ER called report. My next admission was a stable middle-aged male with TIA. OK, another TIA – I knew the protocol. No big deal on my M/S unit.
He was a Canadian tourist who was in town with a tour group composed of his fellow church members.
He arrived alert. But when we asked him to stand and transfer from the wheelchair to his bed, he could not bear weight on his left leg or use his left arm effectively. His speech was a little slurred as well.
The transporter read my furious expression and went into defense mode. She swore, with a vow, that he was not like that when she put him into the wheelchair just minutes prior.
I was livid! This was no TIA, and putting an evolving CVA into a regular hospital room was not OK. I told the charge nurse and called the doctor.
The charge nurse, and several other nurses, verified my claims. But still – we could get no orders for an ICU transfer – no orders to consent him for TPA – and no explanation of why!
The next day, the doctor told the patient that he had, indeed, had a stroke. He said that our hospital would work with his Canadian insurance and provide him with the best treatment options that his policy would allow.
And the doctor added that it was wise of him to have taken out a traveler’s health insurance policy to cover him on his trip. I was thinking, “Then why didn’t you do more for him yesterday?!”
With the news of his diagnosis, he was shocked and called his daughter, with help, and she said she would fly down to see him immediately. He cried – and I felt like crying too.
Soon the therapy began. He was given PT, OT, ST, and every kind of TLC we could think of for him. What a kind person! We all liked him so much!
His tour group visited him. His daughter came and brought him mementos from home. He was a well-loved man.
Meanwhile, our hospital case managers worked with the Canadian insurance people to try to get him home as soon as it was safe for him to fly.
I could not help but wonder, since his CVA was not hemorrhagic, was the lack of aggressive treatment that first day political or insurance-related? Doctors would not answer.
Did his traveler’s insurance contain exclusions? Did our hospital really provide this patient with the best that his country allowed? Were our hands really tied?
I guess I’ll never know about his particular case. But the patient stayed with us a good two or three weeks -receiving his therapies until such time that he could return home.
What a remarkable and kind gentleman! He went home with deficits. But at least I know that the nurses, therapists, and case managers provided him with the very best that we could give, and it was a pleasure to do so.
For more information about traveler’s insurance: Prepare, Travel, Return: A Beginner’s Guide to Globetrotting and
Healthy Travel: Don’t Travel Without It!