Communicating

Hey Guys

I am currently completing my neuro placement on an acute neuro ward. Most of the patients here present with an acute stroke, of varying severity. I came into the placement ready to apply the skills we had learnt during the past year, and contribute to the rehabilitation of these patients.

One of the first patients I was assigned was a 60 year old woman who had suffered a (L) TACI affecting her ACA and MCA. Her MRI revealed massive destruction of her (L) hemisphere, with only a small portion of the occipital lobe left intact. She presented with aphasia and dyspraxia, with very limited voluntary movement. So essentially she was not talking, not eating and not moving. She is able to blink, but in no meaningful pattern, move her eyes (only to the left), move her head, primarly to the left, and squeeze a hand placed into her left hand. It was my task to complete a stoke assessment on her and begin treatment.

As you can imagine, this was not an easy task. I was completely unprepared with reagrds to how to communicate with this patient, and how to go about treating her. Upon entering the room, I was met with the patient sitting in her tilt-in-space wheelchair, with her partner in the corner of the room. I began by introducing myslelf, explaining what I wanted to do and then began examining her chest, and asking if she could cough or swallow. The patient was completely unresponsive to this, and continuued with stare into space, barely making eye contact.

While this may not seem like much, this really hit me hard. I had never encountered anybody in this state, and really felt like I had no idea how to effectively communicate with my patient and go about my assessment and treatment. Coupled with this, with her partner in the room, my thoughts immediately went to her family, and how they might be feeling, and I just got completely overwhelemed. I had to leave the room and ask my supervisor for help. I honestly had no idea what to do!

My supervisor came in and took over the assessment. Just watching how she spoke to the paitent for 5 minutes, and how she went about the process was all it took for me to feel cofident that I could manage the situation. I have since seen this patient twice a day for the rest of the week and am very happy to see small improvements in her every day.

So the point of this is that while we are taught some therory about appropriate comminication strategies with different patients, encountering these patients is a much different story. In these cases, I can reccomend observing those more experienced than us, and taking on board effective communications strategies, and thinking how these can be applied to different situations. No mater how good our treatment strategies are, we will get nowhere without appropriate commincation.