The call is for a possible stroke -- a fifty-year old cancer patient can't move her right side.
I'm thinking it's not a stroke. Maybe weakness, maybe a tumor. But it could be a stroke. We'll see when we get there.
The woman is lying in bed. Her eyes look up at me as I come through the doorway. She is alert, her skin is warm and dry. She looks scared.
She was fine a half hour ago, she says when she took a nap. She woke up and now can't move her right arm or right leg.
Her right arm lies lifeless at her side. She can't squeeze my hand. I lift the arm up and it falls back to the bed. She can't lift her right leg, but when I have her try to push against my hand, I feel some force against it, like the strength is coming from her hip. Odd.
Her speech is clear. No facial droop. Never had anything like this happen before.
Her only history is breast cancer that was cured, and then a year ago, cervical cancer. She's undergoing chemo. And now she can't move her right side. Fifty years old
We lift her up onto our stretcher. She can't weigh more than a hundred pounds.
Out in the ambulance, I check her out. Her heart rate is in the 130's. Her BP is 110/70. Lungs are clear.
No headache. Pupils are equal and reactive. Her right arm is still flaccid. Odd.
I check her other arm for a vein and don't see much. She tells me she has a port.
Okay, I say. I'll let them use that at the hospital. Spare you a needle.
Thanks. I've had my share of needles lately.
I do have to check your sugar, I say. It's just protocol. You ever had any sugar problems? Diabetes?
No.
It's a little prick in the finger. We have to do one on all possible stroke patients. I don't do it, they'll ask what your sugar is, and I'll say, I don't know, but your not diabetic, but they'll still need to do it anyway. Its best to just do it.
Okay.
I prick her finger and squeeze out a little drop of blood. I press the glucometer strip against it, and watch as the blood is sucked into the strip, and the machine starts its countdown.
5, 4, 3, 2, 1. Reading -- 66.
Okay, that's interesting. Your sugar is a little low. Not greatly so -- the normal range is 70-110 -- but a little low. Have you been eating?
Not much. I haven't had an appetite.
Well, protocol again. I really should put in an IV and give you a little sugar water. Just to cover all the bases. So we can rule out your sugar being the cause, which I doubt it is. I've had patients I thought were having massive strokes only to find their sugar down in the 20's, but 66 isn't very low.
If you have to, she says.
All I can find is a thin vein in her hand, which I thread a 24 into.
I squirt out half an amp of D50 into the sharps box, and then stick the needle into a 250 bag of saline and draw out 25 cc. I shake the new mix of 12.5 grams of D25 up and then push it through the saline lock. It flows easily. When I am done, I toss the bristojet into the sharps box, and pick up my clipboard to notate it.
As I am writing, I feel a tap on my leg.
I look over at the patient.
"Hey, look at this," she says. She kicks her right leg up and down and waves her right arm, squeezing her hand in and out, in time like a vaudeville performer.
She has a smile on her face like a little girl at a magic show.
