Rehab potential

I was treating a dense stroke patient on my neuro prac who has a long-standing large basilar artery aneurysm. Prior to this hospital admission, the patient had already had 2 strokes because of this aneurysm, as it kept expanding and compressing various structures eg brainstem. He had been in hospital approximately 3 weeks and rehab was going quite well (a referral to a rehab facility had just been made), when he had a 4th stroke- leaving him with almost no movement on his right side.

Rehab was coming along quite slowly, he was gradually getting some small amount of movement back in his right leg, and to a lesser degree, right arm. His sitting balance was definitely improving and we were eventually able to stand him with 2 MAX assist (the patient weighed 140kg!) and he could stand statically for about 3 mins max.

Anyway the discussion of discharge planning came up and the medical team was left with the following dilemma: due to the nature of this large aneurysm (which is inoperable) and his PMH, the sad reality is that this aneurysm will eventually be fatal, it could be days or it could be years- no one can ever know. The question posed to the medical team and the patient was- do we send him to a rehab facility for long-term rehab, knowing that he could have another massive and possibly fatal stroke at any minute?

Thankfully and rightfully, the decision was left entirely with the patient. He had to weigh up whether or not he wished to spend (potentially) several months in a rehab facility going through intensive rehab or whether he wished to spend his time closer to his family in a high care facility or with services at home. In the end he chose to go to a rehab facility.

The reason I brought up this particular scenario is that I'm sure it is not an entirely uncommon situation for terminal patient's to be in. The patient should be aware of all the facts and options, and then left to make their decision on their own. As health professionals we are used to giving patient's advice wherever possible, but in this particular situation I think it is actually better to keep our opinions to ourselves and let the patient make up their mind- then support the patient's decision, whatever it may be. Having come across this particular situation I think I will now have more empathy and understanding if faced with something similar in the future.