Dale

The car raced up to the emergency entrance and abruptly stopped with one of those wet skids that send shivers down a cyclists spine. Today I wasn't cycling, sadly, but working the ER and waiting for people to come skidding into the hospital.
"Hey, a guy needs help getting out of his car, he might be having a stroke."
The call for help came from Dale, our security guard who was already at the car door when I got outside. A worried looking woman was standing at the passenger door and I asked her what the problem was as I stuck my head inside the cramped little Toyota.
"We were just sitting down to dinner when suddenly he couldn't speak to me".
As I looked at him I had that instant, "Oh crap", feeling in my gut and yelled at him. "Hello, I'm James, one of the nurses here, can you tell me your name?" For some reason I tend to yell my questions at patients who are more critical as if my anxiety level is related to their ability to hear. Now, as you probably know, one of the symptoms of a stroke is a really bad headache. So it must be really annoying then to already have a throbbing cranium when some nurse comes along and shouts into your face. If he actually could have spoken he probably would have yelled, "Shut the hell up young man, I'm not deaf here I'm just having a stroke!" Followed rapidly by the question, "Why are you asking me stupid questions if my wife just told you I can't answer them?"
What was it that gave me that "Oh crap" feeling as soon as I looked into the car? Was it from some mystical 6th sense that medical people develop over years of practice? Or was it maybe from the fact that he was slumped over and limp with his eyes rolled back into his head? Because actually we nurses and doctors and paramedics and EMT's do develop that 6th sense and it is real. It is an odd thing but there is a psychic connection that exists between people that when listened to strengthens over time like an atrophied muscle. A connection that tells your gut "something is not right here...this patient is not OK", even when, by all outside appearances things look good. An example of this is actually on our trauma reports when we take phone calls from the medics out in the field. We check boxes to help determine the severity of a trauma patient. Things like, 'Did the patient lose consciousness?' or 'How fast was the car going?' This way we can prepare the ER for the severity of the trauma coming to us. But there is one box on the list that trumps all others...'gut feeling of the paramedic' who is actually with the patient. There is no quantifying it but having a person just being with the patient and feeling somehow how the patient is doing is more valuable than a lot of our data. Because, deep down we are all connected. We are communicating in ways we don't even know or acknowledge. If we did in fact open up to the realization that we are touching and moving each other in unseen ways, and feeling each others' pain and suffering, it would force us to really be loving to one another. Rather than that, God forbid, we tamper down the subtleties that connect us and instead focus on our differences. It's a lot easier not having to care so much. But not really...not in the long run and at the cost of loneliness and a feeling of emptiness that accompanies our perceived separation. But that isn't why I started to write this entry today, not at all.
A lot goes on in the first few seconds of seeing a critical patient. Visual cues from how the patient is dressed to skin color to posture and breathing rate etc. Auditory cues from what they are or aren't saying, what is everyone around them telling you. Olfactory cues like is there alcohol on their breath or do they smell of cigarettes. The list goes on and on and I won't bore you (sorry, too late?) but suffice it to say that it can be a bit stressful at the very beginning as your brain processes thousands of bits of data in a very short time to direct your next action. Maybe I'm writing this to justify the fact that when I shouted my question to my patient in the car, and his wife outside said "His name is Wayne" my mind heard the name Dale. I heard Dale and dammit, his name was now firmly Dale. In my own defense I have bad hearing and both Wayne and Dale have a long A sound. Also, Dale the security guard was standing right next to me helping me get the patient, Dale, into the wheelchair. Whatever. I put my index fingers into the patients hands and shouted, "Dale, squeeze my fingers"...no response. "C'mon buddy squeeze my hands tight!" This time there was a strong and equal grip from both hands. I was happily surprised as I was expecting one grip to be much weaker than the other if he squeezed at all (a classic stroke sign). He was actually able to stand and move to the wheelchair and my mind was starting to think of the many other neurological problems that could present like Dale but stroke was still high on the list.
I quickly wheeled Dale into the ER bed 1 and his wife went off to register him in admitting. A lot of things then happened in the next 15 minutes before we whisked him into the CT room for a CAT scan. For a play-by-play it went something like this.
"Dale, we're putting you on the monitor and giving you some extra oxygen now". With this, Dale gave a grunting noise.
"OK, Dale, we're getting an EKG now hold really still". "Hhrrmmph" was all he could muster".
"Dale?", now a more agitated grunt, "I'm starting an IV don't move your arm".
"It's all good, Dale, I'm taking you to CT now to get a picture of your brain".
You see, I like to think I'm a good nurse. And a hallmark of good nursing isn't just skill level and speed and knowledge base but also patient advocacy. I was keeping Dale in the loop. Keeping him oriented to what we were doing even if he couldn't understand I was hoping he could hear and understand some of what we were doing.
This time his lips moved and a long "NNNNN" came from his mouth. "Hey Doc, I think he's perking up a bit, maybe this is just a TIA" (mini stroke that has no lasting neurological impairment) I said, and as we pushed his gurney down the hallway someone from admitting came and put a name band on Dales wrist. Once in CT I had to let him know to be as still as possible for the exam. "Dale, hold as still as you can for the next 2 minutes and we'll be all done". This time his eyes opened and he looked confused and mouthed, "NNN NNN".
I reassured him with "It's OK Dale your in the ER and we're taking good care of you". I was feeling really good about the care we were giving him as he was in the CT room in record time with bloods drawn and all the diagnostics done and in the bag. There was only one thing that was a little concerning. When I got him onto to CT table I looked down at his wrist band and instead of reading Dale as I expected, I saw the name Wayne. Two thoughts ran through my mind as the pencil thin red laser scanned down his face. Either someone put the wrong name band on Dale which I could easily fix...or I had been calling this poor guy by the wrong name all this time.
I pulled him from the CT table back onto the gurney he was looking at me now quite clearly and I knew he was rapidly improving but he was still unable to speak. His eyes were tracking mine now although he did still look a bit confused. The CAT scan was encouraging and showed no signs of a bleeding stroke. "It's alright, um...Dale" (hell, I was already this deep, might as well go all the way), "so far so good".
The TIA symptoms were rapidly fading away like memories of a bad dream and he was now trying more successfully to enunciate. Apparently Dale wasn't lying there just worrying about his terrible stroke symptoms and the possibility of never speaking again or going through months of occupational and speech therapy. He was lying there wondering if we were treating the right guy for the right problem because the first words he uttered were...and the most important thing he wanted me to know was..."NNNOT....DALE!"




Of course the names have been changed to protect the guilty...except mine! We laughed about the name exchange all night and "Dale" ribbed me mercilessly. As I was going home at the end of my shift change that night I heard him yell across the ER, "Goodnight Dale"!