Act F.A.S.T.? So why 26hrs to diagnose?

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But I didn’t have any of these signs.

The only link was the left side of my lips felt numb, though this wasn’t visible. I didn’t think I could stand up and walk away (otherwise, I would have!) but I could talk. I knew speaking was taking deliberate effort, but I didn’t think of it as a symptom, and no-one else could tell. In fact, I was only ok about the ambulance being called because I was on the floor in the COO’s office and couldn’t get out of there fast enough by myself!!!

But, the brilliant first aider, Rebecca, did I talk about the left side of my lips being numb.  She said, “What are you thinking?” and I said “I think I’m thinking the same thing you are.”  We’ve spoken since and we were definitely both thinking ‘stroke?’.  But it seemed highly unlikely and I don’t think either of us thought about it again. I certainly never thought to ask at A&E.  I thought it was the cold that everyone at work had, knocking me for six. I think the first A&E doctor thought it was a panic attack or something, despite me not being at all panicked.

So the first A&E doctor was about to send me home, but the consultant marched in and did a hand nose test*, which I failed.  So he put a venflon in my arm and called the Neruos down.  They wanted me to stay overnight to establish what had caused it. My point is, I suspect the A&E consultant suspected it was a stroke from the start. I think that’s why he put the venflon in straight away, called the neuros, and took the first bloods. Even though no one else picked it up for another 26 hours and two more strokes later.

So why did it take more than 24 hours for a diagnosis?  Well, this is what I think I’ve deduced: the average age for stroke is 75 (my age starts with a 3); my stroke wasn’t caused by any general health issues and my bloods – presumably – came back normal; only 2% of strokes (and there are millions of them every year) are caused by a vertebral dissection but I didn’t even present any neck pain. So who’d think to look for a dissection or a stroke?

There was an initial CT. Either it didn’t show up on the first CT, or they missed it. The neuros worked it out on the afternoon of day 2, when they’d been called back to confirm I could go home (with a diagnosis of labyrinthitus).  But it was all worse than the previous day and I threw up when I opened my eyes or moved.  They confirmed with an MRI.

I do think that if they’d paid me more attention in the overnight observation ward that they’d have clocked it sooner.  But, as is human nature, they concentrated on the louder people, not the silent one who wasn’t interacting. (Perhaps there should be the odd reminder that says, ‘Do watch the quiet ones, they might actually be quiet because they are really sick.”  I remember on the handover in the morning the nurse saying, “She’s had a good nights sleep,” and having to pipe up, “Um, actually, I barely slept at all, I just can’t open my eyes without the world spinning.” “Oh,” she said, and moved on.)

So.  I guess there were points at which, if I’d been firing on all cylinders, I would have asked more questions, suggested things, or been more pro-active.  But, I’d had a stroke or three, so I wasn’t really there at the time.  But if I had been, there would have been two points in those first 18 hours where I’d have gotten very cross with them:

  • In the middle of the night I wanted the bathroom. I walked (well, ish, like a drunk, wondering if it was a good idea) to the nurses station to ask where it was.  Instead of walking back I had to sit in the corridor outside the bathroom until someone came by so I could for a nurse to help me.  It felt like my head had ‘popped’ while I was up, and was so entirely light that everything in it swam in graceful blue circles for a few minutes.  I remain convinced that this was the second, more significant stroke happening right then (and the doc in the Stroke Unit says I’m probably right).  But they missed it.  They didn’t even ask what had happened.  They walked me back to bed like it was a bit of an inconvenience and, as far, as I know, that was the end of that. I didn’t think to get bossy – e.g. find a doctor – but I’m letting myself off the hook: I’d just had another stroke!
  • However, I was very irritated for a moment the next morning. Someone asked the others on the ward what they wanted for breakfast and filled in their form for them.  They just handed me the form (no pen) like I could do it myself.  I couldn’t open my eyes to see it. I wasn’t hungry. I wouldn’t have been able to eat anything they put in front of me anyway.  But she came back and told me to fill it in, in a tone that conveyed, Just do it, and hurry up.  I remember being annoyed that she’d helped everyone except me. But I filled it in. I’ve no idea how. Why didn’t I just say, “No”?!?! I don’t know what I asked for.  I didn’t eat it when it arrived.  It got taken away again at some point.  (Again, I’ve never put myself on the hook for this one – by this time I’d had at least 2 strokes.)

The only time I remember thinking, “No, this is actually your problem to fix” was when, after the neuros had been down and ordered an emergency MRI, someone came to take me there. They brought a wheelchair, and expected me to sit up and move and be wheeled.  Right…. I said, “Sorry, I can’t do that”. He said, “You have to, we can’t move the beds in here”.  I think I just ignored him.  Funnily enough they sorted that out quite quickly. Amazing what you can figure out when you’re not given any choice.

Everything changed after the MRI. I got transferred the Hyper Acute Stroke Unit (HASU) at Hospital Number 2 straight after.  They knew exactly what to do about absolutely everything.  The contrast in behaviours is too vast to be expressible. I remain in awe of them, particularly two Irish nurses who were an utter Godsend.

But you know, while I can see the time it took could seem to be too long, I don’t think they necessarily got it wrong.  They have people in all the time who’ve just had an episode and sleep and go home in the morning.  If you think someone is one of those, why would you pay them too much attention? My kind of stroke is less than 2% of all strokes, and the symptoms were not indicative to non-specialists.

Though I’m highly rating the A&E consultant, because I think he knew right at the start.

——

* Note: Hand Nose Test: is when your asked to move your finger from the doc’s finger and your nose, going back and forth between them – I couldn’t do that with my left hand… I believe my response to this in A&E was a cheerful, surprised “well that’s new.).

touch my finger, touch your nose

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One comment

  1. […] Insight into Misdiagnosis of Young Adult Stroke November 13, 2010 Filed under: Uncategorized — Char @ 9:38 pm Tags: A&E, adult, dizzy, ER, numbness, stroke, walking, young (This is a p.s. from the last post). […]

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