Help required urgently

[Ilse_Maria]

Somebody please help me.
My grandmother (77yrs) has been an active lady all her life - for example last wednesday (16th August 2000) she was walking happily along the promenade and driving her car. However, during the night of wednesday 16th August she thought she felt the hand of her late husband on her stomach. (We realise now that she had suffered a mild stroke and it was actually her own hand she felt). On thursday morning when we realised granny had a problem we took her to the hospital. We were told that she had suffered a mild stroke and that she would have to stay in hospital for a day or two. Granny's left side had been paralysed and her speech was a little bit slurred but she could speak and understand everything that was going on around her, so we all thought she would be okay. Granny's condition was the same throughout all day thursday and we believed she would be okay that night, so we all left the hospital that night. During the night at around 4am Granny suffered another stroke and went into a coma. Since then she has been in a deep coma and has not moved at all, however yesterday afternoon (Saturday 19th August) my aunt told granny that one of her sons had arrived from America to see her and at this point granny stopped breathing suddenly for quite a few seconds, as if she had heard and understood. Her blood pressure dropped earlier today. We are desperate to help granny now, but we don't know what to do. Please can somebody help. The doctors have told us that if granny wakes up she will not be able to move at all, she won't be able to speak or swallow and they have asked for us to agree that granny will not be resuscitated if the opportunity arises. Is there anything we can do to help granny now? Please, if anybody knows anything that can be done to help, contact me as soon as possible, as time is of the essence in this matter.
My e-mail address is ***@****
Thank you.

[CCF Neuro[P] MD, RPS]

Dear Ilse-Maria:

I am so very sorry to hear about your grandmother.  I think that the best thing you and your family can do is to sit down with the physicians and find out exactly what type of stroke, where it is located and how large it is, how much brain insult occurred, was it ischemia or a hemorrhage, etiology of the stroke, and the prognosis and degree of recovery.  The physicians who are taking care of your grandmother know the condition and medical state best and should be able to tell you the answers to most of the above questions.  Based on the answers, knowing your grandmother's wishes for the type of life she would like to live, you can begin to sort out the answers to what type of care to give her.  Without knowing the details of the case, there is no physician who can answer the questions you pose.

The type of stoke, either hemorrhagic (bleeding into the brain) or ischemic (embolism or thrombosis that has compromised oxygenation to part of the brain) and the location of the event can give a good idea concerning outcome.  The etiology of the event, whether it is heart arrhythmia, athrosclerosis, high blood pressure, aneurysm bleed, etc will determined what type of treatment is needed now and if there is recovery.  The part of the brain injured is important because certain parts of the brain control basic functions such as breathing, swallowing, eye sight, thinking skills, etc and if the more important brain areas are damaged, this will reflect on what type of recovery and rehab is needed or possible.  All this should be discussed with your neurologist/neurosurgeon.

I am sorry that I can't give you more information, but without knowing more of the details it is impossible.  I hope the best for your grandmother and your family.  Again, I am sorry this happened.

Sincerely,

CCF Neuro MD

[Judy - Follow-up question]

My heart goes out to you.

I don't have any specific information, but always a second opinion by a neurologist is in order when you are considering a "do not resuscitate order". A different neurologist may have specific ideas that may help. If not, ensure you understand why she has no hope of recovery. Ask many questions. Make sure you feel comfortable and understand the reasons for whatever decision you and your family make. Remember to look at the situation from Granny's perspective as well. Does Granny have a living will which specifies the actions she desires be taken in such a situation? My mother specified a "do not resuscitate" under certain conditions. We respected her wishes.

Best wishes.