Science Bedeviled in the ER
While working in the emergency room of a large, urban hospital one afternoon, I was pulled aside by a paramedic who told me that he and his partner had just brought in an unresponsive patient from a nearby high school. Picking up the patient’s chart and my stethoscope, I went to investigate.
In medicine, the word “unresponsive” has bad connotations. It’s a general term that can stand for a wide variety of things, both serious and not so serious. A patient can be unresponsive because he or she is dead (here “unresponsive” is synonymous with “asystolic,” meaning “without a heartbeat”) or nearly dead, say from a large stroke or a massive heart attack. “Unresponsive” is also used in a patient with a systemic insult, such as low blood sugar or a drug overdose, or in an asthmatic who is not sufficiently delivering oxygen to the brain. Often the term is used loosely to describe patients with end-state senility, psychotic disorders, blindness or deafness--and those who are drunk or asleep.
In this case, the patient was a teenage girl, and the main problem was that she had been possessed by the devil just prior to an exam. The prince of darkness had caused her to collapse onto the floor in the middle of her classroom and to remain in a state of flaccid unconsciousness despite efforts by her teacher, classmates and paramedics to revive her. They had tried pinching, smelling salts, sticking her with a safety pin and inserting objects into her nose.
As Thomas Aquinas says: Satan is a most pernicious adversary, both persistent and cunning, and loath to relinquish his hold once obtained.
Possession was a new experience for me.
Thomas Aquinas might know his way around the devil fairly well, but when I entered the room wearing the mantle of modern medicine, I didn’t know what it was I was supposed to do. The paramedics had checked her blood sugar and the oxygen content of her blood; both were normal. The nurses had assured me that her vital signs were also normal.
My examination of the patient proved to me that she was breathing, had reactive pupils, but wasn’t responding to painful stimuli in any extremity.
The ER was busy and I had to make some quick decisions. Should I order lab tests? Should I call a psychiatrist?
I decided instead to rack my brain for more painful stimuli, and my mind went back to stories I had read about the Spanish Inquisition in high school. Fortunately, before I could get started, her father arrived.
He told me not to worry, that she had done this before. Dad, as it turned out, was an evangelical minister at a local church.
Thank goodness, I said to myself, glad that someone there could take charge of the situation. I told him I was Jewish, but that I’d love to help. (As a physician, I’m always on the lookout for learning opportunities.) He assured me, however, that exorcism was a one-man operation, so I resigned myself to watching. But as I was pulling up a seat, other duties called and I had to leave the room.
When I returned 15 minutes later, the devil had been banished, and standing before me was a pretty, smiling teenager as responsive as the day is long. Her father had sweated through his shirt and he looked tuckered out, but stood defiantly with one arm around his daughter’s shoulder.
One of my mandatory responsibilities in the emergency department is to write discharge instructions for all my patients, usually a rather mundane task. In this case, however, I sat hunched over the discharge sheet, pen in hand, wondering what to write. Something pithy, such as “Avoid Satan” sounded too tongue-in-cheek, and the more ominous “Return to emergency department if your condition worsens” seemed like an invitation for trouble. Finally I jotted down “See your own physician for further problems.”
I was content to let it go at that.
Doctors often encounter conditions they’re not trained to treat. In such cases, it’s important to keep an open mind--and to remember that not all problems are strictly medical in nature. Sometimes, a little patience and understanding go a long way, even in the emergency room.
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Steve Edelstein is an emergency room physician in Santa Barbara.
