The Faker

It was the beginning of the shift and even more hectic than usual. The nurses had finally finished fighting and were starting to get to work when one of the physical therapists yelled out that someone by the elevator was having an asthma attack. I could have ignored her like everyone else, but I couldn't just walk away. I gave the therapist an oxygen tank and told her that I would get some tubing and meet her there.

It was a long walk to the elevators, but I walked as fast as I could without running. The sight surprised me. A young woman was lying flat on the floor, unconscious. As I kneeled on the floor, someone said that she had been hospitalized with a pulmonary embolus last week. This was not an asthma attack.

He breathing was unlabored, but uneven. Sometimes she just stopped breathing, but as soon as I shook her and yelled at her she would take a deep breath. Her pulse was good and strong. She was not a patient and we weren't in a nursing unit, so we called an ambulatory response team code and no one came. Well, security, the chaplain and a house supervisor came, but no one who could take over came. Usually at this point, I can just get out of the way and let the code team go to work.

A couple of nurses from my sister unit asked if we wanted a crash cart and I said yes. The supervisor worked on keeping her airway open while I broke into the cart to get supplies. We were in big trouble and couldn't wait any longer for useful people to arrive. We decided to call a code blue.

This time I ran back to my unit to tell someone to call a code. As I ran back to the young lady on the floor, I noticed a huge group of onlookers backed along the wall watching with various expressions of horror on their faces. I've never been involved in a code with members of the public watching.

An ICU nurse arrived and started bagging the patient. I'm not sure why because the patient was breathing if you nagged her, but I guess it's just a different approach. If nagging works, I don't bag. I was getting ready to start an IV when the anesthesiologist tried to jam an airway protecter in her mouth. The girl bolted upright and pulled it out of her mouth. At that point, it was decided to let her breathe on her own.

A couple of guys with a gurney arrived, thank goodness, and we all lifted her up onto the gurney. She was wheeled away to ER.

I went back to work. I was way behind now, but did the best I could. My coworkers had little interest in the code, but every one in a while, I would look at the computer to see how she was doing. Pulmonary embolus was ruled out and she was admitted to ICU to wait an see if there was evidence of heart attack. Eventually, heart attack was ruled out and she was discharged home.

When I had more time, I read her medical history. It wasn't true that she was hospitalized with a pulmonary embolus last week. She had just spent the last two weeks in a psych facility. She is schizophrenic and bipolar and two or three times a month, she comes to the hospital with pulmonary embolus symptoms and states that she has a recent history of having suffered from one. Every time that happens, we have no choice but to do a complete work up which always turns out to be negative. She gets psych referrals and sometimes does time on psych wards, but she always goes back to her old ways of pretending to have an pulmonary embolus.

If she just likes being the center of attention, she picked a good way. People with pulmonary embolus do not wait in the ER . She gets everyone's attention immediately. If she doesn't do it for attention, than I have no idea what her motivation is. Has anyone come across this kind of patient?