Phenobarb… plus he kept her of course on her steroid, Prednisone 10 mg by mouth every other day!
He had been right in spite of his fellow academicians. In retrospect, Dr. Martin could have reported the case -and his management- to a medical journal, but he decided not to. It had been indeed quite an unusual case and going by just his gut feeling against his colleagues had worked!
On the negative side, though he had kept quiet about his management of the little girl’s seizures with Prednisone and did not tell the pediatricians on the floor, his unusual management of the girl’s seizures with a steroid was reported to them by the visiting nurse who checked the group home weekly. Eventually the news reached also by word of mouth the pediatric endocrinology attending who had opposed the steroids. He was outraged, of course. And Dr. Martin’s precarious reputation amidst his academic colleagues only got worse; eventually it would damage him beyond help.
CHAPTER 9
A Very Long Grand Mal Seizure
Catherine Pierce was a grown woman in her late 20s. Dr. Martin being primarily a child neurologist, generally would not have seen her through the emergency department; but he happened to be back then rotating with his fellow adult neurology colleagues to cover the E.R. every 10th weekend or so and he was on call that Sunday.
Mrs. Pierce lived about an hour from Dr. Martin’s hospital. She had been taken to her own local E.R. because of a long Grand Mal seizure. Most big seizures that happen out of the blue do not tend to last more than a few minutes. But this one kept going and going. So by ambulance they transferred her to the larger city where Dr. Martin practiced. When she arrived, the E.R. staff called the neurology resident on call. He happened to be tied with another emergency in the nearby V.A. Hospital, accompanied by Dr. Martin, the attending on call, who’d gone over to help him.
When the call came on their phones from the other E.R. because of the non-stop seizure of that woman, Dr. Martin remained where he was, his hands still tied down with an in-patient with a stroke, and sent his resident across the street to the other hospital to see what was going on in their E.R. with Mrs. Pierce.
When his resident saw her, still seizing, he gave her a 5 mg intravenous dose of Diazepan (Valium) and brought her up to ICU upstairs. The Valium did not stop her seizure; they had already tried 100 mg of sodium Amytal in the previous hospital before they brought her by ambulance. They figured that by then she must have been seizing, since she started at home, for at least two hours. The ICU’s own attending happened to be there and he suggested the resident to give her a second dose of Valium.
The resident injected it himself ‘slowly’ as per protocol. In most cases the seizure stops by the time the whole vial is in. But not this time. Both the resident and the ICU attending were getting nervous by then; the attending yelled at the resident:
“Why your attending, Dr. Martin, is not here yet?”
“I don’t know. He is still at the V.A. probably pretty tied there with another emergency.”
“Well, call him and tell him that whatever it is, that THIS ONE is more urgent. Long seizures like this one do cause brain damage!”
So the resident did. As he was still on the phone explaining to Dr. Martin that a second dose of Valium still was not working, the ICU attending grabbed the phone from his hand and gave Dr. Martin hell.
“God damned, Frank! Why aren’t you here already?”
He explained that he had another emergency at the V.A. But it wasn’t enough.
“Well my friend, whatever keeps you busy there, get the hell in here right away, Your resident can’t stop this hard seizure and she is going to die on us. Will you?”
Dr. Martin left the stroke patient in the V.A. alone with the nurses and we are told that he literally run outside to the other hospital ICU where Catherine Pierce was still seizing. It took him only five minutes to get there. Both the resident, the ICU attending and two nurses were at her bedside. As he nodded his head to his colleague attending, he listened briefly to the history and situation, his resident repeating all to him as he was observing the young woman still quivering all her extremities with her eyes closed. The hard and extremely long Grand Mal seizure did not seem to be taking a toll on her body in any way. There were no asymmetries. She did not respond to his stabbing her with a pin in the back of her feet and hands. She gave no reaction whatsoever to pain and her breathing or heart rate did not change.
Frank Martin then asked those four people in attendance to step a bit off her bed and watch carefully as he literally tickled the woman vigorously on both sides, just above her belly. To the others’ surprise, she immediately squirmed reactively, which she had not done when stabbed with a pin. With all the Amytal and Valium she had already received, Dr. Martin was not sure she was going to react to his tickling her; if she didn’t, he was thinking of repeating his ‘tickling approach’ the next morning when the sedative effect of those drugs would be gone. But in spite of the drugs, she did react to the tickling and ‘sort of caught,’ she slowly stopped shaking. ‘Wow’! His diagnostic impression of ‘a long hysterical seizure’ was firm.
“How did you know it was not a real seizure?” asked him the ICU boss.
“Because she kept her eyes forcefully closed! In a generalized seizure one’s eyes are kept normally open, like when a person dies!”
“Wow, Frank. I am impressed. I am sorry for my initial overreaction. I’ve learned today a big lesson. And I’ll never forget the two pointers of ‘the eyes being closed’ and the ‘tickling trick’ if I ever suspect ‘faked’ coma or a seizure as being hysterical! Thank you! In fact, I’ll try it in every hard seizure I see.”
The neurology resident was also quite impressed with Dr. Martin. He hadn’t been told yet ‘about the tickling and the eyes closed stuff’ in his training…
Needless to say, the patient, already calm, quiet and ‘asleep,’ was immediately moved out of ICU and placed in a regular single room. The next morning a psychiatrist saw her and she was transferred to the Psych ward.
CHAPTER 10
A Very Long… What?!!!
Deidra Bell was 16 and very pretty. For several days she had been noticed in school to act very strange. In the middle of the day she appeared to be… not just herself, as if she was not with it. Her classmates finally brought the matter to the attention of the teacher while it was happening. Her teacher, thinking that she had ‘taken something,’ brought her to the school nurse. She also thought that she was probably on drugs. By the time they called her mother thinking of taking her to the nearest Emergency Room, she had snapped out of it. So they stopped.
But they still told her mother that something really strange was happening with Deidra, and that mom had to watch her better as for whom she was with after school hours, and that she‘might be using speed, or perhaps acid’… Then nothing happened for the next week. But after that, similar episodes of not acting herself started again. Finally in one of her longer episodes of ‘spacing out’ the nurse was contacted again, mom picked her up and she took her to the E.R. She was still out of it so the nurses and doctors had plenty of time to see what was going on. She was ambulatory but non verbal. Her exam was normal and so was her blood work; her drug screen in blood and urine was negative. She was OK again by the time they were done. The next day the same thing happened and mom took her back to the E.R. And as before, nothing abnormal was found and again her toxicology screen was normal; she was not on drugs; after 3 hours or so she again snapped out of it. Someone suggested that she be seen by a pediatric neurologist who was in private practice and who was known for seeing most new patients with a rush within a day or two. So they called Dr. Martin who, yes, could see her in a couple of days. He even offered to see her that very same day, but they told him that she was already fine. The next day would be fine.
Mom and daughter showed up for their scheduled appointment and Deidra was ‘normal.’ She was not acting strange or out of it. Her EEG was