Young Women Have Strokes
Suppose you received a call in the middle of the night from a stranger identifying himself as “Dr. Goodhart” who informed you that your 19-year-old daughter had just had a heart attack?
I went through that horrible experience one bleary-eyed night long ago when I was a young medical resident.
Thinking back, I wonder how implausible I must have sounded to that poor father, who was hundreds of miles away and had probably been sleeping peacefully when my phone call jolted him back to reality. As it turned out my patient eventually died, but I had promptly made the correct diagnosis and she had received the best care for heart-attack patients available in the early 70’s.
Perhaps doctors at Central DuPage Hospital in Illinois were similarly tired and overworked when 24-year-old Samantha Medina arrived on December 10, 2006 complaining of a sudden headache and numbness on her right side.
Although understandable, what subsequently happened was not excusable. Samantha had suffered a stroke and ultimately died. Her husband, Chris, alleged in a lawsuit that if Samantha had been diagnosed promptly and treated properly, she would have survived.
Although the doctors and hospital have denied wrongdoing, on August 26, 2010, they settled with Chris for $5.3 million. Like I’ve always said, defendants don't pay large sums to settle frivolous lawsuits.
Before the late 1990’s, it would not have mattered much whether Samantha’s stroke had been diagnosed quickly. By then, however, doctors were using Tissue Plasminogen Activator (tPA) regularly to treat the main class of stroke patients, although tPA had been used experimentally since the 80’s.
tPA is a “clot buster” that dissolves the blood-flow obstruction to the brain, which is the underlying cause of most strokes. But, tPA has to be given quickly after stroke symptoms begin, or it has no effect at all.
The American College of Emergency Physicians recommends tPA only if less than three hours has elapsed from symptom onset. A study of another clot buster suggested a longer time window, but time is of the essence, no matter what.
Today my long-ago patient would have received tPA or even an emergency stent and, I suspect, she would have survived. But, she would not survive unless some doctor thought about the possibility of a young woman having a heart attack and ordered the right tests and treatment. In Samantha's case, it sounds to me like someone didn't think that young women also occasionally have strokes.