Ralph - Interview 60

Age at interview: 69
Age at diagnosis: 66

Brief outline: One morning Ralph awoke to feelings of pins and needles in his arm and leg. Recognising that there was a problem, he immediately called NHS Direct. Ralph was happy with the quick response, but felt that things fell apart afterward. Since he lived alone and had no social support network (i.e., family to call), he discharged himself from the hospital.

Background: Ralph is 69, retired, and resides at home on his own. He experienced his stroke three years prior at age 66. His ethnic background is White British.

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Ralph is 69, retired (unwillingly as a result of his stroke), and resides at home on his own. He experienced his stroke three years prior at age 66. The day before his stroke he described feeling a bit wobbly in the shops. He returned home, had dinner, and went to bed early. He woke up the next morning with ‘pins and needles’ in one arm and leg. Immediately recognising that something was wrong, he contacted NHS direct. He was informed by the dispatcher that he had likely had a stroke and that an ambulance would arrive shortly. The ambulance arrived quickly and whisked him off to A&E. Ralph was impressed with the quick response and recognition of his stroke by multiple parties, but noted that his care immediately fell apart afterwards. He remained in A&E for some time before receiving any treatment. He eventually transitioned to the Stroke Ward, and later to a rehabilitation unit, where the care was no different than the other hospital units, (besides the presence of other stroke patients). He was surprised by the poor diet and lack of rehabilitation.
Ralph has no other health conditions, and was surprised by his stroke given his healthy lifestyle, fairly optimal weight, no other known risk factors (besides occurrence in his family), and was not aware of the significance of a genetic link. There was no mention of risk at previous GP appointments.
Ralph had no family or friends available to do instrumental tasks (e.g., pay bills, shop, laundry, etc.) and was unable to get formal support for these activities (e.g., social worker could not go inside of his home without him present or handle money) while he was in hospital. Due to growing angst about the things that had to be done at home, he discharged himself from hospital. He felt unsupported after doing so, and the efforts that were put forward by the formal care system were not in line with his needs. For example, he was given an attendant wheelchair which could not be used as he had no one to assist, and was offered laundry services which he refused as he already had something in place. From this, it was misinterpreted that he did not want any care. In addition to physical and instrumental needs, he experienced feelings of depression, thoughts of suicide, and changes in emotion; thus counselling and emotional support would have been extremely helpful.
Despite his functional limitations (e.g., use of only one arm and limited mobility), Ralph navigated on his own, and through trial and error, found a community swimming program aimed for people with disabilities which he rated highly. Other community based programs were inaccessible due to lengthy modes of transportation and timing.
Ralph feels that there is much room for improvement including widespread education about risk factors and prevention of stroke, better supported discharge plans (in general and especially for individuals who discharge themselves), and education about medication (side effects and how to take them). Also required is recognition that not everyone has a social support network to tap into. Active rehabilitation, counselling, and support with tasks in the home (e.g., making meals) is required, and in his case, would have been helpful.



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