Get thee to the ER, stat!
May 4, 2013 8:47 PM   Subscribe

Is this a normal amount of time to expect to wait when YOU'RE BLEEDING IN THE DAMN BRAIN?!

So, I awoke to a frantic call from my friend's mother at 3 am this morning. My friend was taken to the ER at 10 pm last night with a severe headache. He was initially diagnosed with a brain aneurysm.

My son and I drove up to the hospital first thing this morning. By noon today he had been transferred to the ICU but at that point, they had only done a CT scan which showed blood on his brain. They had also significantly doped him up on morphine for the pain. We were told that at noon they would do an angiogram to look for the aneurysm and an MRA at the same time as well.

They did the angiogram and found no evidence of an aneurysm but then inexplicably delayed the MRA. At 4 they took him down for the MRA but brought him back up over an hour later, unable to do the MRA because there was a 15 year old who'd suffered a stroke that they prioritized ahead of him. They said they would do his MRA shortly after that but when I left at 10 pm they had still not taken him for the test. As of 10 pm this evening they're still saying that the MRA is necessary and will get done today. As far as we've been told, there are no other medical complications preventing them from doing the MRA anytime.

I should also mention that at NO POINT has any doctor spoken to my friend's family about what's happening or why / when they're running any tests. Any information we got about the test came directly from my friend who had been informed by his doctor's. Keep in mind, I'm talking about my friend that's out of his mind on morphine and you know, bleeding up all inside his head. Getting any useful information from his nurse when her shift ended was like pulling teeth (and she was giving the information to my friend's mother, not me).

So, is this kind of delay normal? His family is quite pissed but after 24 hours still not pissed enough to vocalize it outside of our waiting room or to any hospital staff. But this seems like a very serious issue to me and it seems like doctors would want to determine the cause and fix this quickly, right? Am I overreacting in thinking that waiting 24 hours for 2 seemingly very important tests is just fucking ridiculous or is this just typical for a hospital on a weekend?

Please note, whatever the answers given here, I do not plan on sharing with my friend's family. I am incredibly close to this family but still, I don't consider this my business and do not plan to involve myself in any way, I'm just genuinely curious. The seeming lack of response over what I think to be a very serious medical issue today just confused me and made me wonder if I have some sort of overly weird idea about how serious this is and the timeframe in which things should be happening...
posted by youandiandaflame to Health & Fitness (11 answers total) 2 users marked this as a favorite
I'm sure an actual ER worker will chime in here at any moment, but just from my limited experience in hospitals (as a patient), hospitals and health care workers are generally trying pretty hard not to kill anyone. Of course mistakes happen, but maybe not jump to the 'malpractice' conclusion first.

Once your friend had been transferred to the ICU and (presumably) stabilized, it sounds like what might have at first seemed like a potential big problem was either downgraded after more information became available, or they're in a wait-and-see mode where they have to see what (if any) complications develop before choosing how to proceed. The triage-based priority changing the scheduling of procedures is just standard procedure, I wouldn't read too much into that.

Unless your friend is a minor, there may be privacy issues regarding the doctors discussing treatment with his mother. I don't know much about that all, but just a thought.
posted by axiom at 9:13 PM on May 4, 2013 [1 favorite]

I would suggest that your friend's mother contract the hospital's Patient Advocate office to help her communicate with the staff and help her understand why this is happening, or why a doctor has not talked to her. There may indeed be privacy issue, but if so then they can help her untangle all of that, or advocate for the patient and his family.
posted by DrGirlfriend at 9:24 PM on May 4, 2013 [4 favorites]

at NO POINT has any doctor spoken to my friend's family about what's happening or why / when they're running any tests...Getting any useful information from his nurse when her shift ended was like pulling teeth (and she was giving the information to my friend's mother, not me).

Some people request that information not be given out to their family, if your friend has done this in the past that may still be on file at the hospital. Even if that's not the case, the surgeon may have been to busy with emergency cases to take the time to speak with your friend's family after his surgery, or if the mother arrived there later on the doctors who saw him might not have still been at the hospital.

