A huge building had gone up near our area. It took up a whole city block but it was unremarkable and there were no signs advertising what it was used for. We weren’t all that curious and just continued to drive past it with occasional passing interest. For many years we were able to blissfully ignore it. But then, one day, our good fortune changed and we became very familiar with this large building, as we started going there all the time.
We found out that the building was a juvenile corrections facility, housing children age 16 and under who had committed the worst crimes and required a high level of security. They had an infirmary and a medical staff that had been getting by without calling for an ambulance for so long that their new about-face was somewhat perplexing.
Our first call there was for a 16-year-old boy having seizures. He had obviously never witnessed anyone having an actual seizure, either in person or on TV, or he could have provided us with a more believable performance. There are different kinds of seizures and some of them present differently, but our patient hadn’t mastered any of them and seemed to be making things up as he went along. With his floppy arm movements and erratic blinking, I had a hard time believing that the professional medical staff in the infirmary had bought into this pageantry. Perhaps they believed he was in need of hospitalization because the kid didn’t have a seizure history and may have been worried the seizures were a manifestation of a hidden brain tumor.
We gave the young man an IV, which was easy to do since he temporarily halted his flowing, dance-like arm motions so we could get it without accidentally sticking him elsewhere. My partner and I had spoken at length about how painful that would be, while we were preparing our IV set up. I guess he had been lucid long enough pick up on that bit of information. After we secured our IV, the patient resumed his feeble attempts at seizing, but would again, temporarily, stop each time we pushed medications through the IV.
We have had many people fake seizures for us, for various reasons. Sometimes it’s to be dramatic, for others it’s an attempt at getting some Valium. We didn’t know the motivations for our current patient, but if he wanted Valium he’d have to do a better job at convincing us.
We could still give him “the cocktail”, however, as we called it, for our “Altered Mental Status” protocol. At the time we carried Thiamine (vitamin B1) which was part of the cocktail triad, along with Dextrose (sugar) and Naloxone/Narcan (the drug that reverses the effects of opioids). It makes me sad that new paramedics will not have the ability to witness the placebo effect of the Thiamine wonder drug, since it has been taken out of our protocols currently. Thiamine was considered so benign that the board, who decide our protocols, found it to be an unnecessary expense. They had obviously never witnessed its miraculous efficacy.
If the kid envisioned a future on the stage, he could have learned something from us that day. Having had so many opportunities to practice our own acting skills, I’d like to think we did our routine convincingly. We used the standard script developed for these occasions. It’s one that all paramedics seem to have subconsciously downloaded into our psyches, possibly acquired subliminally when learning our protocols.
We start out with Dextrose and then deliver the Narcan, each time announcing to each other, with solemnity, that we hope the drugs work because the patient appears so seriously ill. We then kick up our level of resolve by moving to the standard, somber discussion about Thiamine.
“I guess we will have to give the Thiamine,” I announced with extreme concern.
“I know. I can’t believe the other drugs haven’t worked yet. We have no choice,” remarked my partner.
“But remember the last kid we gave it to? He’s a vegetable now, on permanent life support. I’m worried about its safety for teenagers. I don’t think they tested this enough on younger patients.”
“Yeah, but it’s still in protocol, at least until they settle the lawsuit. I’m not getting in trouble. Hand me the vial.”
“I don’t know, I really want no part of this,” I said with emphasis.
“It’s OK,” said my partner, nobly. “I’ll take complete responsibility.”
Miraculously, our 16-year-old made an instantaneous recovery in a matter of seconds. He sat up as if sleepy, wondering what was going on. What was happening? Did he have a seizure or something?
The dopey medical staff was also impressed, which had me seriously doubting the framed credentials hanging on the wall. We took him to the hospital to get “checked out”. We gave the ER staff a brief description of the psychedelic dancing he wanted to have interpreted as a seizure and they said they looked forward to the presentation.
A very short time after we dropped off the male, we were called back for a female. The juvenile center was certainly making up for lost time after all those years of handling the residents by themselves. Our second patient was 15-years-old and she was trying for the Academy Award in the Asthma category.
She had done a good job of convincing the inept staff that something asthma-like was going on. I wondered if they had ever dealt with a real asthma patient. The staff was in a panic, knocking things over and bumping into each other, trying to fill her nebulizer device. We, on the other hand, were extremely familiar with asthma and all of its manifestations. It made up a major percentage of our call volume. We gave her performance a decided thumbs down.
All of her ‘wheezing’ was caused by a concerted effort on her part to constrict her throat muscles. Her lungs were absolutely clear. Because she had to un-constrict her throat muscles to talk to us, her ‘asthma’ was temporarily abated when she answered our questions. I discreetly pointed out to one of the nurses how miraculous her recovery was. The nurse seemed to feel it was their quick action with the nebulizer that was responsible, despite a floor wet with spilled asthma medication. My faith in those accreditations on the wall continued to wane.
