your attending, Dr. Martin, is not here yet?”
“I don’t know. He is still at the V.A. probably pretty tied there with another emergency.”
“Well, call him and tell him that whatever it is, that THIS ONE is more urgent. Long seizures like this one do cause brain damage!”
So the resident did. As he was still on the phone explaining to Dr. Martin that a second dose of Valium still was not working, the ICU attending grabbed the phone from his hand and gave Dr. Martin hell.
“God damned, Frank! Why aren’t you here already?”
He explained that he had another emergency at the V.A. But it wasn’t enough.
“Well my friend, whatever keeps you busy there, get the hell in here right away, Your resident can’t stop this hard seizure and she is going to die on us. Will you?”
Dr. Martin left the stroke patient in the V.A. alone with the nurses and we are told that he literally run outside to the other hospital ICU where Catherine Pierce was still seizing. It took him only five minutes to get there. Both the resident, the ICU attending and two nurses were at her bedside. As he nodded his head to his colleague attending, he listened briefly to the history and situation, his resident repeating all to him as he was observing the young woman still quivering all her extremities with her eyes closed. The hard and extremely long Grand Mal seizure did not seem to be taking a toll on her body in any way. There were no asymmetries. She did not respond to his stabbing her with a pin in the back of her feet and hands. She gave no reaction whatsoever to pain and her breathing or heart rate did not change.
Frank Martin then asked those four people in attendance to step a bit off her bed and watch carefully as he literally tickled the woman vigorously on both sides, just above her belly. To the others’ surprise, she immediately squirmed reactively, which she had not done when stabbed with a pin. With all the Amytal and Valium she had already received, Dr. Martin was not sure she was going to react to his tickling her; if she didn’t, he was thinking of repeating his ‘tickling approach’ the next morning when the sedative effect of those drugs would be gone. But in spite of the drugs, she did react to the tickling and ‘sort of caught,’ she slowly stopped shaking. ‘Wow’! His diagnostic impression of ‘a long hysterical seizure’ was firm.
“How did you know it was not a real seizure?” asked him the ICU boss.
“Because she kept her eyes forcefully closed! In a generalized seizure one’s eyes are kept normally open, like when a person dies!”
“Wow, Frank. I am impressed. I am sorry for my initial overreaction. I’ve learned today a big lesson. And I’ll never forget the two pointers of ‘the eyes being closed’ and the ‘tickling trick’ if I ever suspect ‘faked’ coma or a seizure as being hysterical! Thank you! In fact, I’ll try it in every hard seizure I see.”
The neurology resident was also quite impressed with Dr. Martin. He hadn’t been told yet ‘about the tickling and the eyes closed stuff’ in his training…
Needless to say, the patient, already calm, quiet and ‘asleep,’ was immediately moved out of ICU and placed in a regular single room. The next morning a psychiatrist saw her and she was transferred to the Psych ward.
CHAPTER 10
A Very Long… What?!!!
Deidra Bell was 16 and very pretty. For several days she had been noticed in school to act very strange. In the middle of the day she appeared to be… not just herself, as if she was not with it. Her classmates finally brought the matter to the attention of the teacher while it was happening. Her teacher, thinking that she had ‘taken something,’ brought her to the school nurse. She also thought that she was probably on drugs. By the time they called her mother thinking of taking her to the nearest Emergency Room, she had snapped out of it. So they stopped.
But they still told her mother that something really strange was happening with Deidra, and that mom had to watch her better as for whom she was with after school hours, and that she‘might be using speed, or perhaps acid’… Then nothing happened for the next week. But after that, similar episodes of not acting herself started again. Finally in one of her longer episodes of ‘spacing out’ the nurse was contacted again, mom picked her up and she took her to the E.R. She was still out of it so the nurses and doctors had plenty of time to see what was going on. She was ambulatory but non verbal. Her exam was normal and so was her blood work; her drug screen in blood and urine was negative. She was OK again by the time they were done. The next day the same thing happened and mom took her back to the E.R. And as before, nothing abnormal was found and again her toxicology screen was normal; she was not on drugs; after 3 hours or so she again snapped out of it. Someone suggested that she be seen by a pediatric neurologist who was in private practice and who was known for seeing most new patients with a rush within a day or two. So they called Dr. Martin who, yes, could see her in a couple of days. He even offered to see her that very same day, but they told him that she was already fine. The next day would be fine.
Mom and daughter showed up for their scheduled appointment and Deidra was ‘normal.’ She was not acting strange or out of it. Her EEG was normal and so was her neurological examination including a mini-mental assessment. Dr. Martin felt that perhaps she had experienced brief ‘lapses’ of consciousness -along the lines of the much talked but still poorly understood ‘transient global amnesia,’ perhaps ‘auras’ of unusual migraines, perhaps some sort of seizure or trance though her EEG was not showing anything of such. He reassured mom that whatever those lapses had been that the issue did not seem to him awfully serious to her health. But suggested that as it was likely some sort of identical, repeated event, that mom be prepared to bring her back to his office -NOT to the hospital E.R.- for an immediate exam and an EEG to be done as it was happening. He gave mom his home phone number. ‘Call me WHILE her lapse takes place. Not after. The greatest chance to make the diagnosis is by catching it.’
Deidra did not have any more ‘spells’ in the next several weekdays. But then it happened again on a weekend: Mom called Dr. Martin on a Sunday morning as Deidra all of a sudden did not seem herself. ‘Both of you meet me in my office right away,’ he told her. Dr. Martin, with his wife Isabel -an R.N. and his EEG technician- arrived in their office just minutes before the Bells did, dad included.
Deidra was walking normal, looking straight, but brought in by her mother who was holding her by her hand and was pulling from her like a puppy dog. They were brought immediately to the doctor’s EEG room and Isabel hooked Deidra to the machine with its many strategic wires while Dr. Martin talked to dad. From a good 20 feet away, as the EEG recording started, they could hear the shk-shk-shk-shk-shk-shk-shk-shlk-shk loud thumping of the pins at the pathognomonic 3-Hz speed (= 3 cycles per second) so classical and diagnostic of Petit Mal Seizures: Yes, a tall spike followed by a big domed wave occurring 3 times every second! That went on non-stop as the doctor and Mr. Bell came right in and they could watch it as it was happening.
“It is unbelievable!” Dr. Martin said.
“Why” Mr. Bell asked. “Is this the first time you see it?”
“Well, no. I see it all the time in cases of Petit Mal seizures, but normally we can’t ‘catch’ the spells when they are happening; and then their EEG only shows this type of recording briefly, for a few seconds at a time, off and on, when the youngster seems acting perfectly normal. We never see it occurring continuously without interruption for this long.”
The doctor brought Mr. Bell back to his consultation room as mom stayed with Deidra and the full length EEG