The hospital may not do rounds on the weekend, if the family wants to be able to speak with one of his doctors try to find out what time frame rounds are done and be sure to be there at that time. I feel that I get more information if only one or two visitors are there to speak with the doctors, and if I take notes. Bringing up frustration with the delay in speaking with a doctor here will probably not be helpful, speak with the Patient Advocate if you want to do that.

It sounds like they did an angiogram with some other imaging machinery? The question is how does waiting on this test impact his treatment. If they need an MRA to transfer him out of the ICU or release him from the hospital, that's something which can be delayed if another patient needs an MRI to rule out aneurysm before being treated for stroke. If your friend is under observation, it's pretty common for things to be rescheduled, it's not seen as important to fix things quickly unless there will be some harm from not doing so.
posted by yohko at 9:41 PM on May 4, 2013 [2 favorites]

The family needs to advocate for your friend and get answers from the doctor asap.

We have a family member who's serious brain leak was basically lost in the paper shuffle in the hospital and she had significant damage due to it.

They should have pointed questions.


We thought there was a MRA required asap, it hasn't happened, why not and when is it scheduled?
posted by bottlebrushtree at 9:45 PM on May 4, 2013 [2 favorites]

I am sorry that your friend's family has been frustrated with his care. The most important questions to ask are whether the physician responsible for his management can be paged for a discussion and if not, when the ICU team will be on rounds so that a family member can be sure to be present for questions. If that doesn't work, I agree that the patient advocate would be a good option. One thing to keep in mind is that doctors are not always perceived as doctors. I am a female and I have often been assumed to be the nurse, resulting in complaints that "a doctor never saw me!" from my patients.

I'm an emergency department doctor and I think the main issue here is that you're thinking that the bleeding cannot be treated until the MRA is done. I am going to assume that we know very little in terms of concrete facts here, given that you are hearing all your information through the grapevine, but it sounds like your friend has a subarachnoid hemorrhage (fancy doctor term for bleeding in the brain) probably secondary to an aneurysmal bleed.

In any case, I think your concern is that you think that the MRA is integral to being able to treat the bleeding. It is probably not. The treatment of subarachnoid hemorrhage is generally medical, using medications for blood pressure control and to address various complications of the bleed, like seizures or low sodium levels. If he does have a ruptured aneurysm then the concern will be re-bleeding. Re-bleeding can be prevented by clipping or coiling the aneurysm.

I cannot speak to your friend's case because I don't know if he indeed has a subarachnoid hemorrhage or what the story is, but it is possible that the MRA will not impact his immediate treatment but still needs to be done to plan for a clipping or coiling of an aneurysm to be done in the near future. In this case, it makes sense that more emergent cases, like a 15 year old with a stroke, would be done first, and his non-emergent study would be delayed until all emergent cases were completed. Hopefully when your friend's family does speak with a physician, they will find out all the details about what is going on and the plan.
posted by treehorn+bunny at 9:51 PM on May 4, 2013 [29 favorites]

I had a TIA, a tiny and non-damaging stroke, last year and was admitted through the ER to the hospital. Some of the scans needed were rescheduled for several days and I spent essentially an extra day in hospital because of a holiday weekend to get a scan done. When they were worried at the start, I got pushed to the front of the queue for everything, and as soon as they weren't worried, I went all the way to the end of the queue.

Definitely speak up - I had one doctor decide I just had had a severe migraine and get ready to discharge me, but we refused until the senior doctor had a look at my case and overruled him - but the reshuffling of testing is pretty common. My kid with a severe migraine had the same thing happen - rush of tests to confirm how severe, then back to regular glacial paced testing.

Also, what freaked us the hell out was routine for the staff. Your worst day is another Tuesday for them. I could almost never tell how bad things are from staff demeanor except once when a doctor and nurse sprinted to my child's room - then the nurse told me "Everything's fine, don't worry" while we watched medical staff stream in and out of the room. They want to keep you informed but not hysterical with fear. It's a tough balance.
posted by viggorlijah at 10:07 PM on May 4, 2013 [1 favorite]

Not a brain thing, but when I was very ill twelve years ago, for a time, I averaged two medical appointments per week. For several weeks, doctors were denying me treatment and sending me for more testing. Since they did not know what was wrong, they did not want to prescribe anything and possibly domore harm than good. I was in real danger of dying and enormously frustrated. When I finally got the right test, and thus the right diagnosis, they resumed treatment and were finally willing to treat me aggressively because they had some idea of what they were doing and weren't simply flying blind.

