Friday, May 21, 2004

I is a collidge grajuit. I swear.

There is nothing worse (okay, there is something worse) than having someone pass on your blog address to another person by way of introduction, before you discover a glaring subject/verb agreement problem. I am, of course, talking about E The Matchmaker and Mystery Man.

The problem has been corrected (thank God for edits) and from what E says, he didn't scream and stab his eyes out with a fork when he read it.

Which means he's either illiterate or forgiving.

The Weekly Case Study

In other news, I'd like to tell you about an interesting case that came some time ago.

Several weeks ago, we had a patient come in who had broken her neck somehow. God only knows how she'd managed it; her stories ranged from "my boyfriend hit me" to "I fell getting out of bed." Getting a clear story out of her family was impossible. They were obviously frightened of her outbursts and wouldn't talk about what happened.

Anyhow. Hysterical Woman had surgery, made it through the recovery period, and was discharged home in a C-collar and with medication, with instructions to follow up in two weeks.

You can see where this is going, right? After all, when you're dealing with a person who screams bloody murder all the way down the hall on the way to surgery, takes swings at people, refuses to cooperate with assessments, and calls nurses "bitch", it can't be simple.

And it wasn't. About two weeks after surgery, just before the office appointment that would've cleared her to go back to her normal activities, she showed up at our affiliated hospital's emergency room. The story was that her boyfriend had hit her, knocked her down, and she had no feeling or movement below the waist.

Now...that's difficult, but not impossible, to accomplish. Cervical operations with instrumentation result in a stronger structure than was there prior to surgery. I mean, you've got titanium whatsits in there and screws and so on.

Plus, the spinal cord is a nice, logical thing. Hurt it up high and your deficits will start up high. Hurt it down low and your deficits will start low. It's not unheard-of for a high injury to result in normal function of arms and hands and paralysis of the legs, but it's...well. It's unusual.

Besides *that*, this woman's legs moved of a piece with the rest of her body when we turned her. That and her Babinski reflex was as it should've been (that's that irritating test in which the doctor or nurse scrapes a fingernail down the sole of your foot, hard, to watch what your toes do). When somebody's actually paralyzed or dealing with a spinal cord injury of some magnitude, their Babinski is all messed-up and their legs don't move with 'em when you roll 'em.

Doctor came in, residents came in, they looked her over, they pronounced:

Hysterical Paralysis.

I could see that. Really. And I get irritated by diagnoses that presume a psychological cause for a physical disorder without first ruling out physical causes. But this woman was a piece of work from the great fiery beyond. Normally I can find something to like about every patient I care for. This time I couldn't.

Which made me wonder what on earth would drive a person to act like this. I have an insane ex-mother-in-law who, on various occasions before and during my marriage, threatened to kill me, kill herself, cut us off completely (please! Please!) and ruin our lives. This patient was easily an order of magnitude worse. At least Crazy Ex-MIL could put on a veneer of appropriate behavior when the occasion demanded; this patient was past all of that.

What causes that sort of craziness? What makes people ambush themselves at every turn? How come some of us turn out nuts and some of us turn out okay? Is there a possibility that every sane person could turn wacko, and vice-versa? Does the person who's wacko realize they're like they are, or is everything enslaved to their view of the universe?

I wonder these things sometimes.


-K of the Acres said...

You have a fantastic blog, figured I'd read it from the beginning. I'm an RN working in a mental health treatment facility that works with corrections inmates...hysterical paralysis (pretty rare but I've seen it), pseudo-seizures, all forms of self-harm (headbanging, biting, cutting, inserting...cutting then inserting), the full gamut of malingering, etc. Believe me, I had no idea what I was heading into when I switched from the small town hospital where I worked med/surg. Its definitely a trip.

Anonymous said...

Sounds like Borderline Personality Disorder. My mom is like that. I've rushed her, moaning in pain, to the emergency room; I thought she was dying. She had diarrhea. She's also faked neck injuries and threatened to kill us and herself, etc.
I'm considering nursing for my career and your blog is excellent. Thank you.