‘ROSIER?’ Harry asked. Recognition of Stroke in the Emergency Room was a standard protocol.
She nodded. ‘His score pretty much confirms it’s a stroke. I checked ABCD2 as well, and the good news is that his score is nil on the D—he’s not diabetic. His blood sugar is fine.’
Harry picked up immediately what she was telling him—there was only one section of the test with a nil score. ‘So the rest of it’s a full house?’
‘I’m afraid so,’ she said. ‘He’s over sixty, he has high blood pressure and residual weakness on his left side, and the incident happened over an hour ago now.’
‘Which puts him at higher risk of having a second stroke in the next two days,’ Harry said. ‘OK. Does he live on his own, or is he in any kind of residential care?’
‘He has a flat where there’s a warden on duty three days a week, and a care team comes in three times a day to sort out his meals and medication,’ Isla told him. ‘They’re the ones who called the ambulance for him this morning.’
‘So if he did have a second stroke and the warden wasn’t on duty or it happened between the care team’s visits, the chances are he wouldn’t be found for a few hours, or maybe not even overnight.’ Harry wrinkled his nose. ‘I’m really not happy with that. I think we need to admit him to the acute unit for the next couple of days, so we can keep an eye on him.’
‘I agree with you. His speech is a little bit slurred and I’m not happy about his ability to swallow,’ Isla added. ‘He said he was thirsty and I gave him a couple of sips of water, but I’d recommend putting him on a drip to prevent dehydration, and keep him nil by mouth for the next two or three hours. Nobody’s going to be able to sit with him while he drinks and then for a few minutes afterwards to make sure he’s OK—there just won’t be the time.’
‘Good points, and noted.’
Mr Kemp was sitting on a bed, waiting to be seen.
Isla introduced him quickly. ‘Mr Kemp, this is Dr Gardiner.’
‘Everyone calls me Harry,’ Harry said with a smile. ‘So can you tell me about what happened this morning, Mr Kemp?’
‘I had a bit of a headache, then I tripped and fell and I couldn’t get up again,’ Mr Kemp said. ‘My carer found me when she came in to give me my tablets and my breakfast.’
Isla noticed that Harry sat on the chair and held the old man’s hand, encouraging him to talk. He was kind and waited for an answer, rather than rushing the patient or pressuring him to stop rambling and hurry up. Lorraine had been spot on about his skills as a doctor, she thought. ‘Can you remember, either before or after you fell, did you black out at all?’ Harry asked. ‘Or did you hit your head?’
Arthur looked confused. ‘I’m not sure. I don’t think I blacked out and I don’t remember hitting my head. It’s hard to say.’ He grimaced. ‘Sorry, Doctor. I’m not much use. My daughter’s husband says I’m an old fool.’
So there were family tensions, too. The chances were, if they suggested that he went to stay with his family for a few days, the answer would be no—even if they had the room to let the old man stay. ‘Don’t worry, it’s fine,’ Harry reassured him. ‘I’m just going to do a couple of checks now to see how you’re doing. Is that OK?’
‘Yes, Doctor. And I’m sorry I’m such a nuisance.’
Either the old man was used to being made to feel as if he was a problem, or he was habitually anxious. Or maybe a bit of both, Harry thought. He checked Mr Kemp’s visual fields and encouraged him to raise his arms; the residual weakness on Mr Kemp’s left side that Isla had mentioned early was very clear. And there was a walking frame next to the bed, he noticed. ‘Do you normally walk with a frame?’
‘Yes, though I hate the wretched thing.’ Arthur grimaced. ‘It always trips me up. It did that this morning. That’s why I fell. Useless thing.’
Harry guessed that Mr Kemp did what a lot of elderly people did with a walking frame—he lifted it and carried it a couple of centimetres above the ground, rather than leaving the feet on the floor and pushing it along and letting it support him. Maybe he could arrange some support to help the old man use the frame properly, so it helped him rather than hindered him.
‘Can you see if you can walk a little bit with me?’ he asked.
He helped Mr Kemp to his feet, then walked into the corridor with him, encouraged him to turn round and then walk back to the cubicle. Harry noticed that his patient was shuffling. He was also leaning slightly to the left—the same as when he was sitting up—and leaning back slightly when he walked. Harry would need to put that on Mr Kemp’s notes to be passed on to any carers, so they could help guide him with a hand resting just behind his back, and stop him as soon as he started shuffling and encourage him to take bigger steps.
Once Mr Kemp was seated safely again, Harry said, ‘I’m going to send you for an MRI scan, because you had a headache and I want to rule out anything nasty, but I think Sister McKenna here is right and you’ve had a small stroke.’
‘A stroke?’ Arthur looked as if he couldn’t quite take it in. ‘How could I have had a stroke?’
‘The most likely cause is a blood clot that stopped the blood supply to your brain for a little while,’ Harry explained. ‘It should be cleared by now because you’re able to walk and talk and move your arms, but I’m going to admit you to the acute medical unit so we can keep an eye on you for a day or two.’ He decided not to tell Mr Kemp that his risk of a second stroke was higher over the next day or two; there was no point in worrying the poor man sick. Though his family would definitely need to know. ‘Has anyone been in touch with your family?’
‘Sharon, my carer—she should have rung my daughter, but Becky’ll be at work and won’t be able to come right away.’ He grimaced. ‘I feel bad about taking her away from her job. Her work is so important.’
‘And I bet she’ll think her dad is just as important as her job,’ Isla said reassuringly.
‘Too right,’ Harry said. Even though he didn’t quite feel that about his own father. Then again, Bertie Gardiner was more than capable of looking after himself—that, or his wife-to-be Trixie, who was a couple of years younger than Harry, could look out for him.
He shook himself. Not now. He wasn’t going to think about the upcoming wedding. Or the fact that his father was still trying to talk him into being his best man, and Harry had done that job twice already—did he really need to do it all over again for his father’s seventh wedding? ‘We’ll have had your scan done by the time your daughter comes to see you,’ Harry said, ‘and we’ll be able to give her a better idea of your treatment plan.’
‘Treatment?’ Mr Kemp asked.
‘The stroke has affected your left side, so you’ll need a little bit of help from a physiotherapist to get you back to how you were before the stroke,’ Harry said. ‘I’m also going to write you up for some medication which you can take after your scan.’
‘Is there anything you’d like to ask us?’ Isla asked.
‘Well, I’d really like a nice cup of tea,’ Mr Kemp said wistfully. ‘If it wouldn’t
