Just like every other day

I rounded the corner and saw him lying in the grass in the backyard of a recently renovated home in the West End. From fifty feet away he looked okay, forty not so much, thirty I began to worry, twenty and I knew something was terribly wrong, the last ten feet just happened. His name is Eduardo, and he had just finished work on the house, It was a good job, he told me, in between grimaces.

We had been called for a man down, and that is exactly what we found. his skin was cool and clammy, when he opened his eyes they looked haunted, and he said he had the worst headache ever, then vomited on my shoes. We lifted him onto the stretcher, and he cried “no!” and tried to steady himself. I hoped that he was suffering from vertigo, but knew I was kidding myself.

He took time this morning getting ready, his shirt was new, shoes matched his socks, his dress pants now covered with dirt. A wedding ring matched his watch, both meticulously maintained.

The people who found him told me what they knew, he was doing an inspection, everything was fine, then he said he felt dizzy, then he sat on the ground, and leaned to the side and vomited.

We started an IV, administered oxygen, took his vitals and got rolling. At 220/110, with a “9 out of 10” headache, and a perfect sinus rhythm I thought CVA. I did a neurological exam enroute, everything was normal. But he never opened his eyes. I told him not to worry, that I thought he was having what we call a TIA, or mini stroke, even though I was pretty sure it was a full blown CVA.

Little white lies don’t count when protecting a person I decided, and I wanted him to know that something bad was happening, but certainly nothing catastrophic. He was terrified, but seemed to appreciate my honesty. He nodded his head, and relaxed-a little.

At the ER I got a little testy at triage, I hate it when people just don’t see what I do, and don’t sense the urgency. It’s not their fault, they hadn’t spent the last fifteen minutes with the man, talking to him, touching him, reassuring him, telling him that everything would be okay. They didn’t have much invested, and at that moment, I forgot that. I suppose I was a little nonchalant when I arrived on the scene as well.

Once things got rolling they rolled quickly. The attending ordered some meds and an immediate cat scan. I waited, hoping he was a candidate for tPA. When he came back from Catscan, everything had changed. He could no longer asnwer questions, and his breathing had become erratic. Respitory was called and they inserted a breathing tube.

http://wiki.medpedia.com/Clinical:Guidelines_for_the_Early_Management_of_Adults_With_Ischemic_Stroke#Brain_Imaging

There would be no TPA, his brain scan showed a major bleed. They took him to surgery ten minutes later, hoping to relieve the pressure in his head.

He probably won’t make it through the night, and if he does, he will wish he hadn’t. A few hours ago he was getting dressed, getting ready for another day.

Kind of like we all do.

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