Mary. They said that they knew Mary well, and knew that she would want to do everything to try to preserve her ability to be independent.
I spoke with Mary again as the neurologist and I both felt it was the right decision for her to receive this medication given her level of independence before the onset of her stroke symptoms and her desire to remain that way. In our opinion, the chance for her to have an improved outcome versus the devastating lasting effects of her stroke outweighed the risk of complications from the medication.
Mary grabbed my hand with her left hand and squeezed it when I asked again if she was okay with receiving the medication. Jane and Melissa were also supportive. We administered the mediation to Mary. I went back to check on Mary several times over the next hour and her nurse happily told me that she was improving. She was starting to move the fingers of her right hand and she was starting to formulate words a bit more clearly when she tried to speak. She gave me a thumbs-up with her right hand before she left the ED to be admitted to her hospital bed.
Mary was closely monitored in the hospital for the next few days. She continued to improve but had some residual weakness on the right side. She did therapy with the hospital speech and occupational therapists, and she was able to advance her diet as she was able to demonstrate that she could safely swallow. When Mary was ready to leave the hospital, she briefly went to an inpatient rehabilitation facility to continue working on her strength and ensure she could safely continue to take care of herself at home.
Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.
drerikakubemd@gmail.com
This article originally appeared on The Columbus Dispatch: Dr Kube: Caring neighbors, neurologist help woman with stroke symptoms
