The Patient of the Year

(This is not meant in any way to disparage my patient.  I post this so you get an inkling of the challenges facing the terrifically good-looking but otherwise ordinary Emergency Physician during a shift).

A patient presents to the ED, from an assisted living center.  The Chief Complaint on the triage form says ” ? ”  I’m game.  Into the cubicle we go.

“Tell me the story”, I say.  Blank look.  Look again at the triage form.  ‘Patient is deaf’ it says.  Also, ‘history of schizophrenia, and CHF’.  Ooh.  No medication list. 

Great.

So, a good PE is completed, and a lot of pantomime is done.  The interpreter is called.  And, a wait ensues for said interpreter, though the lab workup continues.

The interpreter comes, sleepy but competent.  After a while signing with the patient, I get something unexpected: ‘this isn’t making any sense’.  What do you mean?  ‘I mean the answers have nothing to do with the questions, and there’s a lot of things that make no sense’.

Ask if the voices are louder than normal.  ‘Yes’, and the interpreter is relieved, as now it’s all making sense, at least for them, if not for the patient.  Does patient think their voices are out of control?  ‘Yes’ says interpreter, clearly relieved that things make sense now.

Labs are returning, and it’s not good news.  Elevated troponin could (probably does) indicate cardiac injury.  ?Chest pain? is asked, and there is no answer that makes sense, per the interpreter.  The EKG looks like the chest xray: wide and abnormal, but nothing that makes the clinician panic.

To say the consultants were thrilled with this admission would be an understatement, but not one griped. Amazing.


Comments

  1. I’m always appreciative of any laboratory value that equals automatic admission.

    Next!

  2. She’s deaf, but she hears voices. This fascinates me. Was she born deaf? You probably don’t know that, but if she’s never heard human voices, what does “hearing voices” even mean to her?

    This sounds like the kind of case Oliver Sacks would love!

  3. I had the exact same thought as Susan. What does it mean to “hear voices” if a person has been deaf their entire life?

  4. Do you think that hearing voices could just mean hearing thoughts coming from a variety of different sources? I mean…..I don’t need to have ever heard someone speak in order to read – and those thoughts get internalized in my own head. For someone who is deaf to communicate at all, they must have a series of thoughts go through their head – and even if they cannot hear a certain voice, they still have that streaming run of thoughts going. So I would think that it would be very possible that they could hear voices, but not by “hearing voices” as we might think – but think of it as having a lot of loud “thoughts” – that appear to come from other places besides within one’s own brain. I may be totally off base there, but that’s how I would interpret such a thing.

    Interesting and challenging patient – sounds like you did a great job to get the patient the help he or she needed!

  5. I believe the correct description is “responding to internal stimuli.”

  6. Don’t you love it when your whole shift is full of these? Sometimes it makes me wonder what week or year of medical school I missed.

    In our ER the patients fill out a paper demographic questionaire that includes a chief complaint. The triage nurse also puts a chief complaint on the chart. I start off by asking why they are here, and often all three chif complaints are widely different and seemingly unrelated. Many times these people don’t play with a full deck, or it has to do with wanting a medication that begins with a “D”, or they need a note for missing work last friday and this monday.

  7. I’ve always wondered what deaf people “hear” when they’re thinking. I believe everyone has that state of conciousness or awareness that is seperate of our physical shells. Could different states of awareness be stuck in the same physical shell?… schizophrenia

  8. Wow – this was a challenge! Thank goodness the objective tests confirmed a diagnosis, because it sure would have been difficult to sort it all out.