Two comments on this:
1. If the patient had been treated to stop the neuronal cascade of death the disability would have been much less. The nurses response should have been to demand that the doctor involved do some actual work to solve the neuronal cascade of death problem.
2. The patient should have immediately been given anti-depressants due to the better recoveries those patients get. Antidepressants may help people recover from stroke even if they are not depressed A complete failure on the doctors part. This nurse and doctor are out-of-date and should have been reprimanded.
http://www.clinicaladvisor.com/dicephering-a-stroke-patients-message/article/315373/?DCMP=OTC-rotatorlink1
I had been working as a nurse practitioner in stroke/neurology for
three years when I encountered Mr. B, a 67-year-old patient who came to
our hospital with acute onset of right-sided weakness and aphasia
following a moderately-sized left-middle cerebral artery stroke.
Mr. B's course was typical of an acute stroke patient, and we
proceeded through our work up and evaluation as usual. Since Mr. B's
language center was in the left side of his brain, he was suffering from
language deficiencies that included profound expressive aphasia. During
his stay in our hospital, he worked with our skilled therapy team. It
was evident to all of his healthcare providers that he was extremely
frustrated with his inability to communicate.
The day before we had scheduled to send him to acute rehab, I entered
the room for daily rounds with another nurse practitioner on our team.
Mr. B again seemed agitated and frustrated as he tried to communicate
his wishes to us. I grabbed my notebook and a dry erase marker, which he
was able to grip in his right hand.
To our surprise Mr. B was able to write, but the letters were
jumbled, and we set the notebook page aside feeling unsuccessful in our
attempt to communicate.
An hour later we were called back to Mr. B's room by his daughter. It
turns out that when she was a child, her father had used mirror image
writing to communicate with her as a special code. She saw the notebook
page from earlier that morning lying on his bedside table and recognized
the pattern immediately. We grabbed a mirror and were able to decode
the message.
Unfortunately, Mr. B had written that he wanted to die. My feeling of
elation at having uncoded this strange mirror writing from his younger
years was immediately overwhelmed by the realization that my patient was
very depressed. Mr. B had been a very active person before the stroke,
and now that he was unable to communicate and unable to walk, he was
dreadfully depressed. He wanted to die.
We immediately got neuropsychology in to see Mr. B, and he was
treated for his depression. He did well in rehab, regained most of his
motor function and his ability to communicate through speech.
Mr. B's clinical course in the hospital was unremarkable until the
moment we discovered the backwards writing. His depression would likely
have gone undetected for weeks longer, if we had not been able to decode
his cryptic message. I will never forget how strange, exciting and then
profoundly sad the experience was for me as a healthcare provider. I am
now much more aggressive in screening patients with stroke for signs of
depression through all means possible.
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