I have officially been a doctor about... oh... one and twelve thirteenths years now. Around the one and seven thirteenth mark I came to a realization about my job that although not particularly revolutionary is still remarkable. That is: there is no escaping the crazy and the boring. No matter what path I decide to take in medicine I will always have patients that are loony toony or just dull, tedious, and boring. For a while I had had reservations about pursuing a career in infectious disease due to the tendency for infectious disease docs to be the antibiotic monkeys of the orthopedic surgeons -- resulting often in clinic visits with nothing more than a demented patient, a handful of illegible nursing notes, and a PICC line -- but now I know we all got our burdens to bear.
This realization came during my neurology rotation. Although I already knew neurology to be full of the dull, tedious, and boring I was caught off guard by the amount of crazy. Where as rheumatologists have fibromyalgia, endocrinologists have "hypoglycemia", cardiologists have "chest pain", and allergists have their entire careers, neurologists have pseudoseizures. Pseudoseizures, for those not in the know, are seizures that aren't really there. Hence the prefix pseudo-. The more politically correct term currently is "psychogenic non-epileptic seizure" but I imagine this will be the case only as long as it takes people to realize "psychogenic" means "full of crap." In every case people twist and turn, writhe and shake, hop and bounce all convinced they're having a seizure when, in reality, they've just got a case of ants in the pants.
The reason pseudoseizures are such a pain is both because of the high incidence of personality disorders associated with them and the requirement of a 72 hour sleep deprivation study to diagnose them. Regular seizures are hard to provoke but it turns out not letting someone sleep for a long time is a pretty good way to do it. It is also unfortunately a pretty good way to make a healthy but ornery person into a healthy but fairly irrational and agitated person as well. The purpose of the study is to capture on video and electroencephalogram (EEG) a purported seizure. Comparing their movements and brain waves gives a nearly infallible assessment of whether the seizure is genuine or not. Although some people can fake seizures with the best of 'em, it turns out it is hard to fake an EEG.
Thankfully, amongst all the painful explaining that all the Depakote in the world won't stop you from having the seizures you aren't having, there are the lighter moments. Specifically, when the patients are *not* good at faking seizures. During my month on the neurology service there was all kinds of wackiness but the best "seizures" of the month were memorable. Runner up went to lady who back flipped off the hospital bed while first prize went to young dude who did some sort of fully upright hokey pokey. In the words of a colleague, "that's not a seizure. That's a dance move." I am sure people with pseudoseizures have great struggles both with their condition and in life, but, man, if you're was going to fake a disease at least take some disease faking classes first. Or go with psychotic parasitosis. Prove to me I don't have parasites!
Showing posts with label patient. Show all posts
Showing posts with label patient. Show all posts
Sunday, June 27, 2010
Monday, June 29, 2009
Welcome to the Circus
For my final act of intern year, a grand menagerie! A collection of things that shouldn't be; a hospital of patients that are not sick! Gather one, gather all to the myth, the mystery, the *greatest* show in history; the last month of inpatient Internal Medicine as an intern!
The Man Without Symptoms!
Straight from Bavaria and to our show exclusively, the man without symptoms! Not a single complaint. Not a single problem. Flawless, painless, soreless and completely disease free; solely in need of a complicated CT scan available only in our very own military institution! Watch as he is not only hospitalized, anesthetized, dialyzed, and lesion localized, but also canonized, exorcised, and cannibalized all over the course of a three day hospital stay. The man has no business being here but because no expense is too small and no admission to the hospital too trivial we will admit him for your viewing satisfaction anyway!
The Respiratorical Horror That Wasn't!
Also for your exclusive entertainment a man so sick, so ill, so reportedly toxic and pernicious, you'll be surprised to hear it's *all* fictitious; the man with a COPD exacerbation so stable it's exasperating! His symptoms are at baseline. His oxygen requirement is unchanged. His breathing is unlabored. He looks altogether all too good; but for a limited time only he will be admitted directly from clinic to receive the same care he'd of received at home!
The Woman that Communes with Spirits!
Next. Born with a terrible gift. A young woman scourged by the Almighty with a supernatural talent lain dormant for centuries. Our very own telegraph to another world. The Woman that Communes with Orthopedic Surgeons! She will be brought to the hospital for reasons unworldly, her care will guided by voices emanating from the very ether, and her entire stay will be determined by a presence heard but never seen! Truly, lads, you have not lived until you have communicated with those not living! Commune with the orthopods for just one shilling! *Never* has health care been so thrilling!
The Amazing Record Player Woman!
Imagine now madams and gents: every day the same thing, every day the same thing, every day the same thing. The next poor woman is bound by an inescapable cosmic cycle to call the police weekly raving of impending robbery at the hands of her neighbors. She is captured in an unbreakable celestial loop to be brought to the hospital on a seven day circuit to be treated for the exact same dementia. She will see exactly the same physicians. Decline exactly the same tests. And be discharged to exactly the same home exactly the same way every time; just like clockwork! It's a rotation so accurate you can mark your calendar by it -- I kid you not! And you're in luck with this one, folks, because if you miss this week's show just come back next week for the encore!
