Re: stroke protocol

jwr4@xxxxxxxxx wrote:
What is the usual hospital protocol in treating stroke patients?
My father was then moved from the intensive care section of the hospital
to a regular room near the nurse's station. This was within an hour
after arriving. Last spring he wasn't feeling well and went to the same
hospital. They found he had an enlarged prostate. He was kept in the
intensive care section of the emergency room for over 24 hours.

Is an enlarged prostate usually considered more serious than a stroke?



It could have been as simple as a matter of where there was room or where there
was adequate staffing. It's not always due to acuity.


While in there with the stroke, his family doctor saw him once a day,
usually around 6 or 7 am. He is a G.P. The rest of the day the nurses
kept an eye on my father. I really got sick of hearing that. Beginning
Tuesday when he had the stroke, the most common answer to ANY question
was, "We'll keep an eye on him."


So why'd you keep asking? Were you expecting the nurses to suddenly develop
some incredible insight into his condition, or perhaps you were expecting him to
suddenly recover? I hate to be a jerk about it, but when you ask questions for
which there are no acceptable answers, you're likely to get noncommital comments
like that.

BTW, ask the doctor. He's the one who knows what's going on if anyone does.
Floor nurses are usually so loaded down, there's little time to look into
history or progress notes. Maybe the doctor will mention something to us.
Often, he does not. In the meantime, we'll keep an eye on him.



Friday, the 24th, his family doctor saw him again early that morning. My
father died about 1:20 am Saturday morning. No doctor had checked him
since Friday morning. Is that usual practice in all hospitals, leaving
most of a stroke patient's care to nurses? If they are as qualified as
doctors, why are there doctors?


Yes, it is usual practice for most of the moment to moment care of a patient,
stroke or otherwise, to be left to the nurses. We are not as qualified as
doctors; you couldn't afford the cost of healthcare if we were.


The death certificate states that no doctor checked him after he died. I
suppose there would be no reason for a doctor to check him after death
if they did so little before that.


There is no reason for a doctor to check a patient after he died if they *had*
done a lot before. The patient is dead. Is checking him going to bring him
back?


The emergency room doctor is the ONLY doctor in the hospital 24 hours a
day. I tried over and over to get a nurse to tell me if he would be
called in if my father got worse. All I got was, "We'll keep a close eye
on him." I asked again, getting a bit angry by then I guess, but still
got the same answer.


The ER doctor isn't going to come up on the floor. His responsibility is the ER
and that generally occupies his every moment. I have NEVER seen an ER doc on
the floor. The attending doctor is the one to call. If he doesn't feel like
coming in, he doesn't. He gives orders or he doesn't.


No neurologist ever checked my father. I asked his family doctor why
and he said it wasn't necessary. If a GP is as qualified to treat
patients with brain injuries, why do some doctors get special training
to become neurologists?


Because they don't want to treat the clap. They don't want to deal with flu or
COPD or infected fingers. Specialists become specialists so they don't have to
see other types of patients. That doesn't mean that a generalist is unable to
care for the patient.

Frankly, internal medicine/family docs have been taking care of stroke patients
a hell of a lot longer than neurologists in the general scheme of things.


If my father had been unconscious from the beginning I wouldn't be as
angry, but he was alert right after the stroke Tuesday morning until
Wednesday night, AFTER they stuck tubes in his nose to remove mucous
from his throat. They said he did not like that. I think they gagged
him, making him vomit, and that's how he got the junk in his lungs that
caused the aspiration pneumonia that killed him.


The last time I suctioned crap out of someone's throat, it was done at the
insistence of the family, even after I mentioned how unpleasant it was for the
patient. I guess the discomfort for the family to listening to some gurgling
overrides that of the patient getting gagged by a suction catheter.


When I left Wednesday night about 10 pm, other than slurred speech, a
his left arm he couldn't move, he was ok. His legs were ok. His left arm
and hand were fine. I asked him to squeeze my hand and he did. He
answered questions nodding yes or no. He tried to talk, looking directly
and whoever he was talking with.

The nurses said they had just finished clearing his throat. Thursday
morning I almost expected him to be sitting up. Instead he was
unconscious and never recovered.


I'm sorry for your loss. I lost my own mother about a year ago. Her case was
not handled as well as it might. I didn't raise hell about it; she had terminal
cancer and was going to die no matter what was done. That being said, why are
you busting our balls? If you're pissed off, go chew on God's ass for a while
instead of ours. I don't know why your father ultimately died. Aspiration
pneumonia? Another CVA? Intracranial bleed? Who knows? But this sort of
thing happens all the time. We are all scheduled to die. We just don't know
when or why.

And in the meanwhile, get off the caregiver's ass. Nobody wants to deal with
*** family. The patient gets less attention when the family is
unpleasant.... that's human nature.

Excuse me for being blunt.



--
Mortimer Schnerd, RN

mschnerd@xxxxxxxxxxxxxxxxxxxxxx


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