Unfortunately, someone who was not at ConAdian was Sharon Farber, who had
received a Hugo nomination in the Fan Writer category. Sharon called us about a
month before the convention to let us know that she would not have Labor Day
weekend free this year, and "...in case hell freezes over and I win, would you
accept the award for me?" Even though the world wasn't treated to the sight of
demons strapping on ice skates this year, we think a rocket for Sharon won't be too
far in the future. Meanwhile, here is another in her series of medical
adventures.
Nostalgia, like beauty, is in the
eye of the beholder. I used to get nostalgic when I'd see, say, a copy of Sgt.
Fury and His Howling Commandos. Then I'd be sunburned on a pier, feet dangling
into the Russian River, eating Cheetos and watching Nick and the boys
single-handedly beat the Ratzis.
Just recently I was in an emergency
room evaluating a penniless drunk who'd had an alcohol withdrawal seizure.
"Thanks," said the ER doc, who then began to apologize for asking me to come see
the guy.
"Hey, no problem," I replied. "It
makes me nostalgic for residency."
Somehow, when one leaves the world
of training programs and charity hospitals, one thinks one's clientele will improve.
No more alcoholics, wife-beaters, drug seekers, and hysterics. But one still gets
them, just a bit more polished and upscale.
My first month of private practice,
I really did think things were better. Then, one night, I met Buddy Boy
Baker. (His name wasn't really Buddy Boy Baker, but it was just as
bizarre.)
I was happily into Stage IV sleep
about five a.m. when a doc called from the ER of a small hospital in Georgia where
we covered. "I've got this guy in status epilepticus," he said.
Status. That was bad.
Seizures that don't stop and can fry the brain. Comatose patient in danger of
dying.
"He told me he has seizures and
takes dilantin and phenobarb, but his levels were zero."
Typical. The number one cause of
status epilepticus is skipping your seizure meds -- waitaminnit! "He
told you??"
"Yeah, he talks between these
seizures."
That wasn't right. So he described
the seizures to me some more.
"They sound kind of phony."
The ER doc agreed that it was pretty
suspicious for pseudo-seizures. So I got dressed and drove on down. By then it
was dawn, with all the marvelous scenery of rural Georgia in the August heat,
namely dust and kudzu. I kept reminding myself, at least, that the guy had
insurance, not that getting paid made up for losing sleep. But I was already
learning that most night time emergencies in this rural hospital were to be total
charity, or Georgia Medicaid, which was like total charity but with annoying
paperwork.
On arrival, I was introduced to
Buddy Boy, a youngish guy with a number of tattoos to help prove the diagnosis of
a sociopath. He had enough sense not to try faking seizures in front of a
neurologist, and instead told me his story of long-term seizures controlled only by
dilantin and phenobarb.
"Gee," I told him. "I'll be happy to
give you the dilantin, but I can't give you any phenobarb."
"Why not?"
I wanted to say, "because you're
drug-seeking and want it," but instead I told the odd truth. "I'm new in private
practice, and I don't have my DEA number yet, so I can't write controlled
substances."
He immediately signed out against
medical advice.
I thought I'd seen the last of Buddy
Boy, but a couple of months later the bookkeeper informed me that Buddy had given
us his father's insurance information, and the company was real mad and wanted a
refund. I was just amazed that the dad's legal name was 'Buddy' too.
Then, many moons later, I was just
hitting Stage II sleep about midnight when a medical resident from the teaching
hospital called me in a state of acute anxiety. They had just got a patient from
the county jail workhouse, and they couldn't stop his seizures. It wasn't my
responsibility, but they'd heard I was friendly and informative, and they sure
needed help with Buddy Boy Baker.
"Repeat that name," I said. I told
them to stop what they were doing -- which was giving forty or so milligrams of
Valium intravenously -- and got dressed and drove on down. Another night's sleep
shot.
It was indeed the guy I recalled.
He was gamely trying to fake seizures, except by now he was inebriated from the
Valium. He had been in the workhouse, only not working because of cerebral palsy.
And now with a couple days left to his sentence, he decided he'd rather be in the
hospital hotel. Word was that he was going to be transferred to a jail in Georgia
when Tennessee was through with him.
I explained pseudoseizures to the
residents, then went home. The next day I dropped by to say hi. Buddy was holding
his hand very oddly.
"What's wrong with your hand?" I
asked.
"I've got cerebral palsy," he
said.
"No kidding, that's amazing," I
said. "That's earthshaking. Because that's something you're born with, and you
sure didn't have it last time I saw you."
Well, the residents wimped out and
didn't take my advice. They let him stay, faking one symptom or the other, until
his sentence was up. Then it was miraculous recovery time, and Buddy checked
out.
And the very night he left the
hospital, I was providentially on call again. About five a.m., I got another phone
call from the little hospital in Georgia.
"We've got a guy named Buddy Boy
Baker here," said the ER doc. (A different doc than the one before. These crummy
jobs have high turnover.)
I started to laugh. "Status
epilepticus, right?"
"Just left the teaching hospital,"
the doc agreed. "You know him?"
So I told him the story of Buddy
Boy Baker and the fake seizures and the desire for phenobarb. "Need me to come
in?"
"Nah, let me handle this," said the
ER doc with an evil little chuckle. I learned much later what happened.
Having hung up the phone, the doc
walked over to the treatment room where Buddy Boy was still vigorously shaking
away, the very image of the unconscious patient in the grips of a dangerous
electrical brain storm.
The ER doctor paused dramatically
in the doorway, waiting until the panicking nurses looked away from their
desperately ill patient and at him. Then, in a loud voice he ordered: "Don't let
this man leave! I have reason to believe he's wanted in the state of Georgia!"
The comatose epileptic suddenly
stopped shaking, sat up, and very earnestly said, "Oh, no, that warrant's been
dismissed!"
It was, to my knowledge, a unique
method of treating seizures.
Title illustration by Peggy Ranson
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