TIA

Today I was working at an extended care facility and I had an interesting experience. One of my patients, a chipper old man with a nice smile, was missing from the dining room around lunch time. Normally I would've waited a while for him to appear, but I thought, why not, I'll go look for him. I took his lunch pills and walked down the long hallway to his room. As I entered I saw him sitting sleeping in his wheelchair, hunched over a little. I came up and called his name, touching his shoulder.
No response. Suddenly I noticed that his skin was pale white and he had the sheen of sweat on his entire head, neck and arms. I put down my things and called his name louder, squatting down in front of him to see in his face. He opened his eyes halfway and barely acknowledged me. I knew he was diabetic, and running through my mind was the possible diagnosis of low blood sugar.
"How do you feel?" I asked him, hands on his knees.
"Not..... good." He barely got out.
"I'll be right back." I told him.
We were at the end of a long hallway and I knew all the other nurses and aides were busy in the dining room and no one would hear me call. I ran down to the nursing station, grabbed the glucose testing kit, a cup of apple juice, and on the spur of the moment, a thermometer, stethoscope and blood pressure machine. I briefly told another nurse what I was doing and I ran back to his room. He was almost slipping out of his chair. I whipped out the glucometer and checked his blood sugar. Normal.
A care aide came in and I said to her, "We have to get him lying down right now."
He was barely breathing. I felt for a pulse but couldn't find one. We pivoted him into bed, laying him down on the mattress.
"He already had a mini TIA last week." The care aide told me. "I'll go get oxygen."
TIA, or transient ischemic attack, is a mini stroke in the brain. I took his temperature, it was way too low. His blood pressure was slipping and I still couldn't find a pulse. His breathing was shallow and for a second I thought he'd stopped all together. The other nurse came in, she'd called 911 and the ambulance was on their way.
"He's had 6 heart attacks," she said, "and several TIA's."
We didn't have the equipment for a cardiac arrest on that ward, so he would need to be transported. We got the oxygen on, assessed him, and I found a pulse, but it was too thready to count, even with my stethoscope.
"I'll go grab his chart for the paramedics." The nurse said. "Someone needs to stay with him."
And suddenly I found myself alone with this semi-comatose man. I was leaning over him, one hand on his wrist and talking softly to him. What if he arrested right then and there? I know I've been a nurse for a while and seen lots of stuff, but I've never done CPR on anyone before. What if he was a DNR (do not resuscitate)? Should I start CPR on him anyway, because I wasn't sure?
I looked down and around his neck was a golden crucifix.
"Are you Catholic?" I answered, and his mouth moved in the shape of yes under the oxygen mask. "Would you like me to pray with you?" I asked.
"Oh, please!" He said.
So I held his hand and recited the Lord's prayer. I wished I knew more catholic prayers, but I didn't, so then I just prayed the words that came from my heart.
The paramedics came and I stayed with them awhile and they took him away on a stretcher.
Afterwards as I was sitting in the nursing station charting, the nursing supervisor stopped by to ask me about him. I explained what had happened, feeling rather good about my complete assessment, and she asked if it was another TIA.
"I think it was cardiac." I explained. "You know he has a history of heart attacks."
She didn't say much and after she left I thought a bit more about it. What was I thinking? Of course it was a TIA, not a heart problem. He may have been showing signs and symptoms of an impending heart attack, but he was missing the one glaringly obvious one: pain.
His complicated history of anemia, diabetes and congestive heart failure made it difficult to determine what was causing what symptoms, but he hadn't complained of any pain or tightness in his chest when I'd asked him.
I had to call his family and explain what had happened. They were upset, understandably, and asked me questions about what had happened. I explained about TIA's and assured them he was getting the best care possible. I got off the phone and thought, it's a good thing you weren't the doctor here today Heather, because you would have screwed up.
Sometimes I forget myself. I forget that I'm just a beginner. While I do know quite a bit because I'm already a nurse, there is so much that I don't know. I haven't been trained to diagnose yet, and I'm obviously not an authority on heart disease OR stroke. It's a good reminder that I need to be humble..... as humble as I can, because when I open my mouth, someone's life may be on the line.