I remember working my first Christmas with an old-school Paramenace.  We’d just attended a drunk who’d been beaten up in the street.  My crew mate showed no compassion and was quite harsh with him, both physically and orally.  Afterwards, whilst I was doing my paperwork, I remember him snapping at me.

“You’ll be this cynical once you’ve been in this job as long as I have!”

When you’re new you don’t want to offend anyone so normally you shut up but this annoyed me.  So, stopping writing I turned to him and retorted, “No I won’t Gavin*.  I’ll never be cynical like you”.  We didn’t speak to each other for the rest of the shift.

I often think back to that statement – especially when certain types of patients start to get to me.  I’ve only been in the job three years so I’ve a long way to go before proving that paramenace wrong but I still hold out to not being cynical.

However, those ‘certain types of patients’ I believe do annoy me are the ones who pretend to collapse . . . or “pseudo-collapsers”.

Why!  Why do it?  I don’t understand.  It drives me mad.  I think it drives everyone mad.  To collapse in the street and either pretend to be fitting or pretend to be dead is beyond logic – especially when loved ones are present and believe whole-heartedly that something is wrong.  It breaks their heart and frightens those around them.

The annoying thing is you can’t say to relatives or anyone looking on that you know they’re faking it.  You want to – everything inside of you wants to tell the onlookers to point at the pseudo collapser and shout in unison, “STOP IT!  GET UP AND STOP BEING A CHILD!!”.  But you never do.  Its not considered professional and the relatives might not be ready to hear such a left-field accusation about their loved one.  So, we do what we have to do – we ‘don the façade’ and play along.  We collect up the patient into the ambulance and do all our normal obs and comfort the relatives at the same time.

But the funny thing is we can tell when someone is feigning it. There are obvious signs.  Firstly, genuine patients will have the appearance of looking ‘ill’.  When someone stops breathing they tend to start turning blue – that is difficult to fake.  If their heart has stopped beating there won’t be a pulse – that is also difficult to fake.  and when they collapse genuinely they often injure themselves on the way down – not something a pseudo-collapser is willing to do.  Secondly, if they have properly collapsed, whether it be post fitting or something else, their entire body will go limp.  There should be no resistense to anything.  Here are some great tests that are good in determining a real patient from a psuedo one:

• Flick your finger over their eyelashes.  A psuedo collapser will not be able to stop the nerve impulses from reacting.  (this is a good test)
• Try and open their eyes.  Sometimes a psuedo collapser will fight against it.  This is a dead give away.
• When you do open their eyes, if their eyeballs suddenly roll backwards – this is another dead give away.
• Try lifting their hand high above their face and letting go.  If it is genuine the hand will wallop the patient in their face without reaction.  Psuedo collapser’s hands magically veer off to one side, missing themselves.
• If they have collapsed into an awkward position the toungue can roll back and partially block the larynx creating a snoring effect.  This is common in genuine fitters.  Psuodo collapsers tend to breath fine in any position.
• Pain stimulus. . . there are several methods used now and in the past such as; squeezing the ear, pressing the bone above the eye, sternum rub, ‘Vulcan’ squeeze or rolling a pen over the back of a finger nail.  All these are good (some are frowned upon now) but sadly I have seen psuedo collapsers take even the best of pain stimulus and not bat an eye lid.

Some psuedo collapsers we go to are regular callers.  So not only are they pulling a fast one – they’ve been doing it for years and know lots of the tricks to make it look genuine.  Some of these can pull off the best epileptic seizures, complete with incontinence and a believable post-ictal stage.  However, there are some that are laughable by any standards.

The reasons why anyone would do this is beyond me.  Ultimately, it is sad.  Sad for their relatives, sad for those watching, sad for the drain on emergency resources and sad for themselves.  I mean, are these people truly proud of their actions?

In the next two entries (which I’ll write today and tomorrow) I’ll give several examples of jobs I’ve gone to which have been pseudo collapsers.  And I’m sure there’s plenty of stories other paramenaces can give that would be better than mine.

Binder

*not their real name of course.