The lucky guy's friend realized this, took him to the emergency room, where they gave him tPA and also did an interventional vascular procedure, got the clot out. He is almost completely normal again albeit with slight memory difficulties and a speech deficit.
One win for neurology.
* * *
On a sadder note, I feel really discouraged in that there are things that I know our patients need that I feel a lack of confidence to follow up on - one patient needed to be told that he had progressing congestive heart failure and probably would die in the next few months, but nobody told him. My preceptor saw the patient and advised our team to consult palliative care, but we did not.
Could I have? I did not want to overstep my bounds with the team, nor to give the patient bad news on my own. But maybe I should have. I hate this. I hate that I can see what the right thing is to do, want to do it, but feel maybe I should not.
I have allegiance to both the patient, the team, and myself, and sometimes the requirements on each conflict. If I had been a braver human being, maybe I would have done it myself. It's a lot of emotional energy to give bad news.
I was shocked how quickly the clinical teams turned over - every two weeks. Things get lost at handover or sign out, or as the teams change. People are overwhelmed and I do not want to add to their workload, but I also have a feeling I am not doing the best thing for the patient. So what is best for the team is not necessarily best for the patient, and what is best for the team is not necessarily best for me (needing to go home to study).
This makes me sad. If I was more confident in my role, maybe I will do more. I do see now how my friend got in trouble with the team doing what she was convinced was best for the patient. It's not malice, but things get lost as the healthcare teams turn over.
It is amazing how chaotic the hospitals are as the new teams scramble to find their footing.
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