Mark Glencourse at 999Medic has an interesting post, Real or Fake about patients seizing or pretending to seize.
I had two calls recently involving seizures of curious origin. One, which deserves its own blog post at a later time (after the complaints are resolved), involved a young churchgoer who was “with the spirit.” The other was a school child who was arching her back and shaking her arms and rolling her eyes quite violently and quite at random.
Every Jerk and Twitch
Were they faking? I have learned in my reports to be as nonjudgmental as possible, simply writing a lengthy narrative notating each jerk and twitch as I saw it. I will say I saw no immediate medical need to give either patient Ativan.*
Still, these were difficult calls. Both performances were in front of large gatherings of concerned onlookers, including a nurse at both scenes as well as top authority figures, a pastor at one and a principal at the other. Each call required an extended extrication, one from the front row of the church balcony, the other out of a school auditorium. None of the onlookers were well experienced in or even aware of the art form of psuedoseizing. On both calls my partner had to leave me for a longer than comfortable period, one to get a stair chair, the other to move the ambulance to the back side of the building. I was left with “seizing” patients, large audiences and nothing to do. Yawning, doing my daily stretches or practicing tap dancing would hardly have been appropriate.
Demons! Be Gone!
If you are in the back of an ambulance with someone faking a seizure, it is one thing to say “Knock it off!” It is a bit more delicate to do so in front of an uncomprehending crowd. In the case of the church seizure, I considered and rejected, placing my hand on his forehead and commanding “Demons! Demons Be Gone!” The problem here was he was not in fact communing with a demon, but, according to the onlookers, with a higher spirit. I did attempt to talk to them (patient and spirit), placing my hands on the patient’s temples and asking if the two of them could find it in their hearts in the interests of safety as long as I wasn’t interrupting anything important, if they could adjourn so we could help him stand, and walk up to the corridor where our stretcher, a clean sheet upon it, lay awaiting his rest. To no avail.
These episodes did remind me later, as I wrote my extended narratives chronicling every jerk, shimmy and coco-bop that a few years ago I had written a post suggesting that we be allowed to videotape our patients as they seized for later broadcast, not on You Tube, but for the patient’s ED doctor and consulting neurologist.
“Let’s go to the tape…”
I feel more strongly today than I did back in 2006 when I posted New Frontier that if we can use digital cameras to capture pictures of crashed cars to show the trauma team, we can use video cameras to record our patient’s busted moves.
On a cautionary note, several years ago I attended an excellent presentation on seizures called a “Whole Lotta Shaking Going On” by noted EMS lecturer Bob Page that revealed to me that seizures are far more complex and varied than I had realized and that I had, in fact, on an occasion or two, mistaken a real seizure for an act. Here are my notes from that lecture;
* While neither patient got Ativan because I felt neither patient was seizing, in retrospect, a couple milligrams of Ativan for each would have made my life much easier and been more pleasing to the audiences (in addition to placating their howls) than simply allowing the patients to continue to perform.
In both cases, I should add, their “seizures” ended once they had been removed from their audiences.