SEVERE STROKE: Identifying Palliative Care Needs in the Neurological ICU
Goals of the project include: 1. To become a national leader in palliative care for patients with stroke and acute brain injury. 2. To explore best methods to enable early recognition and management of the needs of patients with severe stroke and their families. 3. To develop clinical and educational tools and educate neurologists and palliative care specialists about the palliative care needs of patients with severe stroke. 4) To develop and test quality improvement tools for stroke. 5) To disseminate educational material, resources and tools nationally through publications, presentations and webinars.
I knew that a cure would be unlikely for most of my patients, I also know that having no cure is far from being unable to help them. This was the kind of challenge I wanted to face; I was determined to become a Neurologist clinician-investigator.
One of my patients, B.Z., was 58 when he experienced a large left middle-cerebral-artery ischemic stroke…. with brain swelling in an effort to keep him a live part of his skull was removed…. Two years later he is living at home with his wife: we walks short distances with a cane and has started to verbalize a little. He says “no” “yes” and “honey.” Today B.Z and his wife look back at the two years of hard work, several throwbacks and life and death decisions regarding a future with persistent pain, hardship and little change to ever speak full sentences again, let alone live independently . But to them, every step in his management, every intervention and each aggressive measure was worth it because it helped him survive. He is able to interact with his loved ones. Another patient in the same situation may not have wanted to go down this path. Our challenge is to help individual patients and their families identify their own goals of care and then match the care provided to those goals.