saved by god

I am not personally much of a religious being, however, I respect the beliefs of others and I think religion often has great influences on people and how they choose to live their lives. that said, there are also times when religion manipulates people in negative ways, or when it is downright confusing and nonsensical. today we saw more of the latter… here’s my story:

a typical day in casualties: head wound here, sloppy stitches to be removed there, cerebral palsy patient on this bed, woman post-miscarriage on that bed, maasai being carried in lifeless and limp, car accident victim being asked to clear the bed for another patient, lady without detectable bp or palpable pulses… you know, the usual.

I’m taking it all in, trying to be helpful where I can, practice starting IVs and such, when in comes a group of three people struggling to carry an apparently unconscious young woman to one of the beds. I take her head as they heave her down and try to straighten her stiff body. I immediately check for a pulse – strong… I look for breathing – regular and unlabored. then I went to check her eyes – I wanted to know if her pupils were equal round reactive and if she had a pupillary response – but she was actively closing her eyes, scrunching them tight together and I could see nothing (clue one). the others were taking bp, listening to her heart and lungs, checking muscle tone. we worked quickly on the preliminary exam but it was soon apparent that her vitals were all normal (clue two).

the brit student who had started in casualties this week was concerned. he was a bit of a mr. know-it-all (damn medical students, think they know everything ;) and annoyed me from the start. his plan was to treat her for malaria until proven otherwise. at this point I had had the opportunity to exam her further and I wasn’t so convinced – her muscle tone was suspicious, as if she were actively flexing her arms, legs and neck (clue three). to me it seemed like something psychological, as if she was doing this to herself, and that, had I wanted to, I could lay on the bed next to her and mimic her every behavior. am I as jaded as a seasoned ER doc or what? I kept this opinion to myself as the nurses and docs hustled around her, tending to other patients. they didn’t seem too concerned with her, though she was unresponsive. with vital signs that stable, they decided simply to give her fluids and wait (pretty much standard treatment in the casualties ward here).

we continued to observe her and debate what it might be. finally I said what I was thinking: that I know it’s not a conclusion we should jump too, but we should definitely consider that this might be self-induced. kurt was pretty shocked that I’d suggest this patient was faking it, he was as concerned as brit-boy, but I can’t blame him, he’s still in college ;) sorry kurt! anyway, before long this woman, who still appeared to be tensing as many muscles in her body as she could muster at once, started to breath very rapidly. fast onset tachypnea with no aggravating factors you say? sounds…interesting. the brit was super concerned, I couldn’t figure out how he didn’t see that it was her forcing the hyperventilation (clue four). just as quickly as she started, she stopped (clue five). ‘she’s not breathing!’ he said frantically – I think I actually rolled my eyes – ‘look at her abdomen, she’s breathing, just subtly’… who is this guy? no, I promise, im not such a cynic that I think every patient is faking, there were just a lot of signs with this patient that pointed to something aside from a physiological illness. at this point I was voicing my skepticism even more openly (one of the nice things about being in a setting like this is that I don’t make the call – we’re all allowed to make our best guess and whether we’re right or wrong the patient is treated the same, the docs do their thing here regardless of our opinion – so no harm, no foul in proposing that she’s faking).

it wasn’t long before her eyes opened, but despite a slightly crazed look, and a refusal to respond to the doc, she seemed lucid. I went over to her and checked her pupils – perfectly normal. I also noted that she was looking around, unable to fake the glazed, incoherent stare of someone truly out of it. she also couldn’t fight the urge to blink when I moved my fingers quickly before her eyes. janet, the doc we’ve been shadowing, gave me a smile and walked away, she was on the same page. just as amy, thu and kurt were starting to come around to the idea that this might simply be a case of crazemia (brit-boy would have already given her the malaria meds if he had it his way), she sits straight up in bed with boisterous energy and begins yelling loudly the same swahili words over and over again. we were all a bit startled, though I had to laugh because anyone able to yell so articulately is obviously in relatively decent health. we asked janet what she says (janet was sitting at the desk scribbling notes, unconcerned with this behavior), she shook her head as she chuckled and said ‘the woman repeats that god has saved her’.

the nurses and docs alike were now leaving this woman to her thing. when she would start ranting they would look up, make eye contact with one of us, then laugh shaking their heads. I don’t know how they were so light-hearted about it, guess you have to find entertainment where you can get it. the waiting room was absolutely packed and it was bothering me that this woman was taking up a bed. t.i.a. I started talking to kurt about the things I had noticed early on that had clued me in that this woman might not be so sick after all. he was happy to hear my reasoning, he said he had been concerned when I jumped so quickly to that conclusion. ultimately, we laughed at the situation too… you would have had to see this woman in action. can you blame her? I mean, god did save her after all…