Trusting the Patient

I get paged by my resident to go see a 21 year old girl in the ED. Apparently, over the last 3 weeks she has become paraplegic and can't walk. I go in the room and her grandma is there having Taco Bell and the girl is laying in the bed in stupor, coming in and out of sleep. She more or less refuses to talk, has an odd affect and so I use the grandma as my source of information. The story doesn't make sense and my biases start coming into play. What is this girl doing? What is really going on here? Is there a motive to act paralyzed? Is this conversion disorder--was there a recent significant life stressor? Is this factitious disorder, is this malingering? What is going on? Looking at old hospital records only assured my biases-she had gone to two hospitals in the last 10 days both of which told her nothing was neurologically wrong, that she should go home.

Well, today I checked up on her...in the critical care ward. Her mother and grandmother were already in tears when I came in, her grandma gave me a hug when she saw me. I asked them how things were going and to fill me in on what they knew since I am not on the patient's treatment team (just checking up on my consult patient). They asked if I had seen her MRI-I had...that was the reason I came of course. It was terrible looking with demyelinating lesions throughout her brain and spinal cord. The patient began crying and in an attempt to console her, I told her that at least she was in the hospital being worked-up now and beginning treatment rather than being told that "this isn't real" and being sent home. Nonetheless, a lot to handle for a young woman.

Today I re-learned to trust a patient. When things don't make sense, it requires further investigation not dismissal.