Tales From the Emergency Room: Dr. Kenneth Doroski, Brandywine Hospital
For this year's Top Doctors, we turned to emergency room doctors to share their stories of adrenaline, patience and grace under fire.
Coma. That’s what Dr. Kenneth Doroski thought when he saw the patient lying on the gurney. The patient’s wife told Doroski that she’d gotten up first that morning and was bustling around the house when she heard a loud thud. She ran into the bedroom and found her husband lying on the floor. He couldn’t move or talk, and she couldn’t tell the paramedics what had happened.
The man was in his 50s and in good health; he didn’t have any chronic illnesses. The EMT squad told Doroski the patient’s vitals were stable and there were no signs of injury. He looked perfectly fine—except that he was paralyzed and appeared to be brain dead.
But the patient’s eyes were open. “Then I had this strange thought—a memory of a case I’d seen years earlier,” Doroski says. “I asked the patient to blink twice if he could understand me. And he did.”
Locked-in syndrome is an extremely rare, massive stroke that affects the section of the brain that controls the nerve fibers for every muscle in the body, except the eyes. “That part of the brain is supplied by one artery, and if it gets clogged, the patient cannot move,” says Doroski. “The patient’s consciousness is locked inside his body. He can hear, see and understand everything that’s happening, but he can’t respond. His only form of communication is through his eyes.”
Doroski had seen only one other case of locked-in syndrome. The patient ended up paralyzed and mute, living out his days in a nursing home. That’s because there wasn’t any specific medication to reverse the stroke’s effects.
But Doroski thought there was one thing that had a fair chance of working: TPA, then a new, clot-busting drug that was just starting to be used on stroke patients. The side effects of TPA were still being studied, however, and some had proven severe. One thing was known: TPA had to be administered within 180 minutes of the stroke, so time was of the essence. If they were going to try it, they had to act quickly.
The patient blinked twice: Yes, he understood the risk and, yes, he wanted to be treated with TPA. Technically, though, his wife had to make the decision for him. “It really came down to one thing,” says Doroski. “I said, ‘Would he want to live this way, or would he want to take this risk?’”
She allowed Doroski to administer the TPA … and then they waited. It could take a week, a month or a year. This time, it took only days. The patient began moving his fingers, then his hands, and the rest of his body followed. He made a complete recovery and was released from the hospital with a clean bill of health. “Four weeks later, he walked into the emergency department to thank me,” Doroski remembers. “And I couldn’t believe it was the same guy who, just a month prior, had been paralyzed.”