Medicine is a very conservative profession. There are times when that can be enormously frustrating. I wish some things were handled differently and I still bitterly resent the remark by one doctor suggesting that fearing for my life was irrational even though I had been deathly ill for months, they had no idea why and were refusing me treatment. But I also understand that some aspects of it are very reasonable precautions against potentially seriously harmful decisions. Some things simply take time to reveal themselves.

Also, generally, they can't give out information willy nilly these days. There are federal laws seriously restricting who can be told what. Technically, once a child turns 18, even though they may still be living at home, their parents aren't necessarily entitled to medical records/info. The adult child now has to sign release of information forms, etc, instead of the parent, even though they may still be covered by parental insurance. So that piece can be complicated. But there are good reasons for it.
posted by Michele in California at 10:26 PM on May 4, 2013 [1 favorite]

Ah, thanks for the answers and thoughts, all.

It was just insanely weird for me that everything went from an ER doc telling my friend's family to call his loved ones and get them to the hospital to a stand still just a couple hours later. It seems I was overreacting about how these things work.

treehorn+bunny, thanks especially for your thoughts. The angriogram ruled out an aneurysm but still, just the phrase "he has blood on his brain" seemed to me to be incredibly serious and something that needed some kind of treatment immediately. Yesterday was fraught with total freak-outs so it didn't occur to anyone, I don't guess, to think that it could simply be treated with meds. I think the lack of anyone telling us anything didn't help but I get that's just the way it is.

I'll mention in passing to my friend's mother that she might want to seek out a patient advocate if she's still frustrated but I really appreciate the responses here. It's calmed me down when I clearly needed it :).
posted by youandiandaflame at 5:35 AM on May 5, 2013

Hi, ICU nurse who worked on a stroke unit for 3 yrs. If he's been ruled out for aneurysm, then it's possible his blood is an intracerebral stroke or it's from trauma. Traumatic subarachnoid's are treated significantly differently than aneurysmal ones. Many of these injuries just require close monitoring for a while. It sounds like your friend is stable, doped up on morphine sure, but stable. He's able to communicate with you. Trust me, for neuro patients that's good. Should he begin to develop complications, I'm sure they'll be on it right quick.
Until then, you're stuck in line for the MRA.
posted by brevator at 6:10 AM on May 5, 2013 [7 favorites]

A lot of people don't know this but there are "best" hospitals to go to for stroke in every city. The patient didn't know if he was having a stroke, but he had stroke-like symptoms so he should have gone to the best hospital for strokes in his city. You could call the office of the EMS and ask where they take suspected stroke patients.

If you find out he is not in a certified stroke hospital you could advocate to have him moved. But I understand if you don't want to be pushy. He is probably going to be fine.

Read about certification for primary stroke centers.

Everyone should know the best place to take someone with stroke symptoms before they happen. Be prepared.

If something like this happens to you or someone you know consider calling EMS rather than driving yourself. Studies show a better outcome. (my opinion is that EMS arrivals are taken more seriously than walk-ins.)

May is Stroke Awareness Month!
posted by cda at 12:57 PM on May 5, 2013 [2 favorites]

Good feedback so far and I know you're past the worst of this already, but I wanted to add, as a nurse in a busy hospital, that in general, it is very beneficial to be a squeaky (but respectful) wheel when you or a loved one is hospitalized. The reality is, every single person working in a hospital, from the doctors to the folks who operate the MRI machine are overworked. Most of us are doing our best most days, but most days we don't give the full focus and attention we should give to each individual, because it's just not possible.

It makes a difference to calmly and respectfully speak up to advocate for yourself or your friend in this case. It's OK to (respectfully and kindly) ask for the nurse manager, or if you're at a teaching hospital and are being cared for by residents, for the attending physician.

It is completely reasonable to ask for a direct conversation with the physician and to ask questions like,

What is the plan for today? What could be causing these problems? What tests are used to decide the cause? Why are you choosing x test and not y? What would the treatment be if the diagnosis was z?
posted by latkes at 7:09 PM on May 12, 2013

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