I called a Code Stroke on a perfectly able patient the day prior. Quick background: This patient came in for shortness of breath after a round of dialysis. I know what her baseline function is and I know shes’s okay–although with considerable comorbidities due to her SLE (Systemic Lupus Erythematosus). In fact, her being on regular dialysis was caused by one of SLE’s complications called Lupus Nephritis.
Three hours before calling the code that day, she was responding to normally, took her medications per usual. Nothing significantly unusual so I moved on to my other patients. Around 11am, Josh, one of our dietary attendants, told me that my patient in 3246 acted really weird while ordering her lunch and dinner. He described it as enthusiastic response then suddenly flat and blank. I told him I will check on her but went to review her morning labs first. I noticed a big jump on her Creatinine and BUN from the previous day, 3 to 5.2 and 25 to 52 respectively. I told Josh, “She really needs dialysis with these labs probably why she’s off.”
Undisturbed by what I know and what I assumed the clinical presentation was, I opted on calling Dialysis unit to prioritize her–because she’s probably having Uremic Encephalopathy (accumulation of toxins due to acute renal failure), instead of actually assessing her. I went on to attend huddle and IDR but the thought really bugged me, it felt like a nagging itch that I needed to scratch, so after the meeting I went straight to her room. She was freaking aphasic(!), stuttering and was having dexterity issues. The hospitalist was nearby so I called her to evaluate at bedside. Considering the factors that might have caused her altered mental state, it is possible that it is caused by uremia. She said, observe her after dialysis. But I was really uneasy and thought that we can’t just rule-out Stroke here. So I firmly told the hospitalist, “She is not like this at all yesterday. We need to call it!”
At 11:45am, we called Code Stroke and within 2 minutes her room was swarmed with a bunch of clinicians—atleast 10 people was there. Stroke evaluations done then we headed to CT to scan her STAT. Resource Nurse said, “I’ll bet my ass that her scans are clean”. I just smirked.
Neurovascular Surgeon reading the scans in real-time. Well, CT Brain was clearly negative, then he added CTA head and neck (there is a precaution to this given that she’s on acute renal failure but of course we need to!) to check for stenosis, blockages, or worse, bleeds. Then there it showed, a blockage on the posterior cerebral artery! So Neuro went ahead and ordered to administer TNK (clot buster) then transfer to Neuro ICU to closely monitor the patient after receiving a highly potent thrombolytic.
So we went to transfer the patient to Neuro ICU and hand the patient off. Suddenly I noticed that I did not have my report sheet with me. There I was giving report relying solely on what I can remember that are significant and what was done. I did not have time to be anxious about an incomplete report, all I needed was to be confident that I know what happened.
When I came back to our unit my colleagues started commending me for doing a “great job” on catching and calling Code Stroke. Unit leaders came to check on me and told me that I handled the situation exceptionally well. I felt weird because that was what I was supposed to do. I needed to do it. Questions running through my mind: Was it really that big of a deal? Or was it because I became numb of appreciation? I feel like the things that matter became mundane and ordinary to me. The overwhelming lack of feeling has overridden my ability to appreciate the things that I do. Caring for people and saving their lives does not feel like a breakthrough, but you know what I realized? It matters. And I have always thought of the statement “Saving a person’s life” as an exaggeration because, as nurses/healthcare providers, we’ve become accustomed to it, but moments like this remind me that it isn’t.