Smile! You're on Video!

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    A story that happened to me several years ago when I worked with neuromonitoring patients whose "seizures" were videotaped. Not entirely funny but there's no other tag :)

    "Come look at this," said the neurologist. "It's the tape of Ms. Alvarez's events from last night."

    "How many seizures did she have?" I asked.

    I was working on a med/surg floor where two rooms were reserved for neurological monitoring. A patient would be admitted to one of these rooms, have her scalp covered with electrodes to detect any seizure activity and a video camera was trained on the bed at all times to tape any "seizure events" so the neurologist could review them in the morning. There was a video monitor of each monitored patient room at the nurse's station and if the patient had a seizure event, the monitor would alarm and the nurse would have to run down to the room and stay with the patient until the event completed.

    The neurologist smirked. "She had two events. Whether or not they're seizures...just take a look."

    She double-clicked the frozen camera picture on her computer screen and the picture started rolling. It was a green-tinged video of Ms. Alvarez, a young woman, lying in the hospital bed. The time on the screen clock read 1:22AM. She was shaking all over, rhythmically, her head lolled over to the left side.

    "Now watch," said the neurologist.

    Five seconds later, Ms. Alvarez brought her left hand up to face and coughed into it. She was performing voluntary movement during a seizure?

    "I've never seen that happen during a seizure," I said.

    "The next one is even better," said the neurologist.

    She opened up another file on her screen; again, another video clip started. The clock read 3:09AM. Ms. Alvarez was lying in bed. An older woman was visible on the left side of the bed. I recognized her as Ms. Alvarez's mother, whom I'd met the day before.

    Ms. Alvarez was shaking so hard that the bed was creaking; if the brake hadn't been on, she probably would have rolled herself across the room. Her head was tilted to the left side, just like in the previous event.

    Her mother placed both of her hands on Ms. Alvarez's chest. "In the name of Jesus, I command you to come out of her! Come OUT!"

    Ms. Alvarez kept shaking and twitching. The video ended a few seconds later.

    "So," I said, "she had voluntary movement during the first event, which isn't supposed to happen because during seizures you lose total control of your body and neurological function. The second event is vague because her mother was trying to cast a demon out of her."

    "And that could indicate that this is a psychological issue, not a neurological issue," said the neurologist. "If someone believes that they're demon-possessed, that's psych stuff, not my department."

    "What do we do now?" I asked. "Do you think Ms. Alvarez is faking seizures to get attention? She doesn't strike me as a drama queen."

    "We complete the three day evaluation on the neuro unit to see if there are any more events," said the doctor. I'll order a psych evaluation to see if there are any signs of depression or anxiety. We cover all our bases. I don't think she's faking all the events. I think that if we come out and accuse a patient of faking anything, we shut off any open relationship between them and staff."

    "Yes," I said. "I'd want to encourage her to talk to us and not get defensive."

    "Let me know if she has any events during the day," said the neurologist.

    As I left the room, I passed by Ms. Alvarez's room and saw her sitting up in bed quietly watching TV. I had to admit, I found the "exorcism" attempt by her mother amusing, but after thinking about it I realize that if a mother was desperate to help her child overcome an illness she might try anything. Ms. Alvarez was just looking for answers. Ethically, I and the other nurses on the floor had to treat her like any other patient and evaluate her based on the facts and data.

    (not using real name)
    Last edit by Joe V on Jun 21, '11 : Reason: formatting for easier reading
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    About mebahl

    Mary Bahl, RN, is a nurse working in home care north of Boston.

    Joined: Jun '11; Posts: 2
    Home Health admissions nurse; from US
    Specialty: 5 year(s) of experience in home health, trauma/surgical step down

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  3. by   talaxandra
    Our video/EEG monitoring patients are reviewed during the neuro meeting - the video is screened, then the seizure/event is analysed and the intervention critiqued. Though I've yet to see an attempted exorcism, this has lead to a couple of amusing incidents, including several instances of voluntary movement, and at least two of patients carefully lying on the floor before 'fitting.'

    The best stories usually combine the embarassment and accidental humour of staff screw ups. Like the time an over-eager, know-it-all nurse who tended to be unduly influenced by House ran into a MET call for a prolonged seizure on a monitored patient and, evidently oblivious to the EEG electrodes snaking from the patient's head to the junction box, blurted out, "He's having a febrile convulsion!" Not content with her observation, she offered a diagnosis: "It could be malaria!" (Not exactly known in non-tropical Melbourne)

    Or the time a former neurology resident was on covering nights and hadn't realised the new Fellow required bandaging the heavy junction box to the patient's head. Called to review a patient with multiple seizures he looked at the box and asked the nurse, "What's with the ridiculous bandage?"
    She diplomatically responded, "The new Fellow believes it results in a better trace."
    "Well that's just ****ed!"
    She points to the camera directly above her head.
    "Oh, ***! Well, at least they only watch the sections of seizure activity..."
    She pointed to the patient, who was seizing again.
    "Oh." Waves to the camera. "Hi, Dr X."

    Then there was the patient whose unusual EEG reading was because he'd decided four nights was too long without relief. The masturbation was less of a problem than his decision to pull off the bed clothes and smile maniacally at the camera for the duration.
  4. by   dbscandy
    These are funny, but I have to go to the dark side on this one!! In the NICU, the EEG's are on for 24hrs of course, but when the audio recording was added, uhoh, it bit some people in the butt.

    There was some, uh, embarrassment when the EEG tech reported back to the Director. The alarms in the open unit were going off waayyy too long, and some of the staff conversations were not quite appropriate.

    Needless to say, there are now signs posted everywhere when there is an audio/visual EEG going on. Even the parents are warned.