Oh yeah, he did; and no, it wasn’t like your girlfriend does. Sometimes she fakes it for good reasons; this patient has reasons to do so, usually to manipulate the behaviors of others.

I am not saying that what I am talking about has the same implications as an orgasm, it was a way that, that type of person derives pleasure.

To be fair, it is always dicey to talk about cases in a public forum because, as a provider, it is the first priority to maintain confidentiality. I understand personality disorders as well as other psychiatric disorders, and this person has honed these well to derive pleasure. When you first encounter this behavior, in a healthcare setting, your response is usually, “So that’s what ______ looks like.” When you are dealing with it while managing other patients, it is less than charming. Especially if your behavior mimics a medical emergency.

In a hospital ward setting, the last thing anyone wants is to be busy with an emergency. With the costs of healthcare and such, folks only stay in the hospital these days when they are not stable medically to be at home (even then…). The inpatient stay is usually uneventful with both the nurse and the patient learning valuable management techniques for dealing with pain or chronic illness.

The other night started with a foreshadowing of a staff member when the patient approached them and indicated that he did not take one of his antispasmodics as directed and wondered if that person would take care of him if he had a seizure. The beginning of the manipulation has started what fun. Not an hour on the floor and guess what, boom seizure complete with peeing his pants, or so we thought.

When I was called, I arrived to assess what looked like a tetany seizure. Tetany is the involuntary contraction of muscles similar to a seizure. Subtle difference, unlike a seizure, the patient was able to speak and was cognitively able to answer questions requiring complex thought. Ooops, the first rule of faking it, is to know how to fake it. I think he figured he did that when he had peed on his pants.

Well, I work around psych patients, but I am a medicine guy. Meaning I look for a medical cause, long before I worry if its psych. Psychosis might be tough to deal with. Still, I would much rather make sure that the medical end is cleared before I say, “yeah, this is psych and turn it over to the professionals who deal with it.

I suspected that it might have been status epileticus. This is a situation where a person continuously has a seizure without a postictal period (that’s post seizure, and the patient is often groggy with little memory). This patient was cognitively with it. Oh well, let’s send him to the Emergency department (we are not directly connected to a medical ward, so all of our patients requiring an acute level of medical care are referred to the ED), so they can do a better and more definitive workup. For all, we know this patient may have some brain change that we are ill-equipped to deal with.

Once he was safe en route to the ER, we watched the video footage. One nice thing about a psych unit is there are cameras on everything. Well, we saw his very fake seizure begin with him walking down the hall with his pants already wet from urine. The acting caught on camera would have impressed Cecil B. DeMille, I guess we should call the academy.

So why fake the seizure. First off, I think our patient wanted to leave the hospital, however, due to his involuntary hold status, he couldn’t. He also, as I later found out, was withdrawing from lorazepam (the drug preferred to break seizures), so it was his hope we would give him some.

See the level of manipulation? In my practice, I do my level best to take the medical data presented to me. I do this without any assumptions (including possible manipulations) at first glance. I do answer my diagnosis and treatment after all of the reality is presented. Sometimes, I am quickly aware (as in the other night) that something was off.

Folks, cameras don’t lie. When it is on tape, we have the best evidence. Honestly, a recording of an incident, is a rarity in my line of work. We are so often left to guess.

Today was off. The podcast is being edited while I do this. I had a guest planned that ghosted on me, so we ran with a few old topics and put together the best we could. I am going to charge forward more aggressively into the podcast and begin having more interviews with Chris and I. I like Chris’ approach to subjects and the addition of his odd humor.

Anyhow be the kind of person your mom and your dog think you are.