Doctor, My Dad Is Not Waking Up
A harrowing tale of a stroke patient and the sufferings of his relatives.
It was a warm Sunday morning, sometime back in the early nineties when I got this call from a young girl, one of my patient’s daughter. I do not remember the exact date, but I can’t forget that tone of urgency in that call.
At that time, there were no mobile phones available in India. We had a landline telephone. I was enjoying reading my Sunday Times when the phone rang.
As I picked up the call, I could make out some commotion in the background- maybe someone had collapsed, the thought crossed my mind. At the other end, this young lady appeared quite composed while talking “ Doctor, can you come over to our house? My dad’s not getting up. We have been trying for the last 15 minutes.” I replied in the affirmative, picked up my visit bag, and was immediately on my way.
This was one of my patients- let’s name him CS. As I reached his home, I could make out CS lying down in exactly the same way as in the picture shown above. His parents, wife, and children were trying to wake him up. As I approached him, people near him made way for me. I immediately got to work-
- Asked about his age — it was 55 years.
- Checked his pulse- it was regular and strong at 70 beats per minute
- Got his blood pressure checked- it was a bit high at 150/ 100 mm of Hg.
- Pinched him- no response
- Heard his breathing- it was a bit laborious but normal
- Did his neurological examination- his left side was limp
My preliminary diagnosis at the end of this examination- Cerebrovascular Stroke due to a possible intracranial hemorrhage.
What may be the cause of this condition?
Before I go ahead, let me brief you about this patient. CS had undergone an operation for heart valve replacement three years back. At that time he was taking the anticoagulant medication warfarin. Nowadays, many others like blood-thinning medications are available.
Why was he on anticoagulants?
Patients who undergo valve replacement surgery have artificial valves made of high-grade stainless steel. Our body treats these valves as a foreign body. When the blood comes into contact, there is an increased risk of blood clotting inside the body, especially near the valves causing the valves to malfunction.
Moreover, if there is clot formation, there is a very likely chance that this can get dislodged and be thrown into blood circulation.
So, what did I do next?
After assessing his condition, I called an ambulance to move CS to a hospital with a modern ICU facility. I briefed the on-call cardiologist about the patient.
He was also of the opinion that CS had thrown a clot and that it had caused a hemorrhage in the brain leading to coma. A CT scan was carried out which revealed a huge blood clot in the brain — known as intracerebral clot- caused by hemorrhage, just like in the pictures below.
What next?
CS was admitted to the ICU. The cardiologist declared him brain dead, but his heart was still beating strongly. He was put on life- support system. Finally, after battling for 15 hours, his heart stopped beating and he was declared dead.
No post-mortem investigations were carried out as there was clear cut evidence of a brain hemorrhage in the CT scan and a positive history of heart surgery.
It was concluded that he must have forgotten to take his medication which led to clot formation and dislodgement of the clot and ultimately resulting in cerebral hemorrhage.
Takeaway message-
If anyone has undergone heart valve surgery, he or she should not forget to take his/her medicines on time. Otherwise, they can always land up in the hospital with cerebral hemorrhage causing a lot of anguish to their near and dear ones.
