Cranial Nerve problems

Several years ago, as a green EMT, a crusty old paramedic had me going hook, line and sinker about certain people having an extra cranial nerve, the 13th cranial nerve.  Before I finally caught on, he had expounded on how certain stressful situations would cause pressure upon the 13th nerve and cause them to act out, have seizures and fall out.  His description of the common signs and symptoms included OLJ’s (Oh Lawd Jeezus) and Tachylawdis, which was about the point I caught on.

This later became our code for anyone we suspected of acting out, seeking drugs, or in general just plain acting the fool.  And anyone in EMS has run across these patients, wanting attention or hoping to get drugs by mimicking an affliction, and we know its bull, but we have to deal with it none the less.

But what really makes the people act this way, what causes people to display such utter stupidity, such melodramatic behavior at times?  For instance, we recently worked a minor traffic accident, in which two young girls, in their early twenties, were complaining of minor injuries.  We ended up transporting both of them to the ER, and as we rolled into the hospital, we overheard the dispatcher sending out another ambulance to the accident scene for seizures.  Seizures? Who the Hell was seizing, we’d transported both parties involved in the wreck, no one else was in the vehicles, so who was having a seizure?  Apparently a by-stander, who wasn’t even involved in the accident, had decided she wasn’t getting any attention from the police about her account of the accident, and had a seizure because she was mad. WTF?

We see this behavior all the time, a family member or friend is sick, injured, whatever, and there is always someone who has to get involved, has to have a dramatic falling out, faint or seizure.  And without trying to be racial about it, this is usually blacks, but lately more and more, you see it in what my father would have described as po white trash.  I’ve yet to decide if this is a bid for attention, or just common stupidity.

Which brings me to another point, people on scene and their desire to become part of the problem. There are several different characters on every scene, sometimes due to lack of numbers, one person will assume several roles at once, but you can always count on them to be on scene. I do believe if you were in the middle of the Sahara desert, they’d still show up.  Allow me to introduce to you, the main characters in our daily drama.

First we have the Witness, who will loudly demand to be allowed to give their account of what occurred, and will repeatedly give the same account to anyone who cannot escape, and rarely does their account coincide with the actual events. They will argue down the persons involved if allowed to get close enough to them. If ignored too long, are prone to “Skeezurs” and will end up DFO. (Done Fell Out)

Then we have the Curb Side Lawyer, who is extremely knowledgeable in regards to “yo rights”, and will loudly and adamantly yell to victims/patients informing them of what they need to do, who they need to sue, and how ”de gob’ment gots to pay for what done happen.”  If allowed they are allowed, they will climb right on up into the ambulance to ensure justice is done.

Of course no scene could be complete without the Street Doctor, knows your job better than you’ll ever know having watched every episode of ER and Emergency, and gladly instructs you on all patient care, and who often turns into the Curb Side Lawyer, especially if removed from scene by law enforcement. The Street Doctor is also prone to DFO if ignored or removed from patient.

Another favorite of mine is the Grapevine Media reporter, keeps running commentary on what happened, he or she confers with the Street Doctor, the Curb Lawyer and the Witness often, to ensure all aspects are covered, and broadcasts reports to all bystanders within a 3 block radius via shouting, they are often equipped with cell phone and video cameras, and if asked to leave, often become another Curb Side lawyer.

There is another main player, the Enforcer, who is surprisingly, often the smallest person on scene, who issues commands and threats to EMS and Law Enforcement as well as Fire Rescue. Typical comments are about what “dey better do” and what will happen if “dey don’t do somethin’ bout dat mo’fugga”.  Usually they leave the scene in custody of Law Enforcement, and they are seldom prone to DFO, preferring to “fight it out”.  They can often be identified by strong odor of “Knotty Head, Easy Jesus, or Colt 45″, though sometimes they venture out with Old English 800 or Maddog 20/20.

And last but definitely not least, we have the Patient Advocate,  who is sometimes related to victim/patient, but often not, and who assumes role of speaking for the patient, whether asked to or not.  They will demand transport, override patient’s decisions, and if needed, stir up surrounding crowd to ensure good level of tension and drama. When they are informed that patient is only one who can make decisions about their care, will become extremely vocal and threatening,  and their typical comments range from “dees mo’fugga say she don’t need no ambulance” to “dat fat cracker say she ain’t dying” and often, “deez mo’fugga’s don’t know dey job fo shit!”  The Patient Advocate is extremely prone to DFO and subsequent Skeezurs.

It is with this cast of characters, that we find ourselves working the calls we go on, and to be sure they make life interesting.  There is seldom a call, other than hospital transfers where we don’t encounter them, but even that isn’t graven in stone.

I remember a call late on Friday evening, close to the first of the month, a time when most of our usual clientele has available cash.  We were dispatched to a local housing area for a young woman with an unknown medical condition.  Knowing the area, we requested that law enforcement be dispatched as well, and were happy to note as we rolled up on scene that they had responded.

