Seductive Logic

Essential Tremors

The two tone neenaw call of the "pay attention to me" alarm notified us that that we had a paramedic ambulance incoming.  It was transporting one of our frequent flyers, a 27 year old man on disability due to psychiatric problems, probably Munchhausen syndrome.  He had a subsidized apartment just a couple of blocks from the emergency room.  He never walked over.  He had called 911 reporting "A Stroke or something worse".  I was the ER nursing director.  One of the best emergency nurses I have ever known was on triage duty.  The ambulance came in.  I heard it's back up  alarm as it backed up to the ambulance doors.  A few seconds later the double doors slid open after one of the paramedics punched in the code on the numberpad outside by the  ambulance doors.  Barry, the triage nurse arose from his desk to assess the patient's condition as the paramedics rolled him in on the ambulance's rescue gurney.  The triage process was progressing according to standard ER policy and procedure (dogma).

"Hey, Chief, could you come here a minute.  I need some help determining his triage level." Barry, the triage nurse requested in his calm cool and collected tone of voice.

I was in the treatment area and I turned and walked a few steps to where Barry and the patient were.

"Yeah, Barry what is the chief complaint?"  I was at the same time letting my eyes start picking up on clues from the patient.

"Mr. Crock reports that he may have a cerebral vascular accident which has caused him to shake uncontrollably"  Barry was choking down a chuckle and failing on his grin.

I swept the patient with my eyes and listened for symptoms.  I felt and took radial pulses.  Both sides were rebounding the same and the heart rate was seventy six.  I took note of the patient's left hand shaking grossly and violently.  This increased whenever I looked at his hand.  In his right hand he held a cup of coffee without shaking or spilling a drop.

"Mr. Crock. Why isn't your right hand shaking at all but your left hand is shaking out of control"  I had the serious knitted brow expression on my face. 

Without missing a beat.  Mr. Crock switched hands with the coffee cup.  The left hand holding the coffee stopped  shaking.  He  held out his right hand to me that was now shaking violently.

See, Chief, it's the same in both hands" With equanimity and aplomb he demonstrated his symptoms.

At that point, the ER manager, the triage nurse, and the two paramedics burst out laughing so hard they couldn't remain standing erect.