Thursday, July 20, 2006

You know the old phrase... can't bullshit a bullshitter. Well, you can. I have proof. We got played. Truly and utterly played. And it totally pisses me off. Hindsight is always 20/20.

So we get called to an "unconscious trauma". We were about 20 minutes away standing by in another district so we go taking off down this oak tree lined two-lane highway, lights, sirens blaring. FD calls and tells us, Yeah she is totally out, responsive to nothing. Not pain, not voice...nothing. When we get there we are met outside by the FD and staff of the place. They tell us that she was moving tables from a stack and the stack toppled over on top of her striking her in the head and pinning her head between the floor and the table. We walk in and damnit all if she isn't seizing. Not tonic clonic flailing like a fish, but a quiet focal SZ, but apparently she had been doing it about 10-15 mins PTA. So I start a line and give the Ativan...and she stops. We package her in C-Spine and get her out to the truck. Where we discover that her pupils are unequal. Like ones is dialated and the other is constricted. They are sluggish to react. And she is OUT, responsive to only really deep pain. She is breathing and her spO2 is 100% on a Non-rebreather. I call into the trauma center and get orders for another MG of Ativan and one more is the SZs start again. I get a second line put in and my partner notices another SZ. So one more MG of Ativan. Her eyes are becoming less reactive. The sternal rubs aren't doing anything, the big ol' IVs I put in aren't doing anything. So she has had recent head trauma, is unresponsive, has unequal and sluggish pupils and is activly seizing...or so we thought. We had a fire guy drive us in, code 7, risking life and limb driving down the two lane highway with all the trees. Not just risking our lives, but the other motorists on the road because getting over for the blaring ambualnce means risking hitting a huge tree...and we all know that people can freak out with an ambulance screaming down the street. We get to the ER after working our assess off trying to one...figure out why she is seizing and two...trying to make them stop. If she hadn't been holding her own on the airway front, she would have been RSIed and bought herself a tube and an ICU bed. The ER doc actually got into it with a trauma resident over the CT scanner. Feeling that she needed the scan first because of the head trauma and all of the other symptoms, not the stable trauma. Now after the scan is when Mom shows up...and proceeds to tell the ER doc SHE IS FAKING IT. ALL OF IT. She has been seen by several neurologists and they all say the same thing...PSEUDOSEIZURES, faking it. And she has been doing it for years. and has it down to an artform, this girl had us fooled, the FD fooled, the ER fooled. But what about the pupils you ask? She has history of head injury when she was very young, they are always unequal, it happens I guess.

Now the more I thought about this the more pissed off I get. This is EMS abuse at its worst. This pisses me off more that going to an ABD pain x 2 weeks in the middle of the night. For the sole reason that we thought this girl was truly hurt. We worked our asses off trying to help her. We put numerous people at risk just getting her to the hospital, driving down the road CAT 2, we put our lives at risk for the same reason. We fought the good fight for her. Then looked like a moron when finding out is was all an act. It hurts your pride and it makes you think that everyone is faking it. It makes you jaded and mistrusting. We trusted our guts and it turns out that your guts, the ones you use to treat potentially sick people, was so totaly wrong that you don't know if you can rely on them.

As I thought more about the call, I remember her possibly "helping" me move her arm, the seizure might not have looked right. But I could be all wrong.


Anonymous said...

Had you RSIed her she would probably never fake that stuff again.

I'm suprised she didn't scream after the sternal rubs - she must have a really high tolerance for pain.

Anonymous said...

I've played against the very best and just can't tell. YOu have to follow your gut for the 99.99% of the time you're right. No one came to harm from you playing the SZ pt. straight. Stop beating yourself up. It happens to the best of us.


Justbeingreal said...

indeed. fakers are a pain, I've heard though that not all "pseudo seizures" are on purpose. Is it possible that this pt is actually having these things without any control?

painter in hiding said...

No this girl knew what she was doing. According to the mother she liked the Ativan, and Valium that we give to stop the SZ. She also has a craving for attention