Wednesday, March 14, 2012

Giving a Medical History

Whether or not the doctor's had a medical history to work from that night is unclear. I'm not sure if his medical records exist in a central computing system but what I forgot to mention wouldn't have been there anyway.

The first to arrive at the house were the emergency rescue personnel. They asked about what Stephen was doing just prior to losing strength on his right side and the ability to speak. They also asked about whether or not he was on any medications which he wasn't. Stephen always gave the persona of perfect health. When the ambulance arrived, the same couple of questions were repeated. Just before the ambulance left, Stephen got back full use of his right side and went weak on his left side. He went from being totally unable to speak to speaking clearly and intelligently.

The rule is that family can't go in the ambulance if there is any other way of getting to the hospital or allowed to follow the ambulance. There's definitely the possibility that Stephen gave a more complete history during the ambulance ride or during the initial assessment period in Chatham or during the ride and assessment period in London.

I was the one that made the initial 911 call and assumed that he had had a stroke because of the weakness on one side and inability to speak. He must have assumed the same thing because I could see him trying to work his hands. He had this theory that if you moved your muscles immediately that your brain could overcome the loss of function. Our old German Shepherd had had a stroke and loss strength in one side. The dog had also had a flee on his ear that he'd really, really wanted to itch. When we woke up, the dog was happily scratching his ear and he always dragged his paw a bit but was otherwise fine. In the midst of the crisis, Stephen was thinking about his old dog and was hoping to be as lucky.

When the symptoms had been on the right side, Stephen looked severely brained damaged. When the symptoms switched to the left side, he was totally himself - articulate, no distortion of his appearance. Being an experienced clergy wife, the first thing I did when the ambulance left was call the church warden. I thought it was pretty obvious that we were looking at immediate early disability retirement. Being rector of 6 churches in 6 different communities requires being in peak condition. The more experience the priest has, the higher he is on the pay scale. Most parishes are struggling these days and are hesitant to call someone with a lot of years of service so I doubted he'd receive another position. The church warden needed to journey with me to the hospital and handle what would inevitably be as huge a crisis for the parish as it was for us personally.

As soon as I arrived at the hospital, the emergency room doctor told me to bring the family members in as Stephen would most likely die that night. They were going to transfer him to London but it takes time to make the necessary transportation arrangements. Again I couldn't go with him to the next hospital so if additional history was given, it would have had to come from him.

So what did I forget to mention. I had spent the evening upstairs following links on google reader, facebook, twitter, etc. I have a very extensive personal learning network and take Massive Online courses. While I was upstairs my son and husband had been socializing and drinking rum and coke. I didn't think to mention the rum because I hadn't been drinking or watching them drink. All I thought to mention was that the pain in his chest started after we'd finished making love. I'm hoping the rum helped with the aorta pain but was far enough out of his system by the time he arrived at hospital to not influence any pain relievers prescribed.

The other possibly relevant thing I forgot to mention was that Stephen had hit a raccoon on Christmas eve. This had been a bad autumn for deer accidents and there had been several warnings issued in the local paper. I'd done much less travelling around the parish with him and we both weren't that keen about doing any unnecessary night drive. I have a Roman candle type personality. Telling me about the accident would have caused me to go ballistic and I would have said too much until my brain kicked back in a few minutes later. It's 5 minutes of awful and then I drop the subject as each day has troubles enough of its own. So I didn't know Christmas Eve. Did know Christmas day but we'd gone to our daughter's house for a wonderful Christmas supper and then we'd gone to our youngest son's house for a wonderful time on boxing day. On the day after boxing day, he had officiated at a funeral. There had been so many events and the car thing so minor in the scheme of things that in the crisis it failed to come to mind.

At the funeral, Stephen's sister talked about Stephen's last deer hunting visit. Stephen had had severe groin pain climbing into the deer blind. It happened on one side so the following day he used the opposite leg for the climb and experienced severe pain on that side. As dissections usually spread downwards, I doubt that the deer hunting incidents were relevant but a complete history would have included them. Again it was an event I didn't witness. Stephen was loving the hunt too much to interrupt it and went right into his Christmas preparations when he returned. He phoned when it happened but he never mentioned it once he came home. It's our custom to spend the night before a doctor's visit in a hotel and see the doctor the following afternoon as we never changed physicians when we changed parishes. Chatham-Kent has a doctor shortage and we had an excellent doctor in LaSalle so we didn't mind the distance thing. Unfortunately the distance thing is an issue for a priest when he's busy running around giving pre-Christmas communion to shut-ins and nursing home and hospital patients. Maybe he would have checked things out if the doctor was local but Stephen was mainly an annual physical kind of guy and never one to talk about his health.

Unfortunately even if digital health records were available, the rum, hitting the raccoon and the deer blind wouldn't have been on them.

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