Wednesday, January 23, 2008

Dance Your Way to Disability

Great comedy is borne of tragedy. So says the Bible (or Shakespeare or someone important). What is shitty comedy borne of? Pitiful comedy? Absurd comedy? Perhaps it is born as the love-child of stupidity and laziness?

Patient (smiling and chatting with friend in room while flailing arms and legs; sitting on bed without falling off): "I can't stop shaking."
Me: "How long has this been going on?"
Patient: "Well it happened from 2003 to 2004 then it stopped but it's back again."
Me: (quickly considering neurologic crocodiles like Huntington's Chorea and fighting instinct to call 'bullshit'): "Who is your neurologist?"
Patient: "I don't have one, they kept sending me to psychiatrists."

The patient had been fine-tooth-combed at our regional zebra-diagnosing-center and had, in fact, been seen by a few head shrinkers, all of whom believed that this patient had a "non-organic" problem. "Non-organic" is a a handy cop-out for the doctor that doesn't want to end up in hour long depositions sitting with his attorney across from the plaintiff's attorney (and plaintiff in white neck 'brace'). And, to be fair, there is convincing evidence the somatiform illnesses are produced purely without a 'decision' by the patient.

"Malingering", however, is still diagnosed at the end of the 3 million dollar workup trail if the super sub-specialist has the balls to write it down. It occurs in the presence of secondary gain to the patient (i.e. a monthly disability check or a big legal settlement), AND, with a conscious decision by the patient to pursue this secondary gain by faking symptoms.

In the course of evaluating this admittedly very pleasant patient I asked her if she could walk. It seemed to me that if she tried she would smash her hands into walls and step in front of buses and such. She allowed as she could walk and I held out my hands to test her gait. Oh for a video camera at that moment! She made me look like a good dancer and, as my colleague stated to me afterwards, she has a great career in front of her in the tap field. She did a semi-perfect soft shoe all across the floor while following my gentle direction. Strangely, she was able, during this duet, to softly grip my hands.

Enter the neurologist who almost bust a gut laughing. Enter the ativan. Cue the sleep. Cue the CT Scan (negative). Cue the discharge paperwork. Cue the $5000 unpaid bill. Cue hours and hours of tap-dancing jokes.

Ladies and gentlemen. If you are going to fake an illness, don't pick one like schizophrenia or movement disorder. Go with the tried and true... back pain, neck pain and the like, otherwise you will end up exposed if not embarrassed.




10 comments:

  1. 911, lately I've had the urge to walk on my hands wearing little more than well-placed coconuts while belting out a resounding chorus of "Everything's Coming Up Roses." Is there a drug for this affliction where I won't suffer intermittent rectal bleeding and cause my left nipple fall off?

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  2. We had our own "conversioneur" today. He sustained a neck injury a few days ago and came in last night with weakness. Today he decided he was going to go apneic and bought himself a trip to the ICU. He was close to getting intubated when we realized his ABG was WNL. A few hours later, he could communicate by writing but couldn't speak. Another hour later and he was walking. Upon further review, he's done this before.

    We see more conversion disorder in peds than I care to admit or think about.

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  3. Last night, I had 5 patients with "fibromyalgia". Of course, all were on bags of meds (none of which ever helped) and wanted relief of their pain NOW in the ER.

    That was a record for me!

    One of these patients had the trifecta: fibromyalgia, chronic fatigue syndrome, and mitral valve prolapse! She was the only one that was admittable....she had pneumonia and was hypotensive and hypoxemic (I suspect it was an aspiration from the baskets of drugs that she took for her non-existant problems.

    Our hospital is full. We are holding patients in ER, and the chronic pain patients were furious that I wouldn't admit them for "further work up" (they've had it all already) or "pain relief" (IV Demerol works best, thank you very much).

    I wish the FDA would approve HDST (high dose slap therapy) or HDPT (high dose pillow therapy). That's all that was going to help these people.

    Here's the kick.....every one of these people tried to see their PCP and was told "go to the ER". When I called their PCP, they just went on and on about what a kook the patient was.

    "So, why did your office tell them to come to the ER?" I asked. "Well, just to make sure nothing else was going on" was the reply. Admittedly, one had pneumonia and needed to be in the hospital, but the others took a shoe horn and a crow bar to get them out of the ER. And I'll get the complaint...not their PCP!

    Lynn, I'll love you even without nipples....take the medication!

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  4. "Great comedy is borne of tragedy"

    I believe it's actually Derek Smalls who wrote that.

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  5. Derek grew up in Nilford, England, and was the son of Donald "Duff" Smalls, who ran a marginally successful telephone sanitization business, "Sani-Fone". He joined Spinal Tap in 1967 after the departure of bassist Ronnie Pudding.

    Derek described the turbulent relationship of bandmates David St. Hubbins and Nigel Tufnel as "fire and ice". He preferred to find a happy medium as "lukewarm water". He still enjoys his burl-wood pipe on occasion and continues to enhance the fit of his trousers with a strategically placed foil-wrapped cucumber, despite an embarrassing incident passing through a metal detector at Chicago's O'Hare International Airport during 1984's "Tap Into America" tour.

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  6. ps. lynn,
    great to hear from you.

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  7. 911: NICE! did you make that up?

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