Laying on of the Finger

April 29, 2009

healing_fingerPart of my mission with this blog is to help those outside of the medical realm to understand how much BS we often have to sift through in order to get to the bottom of things. Case in point, I get word that EMS is bringing in a potential “neurological injury”.

Let me tell you, neurology and nerve injuries are not on anyone’s list of favorite things to deal with in medicine. They’re confusing, complicated and then you have to deal with neurosurgeons – the medical equivalent of getting sodomized with a baseball bat. So, needless to say, I was worried.

Finally the patient rolls in, appropriately strapped to a spine board and in cervical precautions. He looks scared and worse yet, he’s not moving. He’s a young person, maybe in his mid 20’s, which makes it a recipe for true disaster. So, I carefully start getting the story.

Turns out that John and his girlfriend were having some fun at home and started chasing each other around the dinner table. But then suddenly John hits something and crashes to the ground, unable to feel anything below his waist. His girlfriend starts to panic and calls 911.

My first instinct was to get on the phone with neurosurgery, and get this guy into the right hands ASAP.  But the image of a baseball bat makes me think that I should at least do a thorough neurological exam on this guy first. I start with his cranial nerves, which seem normal above his waistline. Beyond that though, he has no pain response, no movement and no sensation whatsoever in his legs. I’m starting to sweat.

Last on the list though is to check rectal tone. When someone is truly paralyzed below the waist, they almost always lose their muscle tone in their anus and rectum, as well as losing control of their ability to control their bladder. Put simply, they urinate and defecate on themselves. Yet John’s tighty whity’s are Clorox clean. Hmmm? Maybe he was lucky enough to preserve this area I’m thinking. But, like it or not, I have to do the rectal exam.

As I start pulling his underwear down, for the first time it seems, John starts to look anxious. “What … what are you doing??!!”, he blurts out.

I explain, “I have to do a rectal exam … basically involves me putting my finger in your ass to check your muscle tone. It will help me to understand your degree of paralysis.” I have the nurse put the lubricant on my finger and just as my cool, gloved finger touches his anus, something miraculous happens.

John’s butt cheeks clench so tight, and his previously “paralyzed” legs snap shut and come off the backboard with truly impressive force.

So all was well in the ER. I wasn’t going to get sodomized by neurosurgery after all, John had a “miraculous” recovery and I temporarily became known around the ER as “Jesus”.

What had happened? I will never know for sure, but I’m pretty sure John was alright before EMS even arrived to his house. How far could this ruse have gone? Who knows? Why was he faking it? The promise of a disability check, for sympathy, thought it would be a good joke – your guess is as good as mine, but he wasn’t the first and he unfortunately won’t be the last person trying to pull the wool over our eyes for some alterior motive.