Anybody who's worked in a hospital in any capacity can tell you that the nutjobs come out right before the holidays. Not *during* the holidays, mind you--that's when the really sick people stay at the hospital rather than heading home--but just before.
I had fourteen patients (counting admissions and discharges) in two days and only one of them was not a nutcase. Unfortunately, Non-Nutcase Guy went home the same day as his admission. He was that healthy. I wish he'd stayed; I could've used the company.
Every nutjob save one had a neurological condition of some sort that defied all manner of scans and testing. One was demonstrating both la belle indifference and arc-de-cercle, but the latter only if she knew someone was watching. Funny thing: the only thing that cured those compulsive backwards archings was repeated injections of Dilaudid.
Another had real problems with formal neurological testing but was functionally fine. Babydoll, if you're walking around in your room with no trace of the shuffles or the sways, you ain't gonna have that bizarre of a neuro exam five minutes later, when the doc walks into the room.
Why, *why* do people always try to fool neurologists? Why not cardiologists or orthopods or thoracic surgeons? Is it that we don't understand the brain the way we do joints and hearts? Or is it that some folks have a special place in their hearts for neurology and its adherents?
I have, in the last two days, been confronted with a patient who claims to be allergic to water. And every antibiotic known to man. *Every* one. They all cause laryngeal edema and laryngospasm, two things that can kill a person if we don't poke a hole into their trachea somewhere south of that swollen, closed-off larynx to allow them to breathe.
But no, I was told, there's no need to put a tracheostomy tray by the bedside. Because, you see, if the patient in question merely holds up this electrical widget to their temple, it will cause their brain to produce chemicals that will keep their laryngospasm from getting bad enough to kill them.
I had a patient who claimed to have an anaphylactic reaction to tomatoes. And severe and constantly-changing food allergies that could kill at any moment. And who required a special diet so that their energy fields wouldn't undergo a conversion to a negative polarity.
This was, of course, the same patient who managed to put away two Big Macs (which have no tomatoes but which do include Thousand Island dressing, the main component of which is...oh, never the hell mind) in ten minutes, when she thought I wasn't going to notice.
And the one who was allergic to cotton. This allergy was, according to the five-page list of allergies that accompanied the patient, diagnosed by spiral CT scan.
And the one who had the rash and hives and difficulty breathing when given oral Dilaudid, but who could handle the IV form just fine. But only just before he went outside to smoke. Because the nicotine from the cigarettes helped calm down the anaphylactic reaction.
When I admitted the patient with the oxygen saturation of 88 percent on room air, I tried to put oxygen on her. "Don't do that," she protested. "I'm allergic to oxygen."
I gave up. I left the room on some pretense I don't recall just now.
One of the orthopedic residents found me in an alcove, laughing until the tears ran down my cheeks.