The Phantom Fibrillation!
And if that wasn't enough, friends, gather closer as I speak to you of a phenomenon that some say doesn't exist. A phantasm that materializes only to vanish seconds later. A cardiac conduction abnormality that few have ever seen! The Phantom Fibrillation! The poor bearer of this accursed arrhythmic spirit -- a gentleman from our very own town -- is forced to walk the Earth waiting for his next atrial possession. Come awe at the reports from the ER of his shortness of breath. Then astonish as the same ER reports him to be symptom free! And finally astound as we admit to monitor him, test him, and pursue a workup that could just as easily be done at the cardiac clinic anyway! Now we cannot guarantee that the specters will present themselves, but we *can* guarantee that if they do it will be an event you will not want to miss!
The Golden Crap!
But that's not all. No that's not all at all, folks. Don't even think about it -- not a bit! Our very last act -- our very last sensation, the topic of tomorrow's conversation, an aberration of constipation; ladies and gentleman I present to you the Golden Crap! The man has not pooed for days, some say months, possibly even years! Many have tried to disimpact him but some say he is undisimpactable. He will come into the hospital for one day and one day only to have what many believe will be the most expensive bowel movement ever!
(And cue curtain.)
In conclusion: sometimes my life is like a circus. But with less funnel cake.
The Man Without Symptoms!
Straight from Bavaria and to our show exclusively, the man without symptoms! Not a single complaint. Not a single problem. Flawless, painless, soreless and completely disease free; solely in need of a complicated CT scan available only in our very own military institution! Watch as he is not only hospitalized, anesthetized, dialyzed, and lesion localized, but also canonized, exorcised, and cannibalized all over the course of a three day hospital stay. The man has no business being here but because no expense is too small and no admission to the hospital too trivial we will admit him for your viewing satisfaction anyway!
The Respiratorical Horror That Wasn't!
Also for your exclusive entertainment a man so sick, so ill, so reportedly toxic and pernicious, you'll be surprised to hear it's *all* fictitious; the man with a COPD exacerbation so stable it's exasperating! His symptoms are at baseline. His oxygen requirement is unchanged. His breathing is unlabored. He looks altogether all too good; but for a limited time only he will be admitted directly from clinic to receive the same care he'd of received at home!
The Woman that Communes with Spirits!
Next. Born with a terrible gift. A young woman scourged by the Almighty with a supernatural talent lain dormant for centuries. Our very own telegraph to another world. The Woman that Communes with Orthopedic Surgeons! She will be brought to the hospital for reasons unworldly, her care will guided by voices emanating from the very ether, and her entire stay will be determined by a presence heard but never seen! Truly, lads, you have not lived until you have communicated with those not living! Commune with the orthopods for just one shilling! *Never* has health care been so thrilling!
The Amazing Record Player Woman!
Imagine now madams and gents: every day the same thing, every day the same thing, every day the same thing. The next poor woman is bound by an inescapable cosmic cycle to call the police weekly raving of impending robbery at the hands of her neighbors. She is captured in an unbreakable celestial loop to be brought to the hospital on a seven day circuit to be treated for the exact same dementia. She will see exactly the same physicians. Decline exactly the same tests. And be discharged to exactly the same home exactly the same way every time; just like clockwork! It's a rotation so accurate you can mark your calendar by it -- I kid you not! And you're in luck with this one, folks, because if you miss this week's show just come back next week for the encore!
The Phantom Fibrillation!
And if that wasn't enough, friends, gather closer as I speak to you of a phenomenon that some say doesn't exist. A phantasm that materializes only to vanish seconds later. A cardiac conduction abnormality that few have ever seen! The Phantom Fibrillation! The poor bearer of this accursed arrhythmic spirit -- a gentleman from our very own town -- is forced to walk the Earth waiting for his next atrial possession. Come awe at the reports from the ER of his shortness of breath. Then astonish as the same ER reports him to be symptom free! And finally astound as we admit to monitor him, test him, and pursue a workup that could just as easily be done at the cardiac clinic anyway! Now we cannot guarantee that the specters will present themselves, but we *can* guarantee that if they do it will be an event you will not want to miss!
The Golden Crap!
But that's not all. No that's not all at all, folks. Don't even think about it -- not a bit! Our very last act -- our very last sensation, the topic of tomorrow's conversation, an aberration of constipation; ladies and gentleman I present to you the Golden Crap! The man has not pooed for days, some say months, possibly even years! Many have tried to disimpact him but some say he is undisimpactable. He will come into the hospital for one day and one day only to have what many believe will be the most expensive bowel movement ever!
(And cue curtain.)
In conclusion: sometimes my life is like a circus. But with less funnel cake.
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