As usual, there was a large crowd gathered around the apartment door, and the officer was vainly trying to keep them back. We jumped out of the ambulance, and immediately could hear the raised voices expressing their concern.

“Took dem mofugga’s long enuff to get dey ass here.”

“Dem mofugga’s doan care, dey bout sorry as hell”

Ignoring the comments, we went into the apartment, to find a young woman lying on the floor thrashing about. I knelt by her and started talking to her, trying to get a response. She continued to thrash about, as if having a seizure, but unlike 99 percent of seizure patients, she hadn’t urinated on herself nor were her “seizures” like any real ones I’d seen. Most patients who are having a real seizure will bang around on the floor, gnawing on their tongues, and in general act as if they were being electrocuted, they will smash into anything around them, however she was careful not to hit anything around her. I watched her as my partner started asking family members questions about her medical history.  As I watched, she opened her eyes and looked quickly around, then seeing me; she began “seizing” once again.  I caught her wrist and spoke to her loudly, “What’s your name Miss?”

Behind me several voices responded immediately, “Her name Latisha”.

“I’m asking her” I replied, “Please allow her to answer the questions.”

“What dat cracka mofugga said? I be dat girl mama, I answer if I wants to.” This came from a belligerent older female, who glared at me.

“Ma am, I’m trying to assess her mental condition, that’s why I want HER to answer” I said. “If you answer for her it doesn’t help me at all.”

Instead of calming her down, this served to further agitate the woman, “Dey ain’t nothing wrong wiff her mental condition, you tryin to say she retarted?” She was steadily moving towards me, bobbing her head and clenching her fist. “Don’t be telling me my baby retarded, I kick yo mofuggin ass cracker.”

My partner stepped between her and me, trying to explain what I was attempting to tell her, only to be shoved out of the way, the police officer who had been at the door grabbed her and told her to calm down.  All this of course only served to fuel the fire, and the people outside the door began to move closer and start yelling.

“What dey saying?”

“Sombitch sayin Teshia retarded !”

The officer radioed for backup and we had a tense few minutes before the scene was controlled, but not before many threats had been issued, and the woman’s mother had been placed in handcuffs.  This lead to more threats and shouting from the growing crowd, who only dispersed when two other patrol cars rolled up with lights and sirens.

During the whole scuffle, the patient had stopped her “seizures” to watch, when she noticed that I was looking at her again; she immediately started to shake again. I looked at my partner and raised my eyebrows at him, “What you think bro?” I asked.

With a straight face he said, “Duke that is the worst case of 13^th cranial nerve compression I’ve ever seen.”

We loaded the woman on the stretcher, and moved her through the crowd to the ambulance, and loaded her into the back.  During this, she kept shaking and twitching, but her motions had become slower, no doubt due to her tiring, and she kept peeking to see if we were looking.

“What you want Duke?” my partner asked, “IV?”

“Yep, think we might need a large bore IV, and perhaps some fluids, how about hooking me up with a 14 gauge.” I said.  For those who don’t know, a 14 gauge IV is as big as we carry on the ambulance; it’s about the size of an 8 penny nail, and usually hurts like hell. We save them for trauma patients, but I was feeling evil.

Without a word, he reached for the IV tray, and pulled out a orange colored catheter, put a tourniquet on her arm, swabbed her vein, and then said loudly, “I know you’re unable to hear me because you’re having a seizure, but this is going to be a BIG stick. Don’t jump.” As he slid the needle into her arm, puncturing the vein, our previously unresponsive patient screamed out, “Dat shit hurt bitch, why you stabbed me?” Her seizures had miraculously disappeared.

“I thought you were having a seizure.” He said, “What happened?”

“Us was having a skeezur, but you done made it go away wiff dat needle” she said, “I guess de pain done stopped it.”

We assessed her vitals, and then transported her to the local hospital, rolled her inside and into a room. I gave my report to the accepting nurse, who nodded and said, “She’s been in here before, we are very familiar with her.” She gave me a look that told me she knew the seizure was fake as well. I handed her my run report and she signed it, and we left the room.  As I exited the room, the ER doctor walked in, “What seems to be the problem young lady?” he asked her.

“Dem EMT say us got 13^th cranium nerve compression.” She told him. “dat’s why us done had a skeezur.” “Us done had 5 today.”

The doctor stared for a moment, then said, “Hold that thought ma’am, I’ll be right back.” He walked out of the room and approached my partner and me. “What the Hell is she talking about? 13^th cranial nerve compression?”

We explained to him it was our personal code for anyone who was acting out for attention or just plain acting stupid, he stood there for a moment, then laughed and said, “you’re both wrong, that crazy bitch is compressed all the way down to the 15^th or 16^th cranial nerve.”

He walked away laughing, “I knew you two were crazy, but that takes the cake. Get the hell out of my ER.”

As we walked out of the ER I could hear the patient’s family at the receptionist desk demanding to be allowed back to the exam room. From the sound of it, the Witness, Patient advocate, Curbside Lawyer and all the rest were there.