Tangled Web

Sometimes there is a thin line between perception and reality. Between what someone tells themselves is happening and what is really happening. Our ability to deceive ourselves and even our own bodies makes understanding and believing others, and even ourselves, harder than it should be.

She was brought in by ambulance, and she was thrashing and weeping and screaming as they transferred her to our gurney. Her back would arch and her body jerk side to side as tears streamed down her face. She would make eye contact with me and then with her husband who stood helplessly and awkwardly at her bedside. Her admitting complaint was "seizure" and her husband reported that she had a history of these "seizures".

If you know anything about seizures, you may know that they involve more than uncontrolled jerking of the body. The person is not conscious during a seizure, will often lose control of bowel and bladder, and afterward has a period of confusion, we call being "post ictal". A person in the midst of a true seizure will not be crying or screaming and most certainly cannot make eye contact.

"Can't you do something to help her??" Her husband looked at me and back at his wailing wife with a mixture of concern and uncertainty.

I shifted uncomfortably. I was still fairly new to the ER and no Neurologist, but I was pretty certain whatever was happening to his wife would fit more appropriately under the "mind" than "body" category. But you can't really tell someone's worried spouse, "You know it's probably all in her head..."

We gave her Ativan (helps seizures and agitation), tested her blood and scanned her head. As expected, everything was normal. "What do you think is going on?" Her husband asked me later. I explained carefully that the symptoms she exhibited varied largely from a classic seizure, but it didn't feel right to express to him that it might be a psychological issue. I saw the glimmer of doubt in his eyes as he stood there.

I've wondered many times since about this woman, hypothesizing about what goes on in her head when she has these "episodes". Does an increasingly aloof and distant husband suddenly become attentive and concerned as he leans over her bedside in the hospital? Does it give her temporary respite from stress and responsibilities? Has it become her back door, her excuse, her crutch? A fake seizure is much further down the line than faking a headache to get out of school, or over-exaggerating an injury for the attention it brings, but isn't the root the same? I'm willing to bet she doesn't even admit to herself that there isn't something physically wrong. Because it's amazing how adept we can be at deceiving ourselves right along with deceiving others.