Unfortunately, someone who was not at ConAdian was Sharon Farber, who had
received a Hugo nomination in the Fan Writer category. Sharon called us about a
month before the convention to let us know that she would not have Labor Day
weekend free this year, and "...in case hell freezes over and I win, would you
accept the award for me?" Even though the world wasn't treated to the sight of
demons strapping on ice skates this year, we think a rocket for Sharon won't be too
far in the future. Meanwhile, here is another in her series of medical
Nostalgia, like beauty, is in the eye of the beholder. I used to get nostalgic when I'd see, say, a copy of Sgt. Fury and His Howling Commandos. Then I'd be sunburned on a pier, feet dangling into the Russian River, eating Cheetos and watching Nick and the boys single-handedly beat the Ratzis.
Just recently I was in an emergency room evaluating a penniless drunk who'd had an alcohol withdrawal seizure. "Thanks," said the ER doc, who then began to apologize for asking me to come see the guy.
"Hey, no problem," I replied. "It makes me nostalgic for residency."
Somehow, when one leaves the world of training programs and charity hospitals, one thinks one's clientele will improve. No more alcoholics, wife-beaters, drug seekers, and hysterics. But one still gets them, just a bit more polished and upscale.
My first month of private practice, I really did think things were better. Then, one night, I met Buddy Boy Baker. (His name wasn't really Buddy Boy Baker, but it was just as bizarre.)
I was happily into Stage IV sleep about five a.m. when a doc called from the ER of a small hospital in Georgia where we covered. "I've got this guy in status epilepticus," he said.
Status. That was bad. Seizures that don't stop and can fry the brain. Comatose patient in danger of dying.
"He told me he has seizures and takes dilantin and phenobarb, but his levels were zero."
Typical. The number one cause of status epilepticus is skipping your seizure meds -- waitaminnit! "He told you??"
"Yeah, he talks between these seizures."
That wasn't right. So he described the seizures to me some more.
"They sound kind of phony."
The ER doc agreed that it was pretty suspicious for pseudo-seizures. So I got dressed and drove on down. By then it was dawn, with all the marvelous scenery of rural Georgia in the August heat, namely dust and kudzu. I kept reminding myself, at least, that the guy had insurance, not that getting paid made up for losing sleep. But I was already learning that most night time emergencies in this rural hospital were to be total charity, or Georgia Medicaid, which was like total charity but with annoying paperwork.
On arrival, I was introduced to Buddy Boy, a youngish guy with a number of tattoos to help prove the diagnosis of a sociopath. He had enough sense not to try faking seizures in front of a neurologist, and instead told me his story of long-term seizures controlled only by dilantin and phenobarb.
"Gee," I told him. "I'll be happy to give you the dilantin, but I can't give you any phenobarb."
I wanted to say, "because you're drug-seeking and want it," but instead I told the odd truth. "I'm new in private practice, and I don't have my DEA number yet, so I can't write controlled substances."
He immediately signed out against medical advice.
I thought I'd seen the last of Buddy Boy, but a couple of months later the bookkeeper informed me that Buddy had given us his father's insurance information, and the company was real mad and wanted a refund. I was just amazed that the dad's legal name was 'Buddy' too.
Then, many moons later, I was just hitting Stage II sleep about midnight when a medical resident from the teaching hospital called me in a state of acute anxiety. They had just got a patient from the county jail workhouse, and they couldn't stop his seizures. It wasn't my responsibility, but they'd heard I was friendly and informative, and they sure needed help with Buddy Boy Baker.
"Repeat that name," I said. I told them to stop what they were doing -- which was giving forty or so milligrams of Valium intravenously -- and got dressed and drove on down. Another night's sleep shot.
It was indeed the guy I recalled. He was gamely trying to fake seizures, except by now he was inebriated from the Valium. He had been in the workhouse, only not working because of cerebral palsy. And now with a couple days left to his sentence, he decided he'd rather be in the hospital hotel. Word was that he was going to be transferred to a jail in Georgia when Tennessee was through with him.
I explained pseudoseizures to the residents, then went home. The next day I dropped by to say hi. Buddy was holding his hand very oddly.
"What's wrong with your hand?" I asked.
"I've got cerebral palsy," he said.
"No kidding, that's amazing," I said. "That's earthshaking. Because that's something you're born with, and you sure didn't have it last time I saw you."
Well, the residents wimped out and didn't take my advice. They let him stay, faking one symptom or the other, until his sentence was up. Then it was miraculous recovery time, and Buddy checked out.
And the very night he left the hospital, I was providentially on call again. About five a.m., I got another phone call from the little hospital in Georgia.
"We've got a guy named Buddy Boy Baker here," said the ER doc. (A different doc than the one before. These crummy jobs have high turnover.)
I started to laugh. "Status epilepticus, right?"
"Just left the teaching hospital," the doc agreed. "You know him?"
So I told him the story of Buddy Boy Baker and the fake seizures and the desire for phenobarb. "Need me to come in?"
"Nah, let me handle this," said the ER doc with an evil little chuckle. I learned much later what happened.
Having hung up the phone, the doc walked over to the treatment room where Buddy Boy was still vigorously shaking away, the very image of the unconscious patient in the grips of a dangerous electrical brain storm.
The ER doctor paused dramatically in the doorway, waiting until the panicking nurses looked away from their desperately ill patient and at him. Then, in a loud voice he ordered: "Don't let this man leave! I have reason to believe he's wanted in the state of Georgia!"
The comatose epileptic suddenly stopped shaking, sat up, and very earnestly said, "Oh, no, that warrant's been dismissed!"
It was, to my knowledge, a unique method of treating seizures.
Title illustration by Peggy Ranson