How Would a Doctor Respond

kngwzr_d

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*Edited*

Hello,

I am writing a short story that has a doctor trying to save the life of a very old man in the hospital. The patient (the old man) had a stroke. If this took place in a hospital and the family wanted the doctor to do his/her best to save their family member's life, what would they do? What medical procedures would they attempt? What medications would they administer? Also, when they ultimately lose the battle to save the man's life, how would they tell the grieving family members?

Thank you for your time!
 
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ElaineA

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My father recently died of old age, a long grueling process. You are saying two different things in your post. He's dying of old age, and they are "battling" to save his life. If there's something to "battle" (in other words, something acute, like heart attack), he might be in the hospital for a short stay. However, in the US, people dying of old age don't get much treatment in the hospital. Hospitals won't admit them unless there is something that specifically needs hospitalization to treat. Even things like kidney failure and heart failure are treated more on an outpatient basis. I think you need to decide on a specific emergency medical problem (ie heart attack, or...stroke, maybe?), and then people can be more specific about what a doctor or hospital would do.
 

RKarina

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I'm not a doctor or nurse, just a former paramedic, but I've seen enough death (family and otherwise) to be familiar with some of it.

Generally, a doctor isn't going to "battle" to save someone who is quietly dying of old age.

Why? Because there is nothing to treat, and most people prefer to approach age-related death with some degree of dignity and comfort, rather than have their last days/hours filled with uncomfortable and invasive "treatments". (things like IVs, intubation, etc)

That doesn't mean they'd sit back and do nothing, just most families would rather let great-grandpa go to sleep peacefully and simply not wake up, rather than subject him to the less than fun experience of "heroic measures" that may, or may not, work.

Medical personnel will treat the symptoms and diseases that exist. Old age is not a disease. There is no cure. So they could only treat whatever problems the man presents with.

The cause of death, while natural and age-related, is still likely to be cardiac, or other organ failure. Unless the patient was in a nursing home, or had some medical issue/emergency, death of this variety usually happens without medical intervention.

If the patient has had a heart attack, or stroke, or severe shortness of breath, or things of that nature, he would have been taken to a hospital (possibly treated in the emergency room, possibly admitted). The doctors would treat the relevant symptoms and would, if another incident happened while the patient was there, of course battle to save the patient's life.

As for what treatments and medications - I'll leave that to the doctors and nurses here - but that would greatly depend on the cause, and what the patient and/or their family wanted.

On telling the family - that depends greatly on the type of facility. A large hospital in a city might have a chaplain, or other trained personnel who could be the one telling the family. They often have private rooms for family members to gather out of the way (and without the distractions of other patients/families). A smaller facility, or one in a less populated area, the doctor might be the one to share the news.

Most medical personnel will use fairly straight forward terminology - they will say the patient died, not "passed on" or other euphemisms. A chaplain, or doctor who knows the family personally might be softer about it. But they're all going to say pretty much the same thing: I'm sorry, we did everything we could.

Death, even from age-related natural causes, is never quite so simple.
 
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GeorgeK

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The two posters are referring to honest physicians. There are also ones who should not be in the profession who do a wallet biopsy and want to do all sorts of procedures because they are a billable, "service."
 

kngwzr_d

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Since the editing of my original post, I have it narrowed down to what I'm looking for: how would a doctor try to save the life of a patient who had/is having a stroke? What would the conversation in the room be like among the doctors and nurses? It's for a short story but I want that piece (the hospital scene) to be as real as possible
 

GeorgeK

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Since the editing of my original post, I have it narrowed down to what I'm looking for: how would a doctor try to save the life of a patient who had/is having a stroke? What would the conversation in the room be like among the doctors and nurses? It's for a short story but I want that piece (the hospital scene) to be as real as possible
In that case you have already decided that the person is in good enough shape to have a life expectancy such that it is worth treating. The first things would be to rule out something simpler like hypoglycemia or hypoxia which could be done at the bedside with a fingerstick and pulse oximeter. If they are convinced that it is indeed a stroke then they'd need to know if it is occlusive or hemorrhagic because one is treated with a variety of anticoagulants and possibly certain invasive procedures and the other would probably start off with Vitamin K, maybe some fresh frozen plasma, maybe other blood products perhaps with a totally different type of invasive procedure. It's too large of a topic for a BB post.
 

kngwzr_d

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In that case you have already decided that the person is in good enough shape to have a life expectancy such that it is worth treating. The first things would be to rule out something simpler like hypoglycemia or hypoxia which could be done at the bedside with a fingerstick and pulse oximeter. If they are convinced that it is indeed a stroke then they'd need to know if it is occlusive or hemorrhagic because one is treated with a variety of anticoagulants and possibly certain invasive procedures and the other would probably start off with Vitamin K, maybe some fresh frozen plasma, maybe other blood products perhaps with a totally different type of invasive procedure. It's too large of a topic for a BB post.


So let's say that it is a hemorrhagic stroke, what methods would they use? As a doctor and given the patient's old age would they attempt an invasive procedure? Or I guess, a better question would be, regardless of age, how severe would the stroke have to be when the doctor's would call it? What signs would they see to know that no other measures should be taken because the patient has died?
 

GeorgeK

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I'm unclear as to what you are actually asking. It seems like you keep changing your mind as to whether they want to do anything or not. Are you saying the family wants everything done to save Grampa because they want to assuage their guilt for ignoring him the last 40 years and treating him like dirt? (I've actually seen that scenario many times) But the doctor believes best case scenario is a complete vegetable in a total care nursing home eventually to die from bedsores?

If that is the case, then age isn't so much the issue as general health. I've had patients in their 90's who were in better shape than people in their 30's. Did the attending physicain know the patient prior to the stroke, so they know when the family is lying about what kind of state the patient was in at home? Some families make up all sorts of crap to shove Grampa into a nursing home and seize control of assets.

There are many possible tests and it's not that any one is necessarily the best. They all give you a different piece of the puzzle, doppler ultrasounds, CT's MRI's nuclear scans, arteriograms. The simplest is to just do a physical exam. Is the patient alert and talking? Is the patient obtunded and unresponsive to stimuli?
 
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King Neptune

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I think that you should simply ask what the treatment for a hemorrhagic stroke would be. The age of the patient is not very relevant, if he is healthy enough be treated. If there are other medical problems, and the physician has written the person off as terminal, then nothing would be done.
 

kngwzr_d

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Sorry, ignore the age. I'm asking for this information while I'm at work so I don't have much time to phrase my question properly. What has been given helps. Thank you all!

The story *(in my head) opens up with the MC trying to save the life of a patient that has had a stroke. I just want that opening scene to be authentic and not just a generic scene that I made up.

To answer your question, GK, the patient is loved. He hasn't been ignored by his family. I think I have enough to start. I'll write it and I'm sure during the editing of the story, I'll have a better grasp of it all.
 

GeorgeK

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You probably should look up things like coma scores. A trained physician should be able to 85% of the time make the correct diagnosis just on history and physical exam. The tests come in for finding curve balls or just confirming the diagnosis.