Saturday, November 11, 2006

Think Before You Speak- A Nurse Practitioner's Personal Experience With A Stroke

The following story was sent to me through email to preserve his confidentiality. Though he didn't want anyone to know who he was, he wanted his story told in order to benefit other NPs in their practice...

I remember the day well, as it was 118 degrees in the shade. I was busy shuffling from building to building and seeing patients. It started slowly and I initially mistook it for just being dehydrated in the extreme heat. After all it’s not unusual to become dehydrated and dizzy in those types of extreme temperatures. I met with the physician about 1300 in the afternoon to do rounds. I stole a bottle of water from the Nursing Directors fridge and sucked it down. I went and stole a second bottle of water and drank about half of that bottle.
I figured if I could get enough water back in me the dizziness would resolve. I thought well, I’ll just go home and drink a bunch of water and the dizziness will go away. I continued to do rounds with the physician and as we got to the last nurses station I noticed that I was having a bit of trouble walking. My balance seemed ok but it seemed as though my brain was having trouble telling how far down to place my left foot. The worst of it was trying to navigate from one color of tile to another.
The floors are bright shiny tile and are generally white/beige with black squares interspersed at the hallway intersections. As I tried to step from light tile to dark tile my brain was sending a signal to my back and legs to brace myself for a fall. I sprained my left knee badly while trying to step across the differently colored tiles.
I tried to explain to the doc what was happening and he joked “why don’t you lay down on the floor and I’ll call 911.” He said I was probably just dehydrated and to go home and rest which is what I did. I went home and drank copious amounts of water and reclined in the Lazy-boy.
Towards the evening I felt better, didn’t seem as dizzy and went to bed not thinking anything of my symptoms. The next day it was also 118 degrees in the shade. I was a little dizzy in the morning and still seemed to have a bit of trouble walking but felt better. By about 1300 in the afternoon I was exhausted and again having trouble walking so I left work early and went home to rest. I figured that I was just worn out from the previous day and some rest was in order.
By the third day the symptoms had not resolved and I started to be concerned that something was not right. I explained to my boss what symptoms I was having and was given off all the time I needed to work through what was happening.
I saw a Nurse Practitioner and got a script for a head CT which I was sure would be negative (and it was). The NP was not impressed and told me it was probably all in my head, especially after the CT was negative.
Fortunately my insurance allows can self referral. I called a neurologists office and made an appointment. She went through the cranial nerve tests and had me do the other neuro-tests. I passed them all without her detecting a deficit but had great trouble walking heel to toe. I tried to explain to the neurologist what my symptoms were and that I was able to compensate outwardly but that I was really having trouble walking.
She told me “You’re probably just crazy.” She agreed however to order MRI/MRA of my head and neck.
I’m a large person with broad shoulders and don’t fit well in an MRI machine. I have to cross my arms over my chest and roll my shoulders inward to fit into the machine. I do not like MRI machines. I glanced at my watch prior to taking it off and placing it in the locker. I was strapped into the machine and stuffed into the tube for the MRI. The tech kept coming up on the headphones and telling me how long each segment of the testing would be. She told me the entire test would take about 17 minutes.
The segments keep rolling by and I began to feel as if I was in a human sized easy bake oven. The plastic table I was lying on started to heat up almost immediately and I could feel the sweat and panic rising. Though I’m not claustrophobic I should have taken the Neurologist up on those valium she offered me.
Finally the test was over and I was removed from this medical torture. I was soaking in sweat and the tech helped me to a sitting position to recover. I glanced at the clock in the control room, 47 minutes. Forty seven minutes I was trapped in that terrible machine. I didn’t have the stomach to ask the tech why she lied to me, I just would have preferred an honest answer and perhaps a brake between segments.
I took the MRI results with me to the Neurologists office so she could evaluate the films. She again examined me and was suitably unimpressed. She placed the MRI films on the viewing board one at a time and went over each film with me noting the absence of any pathology.
On the second to the last film there it was. A congenital malformation of the vertebral artery which had probably been briefly blocked causing a small stroke. She did not say anything more about me being crazy but she did not apologize for the remark. Yes some crazy people will spend thousands of dollars on unneeded medical tests but I’m not on that list. She spoke briefly about taking aspirin daily and about further testing that could be done. I was apprehensive about having a cerebral angiogram and also worried about the mounting costs so I opted not to continue any further testing.
I am left with residual deficits in balance, ambulation and a headache that never goes away but am doing reasonably well. As a provider myself I was somewhat discouraged to have been disparaged by not one but two other providers before they had the full picture. I already hate going to the doctor and this entire experience has reinforced that feeling. I wrote this to share with other NP’s that perhaps it is better at times to withhold comment and to think before you speak.

I hope that you learn from this story and think before you speak. Be aware of disparaging symptoms that seem benign. They could be something very serious. Every person is indivdidual and symptoms are often different for different ages, races, and sexes. I know that I will think twice from now on before I disregard something that may be important.

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