This was an ethical problem with a simple solution.

If you have a patient who's been a heavy drinker and heavy smoker (like five 40-ouncers and a couple packs a day) since their teens, and they're now in their 60's, and they live with family members who are unlikely to stop smoking and drinking just to keep them healthy, and they also live in a food desert and have multiple comorbidities and things generally suck, it is not a dereliction of duty not to suggest that they get their carotid arteries Roto-Rooted in order to restore blood flow to their brain after a minor stroke.

Especially since no amount of improved blood flow is going to repair the damage caused by forty years of vascular dementia. You could've driven a truck through this guy's sulci. I mean, seriously. There was so little working brain tissue in his skull it would've been a crime to reperfuse it.

So we sent him home on blood pressure medicine that he won't take, and aspirin that he won't take, and comforted ourselves with the knowledge that, had we done everything in our power to make him better, he would've been nickel-and-dimed to death with tiny strokes. This way, what with the drinking and smoking and high-fat food, he'll likely have one huge stroke and that'll be it.


In response to a question below in the comments on the last post: Where I come from, "CCU" means "Critical Care Unit." It's the same as an ICU. NCCU, therefore, is Neurological Critical Care, whereas NSCCU is NeuroSurgical Critical Care. There is no difference, just as there is no difference between an LVN and an LPN--they're both skilled nurses who aren't allowed to hang blood in this state. The difference in terminology is a conceit of the facility, nothing more.

And with that I'm going to go eat junk food and fall down for a couple of days.