Wednesday, October 13, 2010

Shock and awe in the neuro critical care unit.



I can't believe it.

I'm flabbergasted. Gobsmacked. Flubbered.

Doctor Moron--remember him? The one who sent us a rotator cuff tear because he thought it was a stroke, and missed that big neck fracture?--actually got a diagnosis right. And it was actually a real, true, honest-to-Frog stroke.

And he treated it correctly. In a timely fashion.

(Having spoken to the folks at the emergency department in question, I'm inclined to believe it was the resident and nurses who saved the day on this one. But then, that's always my inclination.)

Meemaw noticed over breakfast that she was drooling out one side of her mouth, and that the peripheral vision out of her right eye was suddenly less-than-ideal. Meemaw, being one of those folks who actually reads the emergency cards in the airplane seat pockets and watches PSA's, immediately suspected a stroke.

So she glanced at the clock--this part is vitally important--and called 911 (also vitally important).

See, when you have an occlusive stroke, the main determinant of whether you get clot-busting drugs is your Last Known Well time (LKW). Most hospitals have a protocol that says that clot-busters can't be given to anybody whose LKW is more than three hours past. (We have a slightly looser protocol, due to some research that Dr. Heron and Dr. Unpronounceable are doing, but still. It's a tight timeframe.) We can occasionally go in and yank a clot out after that window for clot-busters closes, but mostly we just do what we can to salvage your brain with anticoagulants.

The paramedics, also being the sorts of people who read airplane emergency cards, took her to Holy Kamole after giving her some aspirin.

Where they did everything *right*.

Now, let me say one thing here: If I ever accidentally saw my leg off with a steak knife, or have a heart attack, or get dropped into a vat of chocolate-chip cookie dough, or need an elbow transplant, there is nowhere I'd rather be than Holy Kamole. What they know, they know really, really well, and their patients get better. It's just that they're not all brains, all the time, like we are at Sunnydale. Anything above the collarbone is a little vague, just like anything *below* that landmark is a little vague for me. Every hospital has some specialty. HK's just isn't that lump of pinkish goo between your ears.

Anyway, Meemaw got her drip-and-ship--an infusion of clot-busting medication and transfer to my little NCCU--and was doing better within an hour of landing in my bed.

This one is going to have a happy ending. An independent 80-year-old lady with a busy life of volunteering and working part-time will be able to go back to that life no later than this weekend. Her grandkids will be happy that she's still around. Her cat won't have to have a new owner. She won't have to end up in a long-term care facility somewhere.

She's getting better even as we speak. And that's kind of nice.


TheBoatswain said...

Before I was The Boatswain, I Road Dr.'d (read EMT-P) for (large SoCal)City EMS. I had the great fortune to take a 36 y/o F with sudden onset stroke to one of the hospitals doing the initial clinical trials for tPA in stroke patients. Yeah...I'm that old

Fortunately for her, she wasn't in the control group. Happy ending.

Anonymous said...

Wonderful story!

Crazed Nitwit said...

YEAH For Meemaw! I do so like happy endings.

Anonymous said...

That is very nice!! and probably the reason we stay in nursing--once in a while all that research actually means good things actually happen to real live people right in front of our eyes. Whoo Hoo for Gramma!

Your Bartender, RN said...

Just another lurking minion/new RN here. Great story!

Fuck Cancer!!

terri c said...

How wonderful! So glad it all worked RIGHT. For once!

Albinoblackbear said...

Great story.

Made my night.

Hooray for smart LOL's and good medical care!!

bobbie said...

I LOVE happy endings!!! Meemaw's story, and the rescue of the miners are rocking my world!!!!!!!!

messymimi said...

I needed to hear a good one today.


Anonymous said...

Yaaaaaaaaaaay Meemaw!! Yaaaaaay Holy Kamole! root-root-n-shit-yaw!

Good news, like mercy falls on my catastrophized completely FUBAR day. . gracias por share. .Elyse in SoCal

gorochan said...

wait, I thought ASA use precluded TPA?

'Drea said...

That is kind of nice...

Anonymous said...

Nice to hear a good outcome.

You've probably already heard them, but I just ran across a group of singing CRNAs called The Laryngospasms. I thought you might get a chuckle out of their video "Waking Up Is Hard To Do", so here's the linky.

40-something Nursing Student in NEOhio