Patient:  It’s not my fault, the problem is that obesity runs in my family.

Doctor: No, the problem is that nobody runs in your family.

I consider myself quite tolerant, though I have been a documented fattist.  Losing weight is the fourth most important thing my patients can do for their health.  You want the first three?  OK, fine, since you’re looking especially handsome today, I’ll give it to you.

The top 5 best things my patients can do for their health.

#5:  Stop existing in a vegetative state.  If you need a small cart to haul yourself around while you shop, you should not be in a small cart to haul yourself around when you shop.

#4:  Lose roughly 2/3 off your weight (get that BMI below 30 (25 for the dreamers))

#3:  Stop smoking crack, doing heroine, and other drugs (yes stop smoking pot, it doesn’t kill you but it makes you useless to society.  Also, don’t let your 7 year old child do it either).  Pot does not cure cancer, sorry.

#2:  Stop drinking.  One glass of red wine is good.  Two fifths of vodka, not so much.  It just makes gravity stronger for your face.

#1:  Stop smoking.  No.  Shut up.  Please just shut your mouth and stop smoking.

There you go.

I’ve ranted about all of the above.  But #4 was reminded to me by a nurse who was trying to insert a foley catheter into a man, but he was so fat that she could not find his penis.  Yep.  COULD NOT FIND IT.  You know how you can have an inny or outie belly button?  Usually that’s not so true for your penis.  Oh well.  In fact, she actually thought his penis initially was his belly button… but he said “yes” when she asked if that felt like the area where urine usually came out of.  And Lo and behold, under the folds was a ding-dong and a ding-a-ling.

Secondary gain: And external usually incidental advantage resulting from a disease process. 

Usually people get secondary gain in the form of attention from other individuals, days off work, rest, gifts, etc.  If you have the flu, people often try to make you feel better and thus provide secondary gain.

Sometimes people actually pretend to be ill in order to get attention, or days off work, or disability or whatever.  This is where our story begins.

If you have ever seen a seizure it is a terrifying experience.  Though there are a wide variety of seizures, grand mal are both the most common and visually the most terrifying.  A person collapses to the ground, their entire body stiffens, then this is followed by rhythmic jerking while the body is unconscious.  This is often accompanied by tongue biting, incontinence, and periods of apnea (breath holding).  Also (and this is important), after grand mal seizures there is a period of confusion, disorientation, and exhaustion immediately after seizures called the “post ictal” phase.  After a seizure, you don’t just wake up and feel completely better, your brain just pressed the reset button, it takes a while to reboot.

However, there is an entity known as Pseudo seizures.  These are when a person demonstrates seizure-like activity without the actual neurological brain firings seen in epileptic seizures.  There are a wide variety of causes for these, the most frustrating (and seemingly the most commonly seen in the ER) are pseudoseizures for secondary gain.

Yep, some patients actually just pretend to have seizures so they can come into the ER and have people feel sorry for them.  Now, don’t get me wrong, all pseudo-seizures are not willfully caused by patients, but let me give you an example from one of my nurses.

My nurse: Yeah, she’s having another whatever you want to call that.

Friend in room: “Can you get the seizure pads?   She’s having a seizure”

Patient:  <Moves arms back and fourth randomly in a poor representation of a pretend seizure>

My nurse: <Walks into the room> “Yeaaaaah.  We don’t need to do that right now, she’s fine.

Friend in room: “Why not?!”

My nurse: “She’s fine.  She’s not having a seizure.”

Patient:  ”Yes I am, this is a real seizure.”

My nurse: <sighs and walks out>