Recognizing stroke warning signs in an ESL patient

Recognizing stroke warning signs in an ESL patient
Recognizing stroke warning signs in an ESL patient

I have the privilege of working with patients of different cultural backgrounds, which can be both rewarding and challenging. The patient population I serve consists of many nonnative English speakers, who are often difficult to understand because of both their accents and the way in which their concerns are presented.

In this instance, a 40-year-old Southeast Asian woman presented to my office saying that she didn't feel well.

"I have fire in this side," she said, pointing to the right side of her head. "And winter in this side."

She pointed to the left side of her head.

The patient had a history of hypertension, for which she had been taking medications on and off for four years. Her neurological exam was normal, and she had a BP of 170/140 mmHg.

I remembered it had been difficult explaining to the patient why she should take medication every day, if she was feeling fine. She had pre-eclampsia during a pregnancy four years earlier and had taken medications at that time, but had stopped taking her meds again.

I slowed down. Putting together all the pieces and listening beyond the words, I realized she was telling me that she was having a stroke.

I called the ER, told them the situation and that the patient was coming in STAT. I didn't call an ambulance as the hospital was closer than the ambulance station. I knew her husband could get her to the hospital faster than the ambulance. Looking back, this was risky medical legally but I felt it was in the best interest of the patient.

The ER was ready for her, because I had called ahead and given the patient's history to the attending physician. Fortunately, at this hospital patients do not have to come in by ambulance to be considered an emergency. The ER clinicians scanned her head immediately, found a pontine hemorrhage and admitted her in the ICU within 40 minutes.

This patient emerged from the stroke with no sequelae and is now fastidious about managing her BP. She went on to have a successful pregnancy the next year.

I can't say exactly what helped me understand what "fire on this side and winter on the other side" meant. But I am sure I was able to figure it out, because I had such a long relationship with this patient. What a privilege it is to be able to practice medicine in a close-knit community, where getting to know patients can make a big difference in the delivery of health care.

Lucy Judson, PA-C, is from Boulder, Colo.

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