Ma’am I think you did the right thing. I had to intubate your husband because he came in in acute complete respiratory failure and sepsis. His premorbid condition as you know was horrible. He had cancer and was bedridden.
Your decision to have me extubate him and to make him palliative care only is what I would have done were he my loved one. He died comfortably and with dignity. I just wish more people were given that opportunity.

So, as you may have gathered from previous posts, I am not a huge fan of TPA in many cases of acute stroke for a whole variety of reasons – however, one of the biggest ones is that so many people that have acute strokes are ancient. Anyone I see with a stroke under age 80 is effectively an infant (and much more deserving of TPA in my opinion owing to lower incidence of side effects, etc) in my ER. Generally in those super old people with stokes there is underlying dementia and serious difficulty in ascertaining the onset of symptoms. However, once and a while you have a fairly straightforward story and exam and solid evidence of time of onset. However, even in those cases, when you are over 90, there is a real chance of bad outcome (bleeding, etc) so I always grit my teeth when we push the clot-busting juice. Even if these folks don’t bleed, it’s pretty uncommon for me to hear about, let alone see significant improvement of symptoms.

The other day was different however. We pushed TPA on a 92 year old fully functional guy within 2 hours of onset of symptoms and BAM !, he started improving during the 2 hours he waited for an ICU bed. His aphasia improved and he lost his facial droop. For once I felt good about the decision to give it in people born before WWI. Time will tell how he does over the next few days to weeks though.

So, I often blog about drug seekers (all ER bloggers do) and recently our new state narcotic database has become a formidable weapon in our armamentarium against them.
However, just as importantly, it can help people. For example, perhaps your personality is kinda whiny. Maybe you are melodramatic or demanding. If you have these attributes, you are likely to be looked at with a quizzical eye when you come in screaming for pain meds, especially when there is nothing obvious going on and your work up is negative.
A quick look on the database can show us that you haven’t had any narc prescriptions for the last year, thereby verifying your story. Of course you could have gone to another state for them of you could be buying them on the street but I’ll give you the benefit of the doubt and chalk up your screaming, swooning, and drama to the unfortunate personality you were born with.