FY2 in Med department. Mr. Smith has suffered from another stroke and now he is in coma. CT findings bilateral ischemic stroke. He was admitted after a stroke 2weeksa ago for which he received meds. MDT meeting has decided only PC. Talk to the daughter and address her concerns.
MDT no CPR, no assisted ventilation.
Only IVF and analgesia
Suffered an initial stroke. He has suffered a 2nd one. Serious stroke 4days after leaving him in a coma. CT scan showed bilateral ischemic stroke and PC was decided. You are Mrs. Smith 36weeks pregnant. This will be his only grandson and only family he has apart from me. You want the Dr to delay his death by at least 1week.
ntroduction: Hello, I am Dr… one of the Drs here, may I confirm your name please? Your relation to …?
Asses knowledge: I am here to talk to you about your dad’s condition. I understand that he was admitted to the hospital few days ago. Can you please tell me more about it?
History: What do you know so far about his condition? Has anyone talked to you about your dad’s condition? What did they say? Did he complain of any headache? dizziness? SOB? What do you understand about stroke?
Risk Factors: has he had bleeding disorders before? Has he been diagnosed with any medical condition? EXPLORE. Has he been taking any medication like blood thinners? Any allergies you are aware of? Does he smoke? Any family history of bleeding disorders? Whom does … Live with? How are things at home? Any kids at home?
Invitation: is it okay if I update you about your husband’s condition? Is it alright to talk to you? is there anyone you would like to be here? Is there anyone with you at the moment at the hospital?
Knowledge: As you mentioned your dad had a stroke 2weeks ago for which he recovering well. Unfortunately, he suffered a second stroke. The 2nd stroke is a big one because it has affected both parts of the brain. He has suffered what we call a bilateral stoke. PAUSE
The second stroke seems more serious than the first. He is in a serious condition at the moment. He ha been reviewed by the MDT this is a group of specialists that have assessed your dad and they decided what is best for him. They recommended palliative care only for him (IV fluids, CPR, no resuscitation).
Can you keep him alive for at least 2weeks? May I ask you why 2weeks specifically? I am going to give a birth in 2weeks time and I want him to see his grandson. It is quite considerable what you are going through but he has been placed on palliative therapy. It is difficult to say how long he has left. We can’t do much of delaying someone’s death. It has to be done naturally.
Strategy and summary: he has been placed on PC, this is a treatment to make him comfortable and to make sure he isn’t suffering. He will receive things like fluids, pain relievers and if he is in any stress, we will make sure he isn’t in distress. Your dad is currently in a coma. We can speak to nursing team and we can arrange you to see him. Unfortunately, he wouldn’t be able to talk or see you when you see him. He may not be able to come back this time around.