Opinion ON THE BRAIN Shewasneverevensupposedtobeinthehospital.Wegot treatment.Ipausedtogiveherachancetoobject,butnone David Dongkyung Kim, MD a telephone call from an ophthalmologist who suspected came. I explained that her MRI had revealed strokes in Department of Clinical a stroke in a woman in her early 70s after finding a visual multipleareas,butsomeweresosmallthatsheeitherdid Neurological Sciences, field defect. She had gone to the clinic because she was notnoticethemorhadrecoveredquickly.Ireferredtoher Western University, bumping into objects for a few days, but she expected to medicalhistoryandhowshewasatahigherriskofcardio- London, Ontario, Canada. doafewtests,getadiagnosis,andgohome,becausewhat- embolicstrokegiventheimagingfindings.Withadditional everwaswrongdidnotevenbotherhermuch.Instead,she considerations that included her individual bleeding risk, wastreatedtoanadmissiontoourstrokecenterandanoth- properinformationwasnecessarybeforechoosingatreat- ing by mouth designation overnight after she failed the ment plan that may include anticoagulation. After I explained this, she looked down as if she was nurse’s swallowing screening. The ambient music of the ward—the echoes, beeps, snoring, and nurses and physi- afraidIwouldconsiderheradifficultpatient.Thenshequi- cians shuffling about—meant she did not get much sleep etly repeated that she had been in the hospital for a few that night. daysandjustwantedtogohome.Iconcededsomeofthe The next morning, the junior resident physician pre- tests could be done as an outpatient, but cautioned that sentedhercase:thepatientwithamedicalhistoryinclud- it was difficult to have them rushed. If she was lost to fol- ingsystemiclupuserythematosusandmultipleorganfail- low-up without a proper treatment plan, she could be at ure,
JAMA Neurology – American Medical Association
Published: Apr 26, 2018
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