MS-3 · neuro

“My” patient

There is a patient on my service.  He had a hemorrhagic stroke. The senior resident assigned him to me a couple of days into his hospital stay. I can’t really get any sort of history or exam on him. Level of consciousness fluctuates — unarousable to me this morning, resident got him to curse on sternal rub, attending just yelled and his eyes opened.  Fails formal swallow evaluation, but I’ve seen him eat applesauce when given by the resident.

The first day, before he was “my” patient, he just kept yelling his address over and over in Spanish and demanding to know why he was in the hospital.   He’s had to be in restraints — including handcuffs — to prevent him from pulling out his tubes and IVs.   Since then, he’s become increasingly unresponsive.  When he is arousable, he just says “agua, agua” over and over.  But since he keeps failing speech and swallow, no one wants to risk giving him water by mouth.  (He’s getting IV fluids, but it’s hardly the same thing.)

I know that he is extremely old.  And that his quality of life, which wasn’t so great before the stroke, now sucks.  I know that I, personally, wouldn’t want to live in the state he’s in.  But still, now that the team is discussing withdrawal of care and end of life issues with his health care proxy, I’m feeling incredibly helpless.  I keep looking at the labs, just in case there’s something we can just fix and make him — maybe not totally cured, but at least well enough to eat again.

I like neuro, I really do.  It’s logical and straightforward, the ultimate detective work.  But if this is what it’s going to be like, it’s going to be a long five weeks.


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