I was back at St. D's and the signal event of the day was a medicine hack coming down to tell me about the guy I gave TPA to. He bled horribly into his brain. Argghhhh! Of course I found myself second guessing my decision and worrying over the medico-legal issues. Even though I think it was the only right thing to do, and even though I'm certain it fits the decribed standard of care, its demoralizing as hell to have a bad outcome. As for a lawsuit--what can be done? This meat head medcine doc was ;ecturing me on not giving TPA. Her reasoning was spurious, unsupported by the literature, and basically rooted in fear. But nevertheless she felt quite comfortable telling em to never give TPA again--not without a neurologist and a neurosurgeon on staff. What neurologists and neurosurgeons have to do with the desperate 3 hour window of action is unclear. She just wanted to have someone else on hand to tell her what to do--she's lost without her consults. I didn't punch her in the nose for her unwanted advice, but I certainly considered it. U-561