A Change of Course: The Case for a Neurorecovery Clinic

NCJ_cover.jpgBy Matthew N. Jaffa, Jamie E. Podell & Melissa Motta

First Online: 24 April 2020

Everyday during neurocritical care rounds, we find ourselves obsessing over dips in sodium, liquid stool, and whether a urinary catheter is truly indicated. We scrutinize minutiae with the goal of keeping those teetering on the edge, alive. The long-term implications of the patient’s brain injury are often left for whispered conversations or private contemplation, when we question whether our patient will ever be the person he once was. During family meetings, we describe in broad strokes the natural history of the patient’s disease and potential outcomes. Often these conversations end with a discussion about goals of care (GoC) and questions posed to families—“If your loved one was able to make decisions; how would he want us to move forward? What amount of disability would be acceptable to her? In light of this, often uncertain, prognosis and potential for recovery, would they choose a medically-aggressive restorative path or ask to focus solely on comfort?”

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