We took the asthma-girl to the same hospital as the seizure-boy because it was the closest. As per the policy of the detention facility, each trip to the hospital meant that two corrections officers were needed to accompany the patient. At the hospital, the two pairs of officers met up. They resented that their day had been interrupted by extraneous visits to the hospital, as it left them short-staffed at the facility. They too suspected the youngsters were faking their illnesses and they were furious.
About two days later the ‘asthma girl’ had another attack, despite a handful of new medications prescribed by the hospital. We had only gone to our newly-noticed juvenile facility three times at that point, but it was already growing tiresome.
When we wheeled her into the pediatric emergency room, lo and behold, the seizure boy was there again also! He had suffered another episode. It was a spectacular coincidence.
I noted the time on my watch and saw that the pair’s latest medical attacks had occurred at the same time of day as their previous episodes. Their amateurish performances were on a schedule.
I took one of the disgruntled correction officers aside and inquired about the relationship between the two and was shocked to discover that not only were they boyfriend and girlfriend, they had landed in the facility for committing the same crime together. I could have never predicted it.
The corrections officer had much dirt to spill for us. It turned out that the lovers were not just terrible actors, but terrible human beings as well. He, and later the other officers, told us that the young couple had attempted to kill the girl’s grandmother when she became an impediment to the young lover’s plans. She had not approved of her granddaughter’s dating choice and grounded her one weekend. The next day they put drain cleaner in her coffee. Despite the unusual smell and taste, the grandmother had ingested enough to cause severe burns to her esophagus and was in critical condition at a hospital. The pair had left the drain cleaner and the coffee cup containing the drain cleaner on the same counter, making it easy for the police to put two and two together. Their fingerprints were all over the bottle and the coffee cup and neither of them had called 911 when the grandmother began choking and writhing in pain. A neighbor happened to be walking past the apartment and heard the fall and the elderly woman’s attempts at screaming. The acting debut of the young criminal lovers, which consisted of pretending to be upset and shocked that grandma had drunk something so toxic, was not well received by the police or the neighbor.
Ever since their arrest, the two had been housed in separate areas of the same facility and there were never opportunities to come in contact with each other. It seemed that the only place the couple could be reunited was at the hospital, even if only for a short time. As a result, their “illnesses” became more and more chronic, wearing out the patience of the EMS community, and also the hospital staff. Many people we knew had taken at least one of them to the hospital at some point, and all of them, thankfully, mocked their poor interpretations of an asthma attack and a seizure.
Having witnessed the damage drain cleaners can do when ingested, I had zero empathy for the plight of the star-crossed lovers and their efforts to be together. Nor did any of the other EMTs and paramedics, who were getting a little tired of having to participate in their charade of a medical emergency. It was curious that those two were the only patients we were ever called for. How long would we all have to wait until they were sentenced and incarcerated elsewhere? We agreed that this thing needed to be nipped in the bud if we wanted to resume our ignorance of the large building on Pitkin Avenue.
We collectively decided that other hospitals should share in the poor acting abilities of the young would-be murderers. We were sure the corrections officers would be willing to assist us in the endeavor.
The next time we went there, it was for the female, who protested when we gave the name of our intended hospital destination. “Her doctors” were waiting for her at another hospital. Surprisingly, it was the same hospital her boyfriend had been transported to just an hour before. The corrections officers jumped right in and explained that their policy had been revamped to keep inmates separated outside the facility as well as inside.
During discussions of the new policy, our patient’s ‘asthma attack’ miraculously subsided and she decided that she no longer wanted to go. We had to take her anyway since she was not old enough to make the decision on her own and the facility required transportation. Since her reason for going had been thwarted she protested wildly over her desire to stay. But the concerned nurses at the infirmary noted how her disease had been progressing so badly as of late and they would not be comfortable with her staying there. The young actress was a victim of her own success.
Now that she was going against her will, she whined and complained about the waste of time it was for us to take her. Why was she going if she was OK now? She glared with hatred at me and the corrections officers when it was clear we weren’t going to turn the ambulance around, despite her best arguments.
After a short interval of quiet contemplation, she suddenly told us, and this was shocking, that she *didn’t* really* have* asthma! The whole thing had been a sham! Just to see her boyfriend! She had put one over on us, but good.
I couldn’t believe we had been tricked. I tried my best to convey how stupid we felt, that as medical professionals, we had not been able to tell. She smugly nodded, proud of the way she had manipulated us into believing her. She let us know that she was going to use the exact same skills to convince the jury that she shouldn’t go to prison. She admitted the case didn’t look good but she was sure no one would want to send a young girl to prison for killing someone with so little time left on the planet anyway. She was confident the acting skills she had honed on us could make a jury feel sorry for her, and probably her boyfriend too. After all, look at how many professionals had bought into her performance. She smiled a self-satisfied smile of superiority that I hoped would serve her well in prison when she got convicted.
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