And the ‘Actor of the Year’ award goes to…
The lady from number ten with the dizzy spells!
Everyone puts on a show. Absolutely all my patients bar none. I’m not implying that they don’t / didn’t feel well. I’m suggesting that people don’t say “the whole truth and nothing but the truth, so help me G-d.”
Some put on more of a show; some less – depending entirely on their self-esteem and emotional stability.
Some put on an impeccable show; some put on an inferior show – depending entirely on their acting skills.
The only patient that doesn’t perform is an unconscious one. It is then and only then, that one can see the person as they actually are – making the initial diagnosis thankfully, remarkably simple:
For all my other clients, accurate diagnosis is more difficult and is, essentially, a labor of love; separating the wheat from the chaff. ‘Tis an art form – of which I am the artist. Theatre – wherein my patients are actors. In the early days it was near impossible, but ultimately, I have become somewhat of an expert in distinguishing the percentage of the ‘illness’ that is life threatening and the fraction that belongs to Bollywood.
Nothing against Bollywood – it’s a perfectly nice place, sunny, music, dance and all. I just want to know who hails from there. Please.
“Why is it?” you ask.
“Why is it that everyone becomes a red carpet actor when it comes to emergency medical situations?”
The answer, or answers, brings us to the core of the human condition and the psychological or perhaps psychosomatic heart of operations beating within all of us.
Do please come inside for a closer look.
The Why, Who and How
The reasoning is remarkably simple. We can all relate to it, and if but perfectly honest with ourselves, are guilty of it.
Hint – Ever pull out your Iphone and scroll aimlessly through decade old whatsapp history when someone joins you in an empty elevator.
You must not have an Iphone, whatsapp or elevator!
The inner emotional mechanism goes something like “I’m embarrassed, I feel silly, I feel insecure.” Translated into real-time: “I made a fuss and initiated an emergency medical response. There are lights flashing, sirens blazing, and ambulances speeding through the streets towards me; they can’t land here to find me well and healthy!”
This quickly turns into – “Oops, they’re here now; someone’s taking my pulse, another’s unwrapping a non-rebreather mask; I can’t just stand up, dust myself off and go buy a bagel.” It becomes a snowball situation, once started, nigh impossible to stop.
The more immature the person, the longer the spiel goes on. And in case you were wondering, maturity in these matters is in no way correlated to age. On the contrary. It’ll very often be the younger ones that say, “Hey, it doesn’t hurt anymore – See ya later!” before whizzing off like a speeding bullet.
Forgive the cynicism, but my lamentable, ineluctable and yes, cruel deduction is that:
- The younger the child, the less room there is in his life for falsehood and inflated ego. Gimme a toddler’s honesty over an adult’s artifice anyday.
- Tweenhood is a time of businesslike deliberation, “Go back to the skatepark, or milk this for all its worth?” Better yet, “Will this buy me time off school, or a reprimand from Dad?!”
- Late teens, early twenties – same type of considerations, except higher stakes and more intense social pressures; chicanery in full bloom.
- Forty, Fifty, Sixty year olds – Ladies and Gentlemen, take your seats and pray silence for an all-out performance of Phantom of the Opera.
It all starts with eyes shut tight. This allows the patient to slip, quite seamlessly, into the fictitious world of sirens wailing, people encircling, bystanders observing, someone trying to get my Mum on the line, and then eventually the quintessential desperately anxious shouts of “Will somebody get some water ASAP?!”
And now, deep into the first half and nearing the intermission one can’t expect the leading actor to sit up and say “Thanks everyone for your help – and that’s a Wrap!”
N’est pas possible.
And so therein begins a particularly problematic escalation that can continue ad infinitum. Bystander to Teacher – Teacher to EMT – EMT to Ambulance – Ambulance to ER Nurse – Nurse to Doc – Doc to Surgeon. A lie; perpetuated with no foreseeable end in sight.
Why’s this all happening?
Oh that’s right, feelings of insecurity.
Of course not all patients behave in this manner; stay tuned for another post with detailed case studies and examples. Oh and if you’re looking for the trusting, undoubting, believing, optimistic Shmeel – He’ll be back in the office on Thursday.