Sunday 16 February 2014

Fakin' It

"42 year old female, ?CVA, facial weakness and slurred speech, NHS111"

This type of call is a high priority and as such gets a response to match the level of urgency. For those not in the know, a CVA is medical jargon for a stroke. Admittedly, I felt she was a little on the young side for a stroke, but it's not unheard of so I would treat it as such until I arrived. I had a pretty long journey to get there and because of that a vehicle containing community volunteers was also dispatched. Despite this, I arrived on scene first. I don't know what that says about my driving, or even theirs! 

I was let into the house by her some, who looked pretty annoyed to be honest. 

"She's upstairs in the loft room."

Of course she's in the loft room! They are always in the loft room! Not the living room, or sat by the front door. Oh no! The loft room, every time! 
The EMS Law of stairs: The severity of a patients illness or injury is directly proportional to the number of stairs said patient has climbed to get away from the front door. The worse the patient is the more stairs they will have climbed. 
Corollary 1: If a patient can't walk, has chest pain or is fitting they will have gone upstairs to call 999
Corollary 2: If a patient is heavy they will have gone upstairs to call 999
After staggering up the stairs with all my bags, watched by the many people in the house (clearly chivalry is indeed dead) I made it to the loft room. Laying on the bed, in the dark was our patient. My first move was to turn the light on.

"Turn the fucking light off will you."

Note to self: A) I don't like this patient B) The light stays on.

"Hello there, I'm afraid whilst I am examining you, the light will need to stay on. Also, if you swear at me again, I will be leaving and cancelling the ambulance. Now, what's the problem today?"

"I'm having a stroke."

"What makes you think you're having a stroke?"

"I've got a really bad headache, slurred speech, facial weakness and weakness on my left side."

"You speech doesn't sound slurred."

"Wellll iit issss."

It was the worst attempt at faking slurred speech I had ever heard and only appeared after suggesting it wasn't slurred. There was certainly no slur in 'turn the fucking light off'! Anyway, I decided to go through the motions and see where we got. At this point the community vehicle walked in, we exchanged hellos, and I continued with my assessment. 

"Can you sit up for me please?"

"No, I can't."

"Well I need to assess you and I can't do that with you lying down and facing away from me."

With all the moans and groans she could muster, she eventually righted herself to sitting, refusing to open her eyes because of the apparent photophobia. I knelt down in front of her. 

"Can you look at me please. Right, now give me a big toothy smile."

Her face contorted into some kind of weird position. I asked a number of times for her to smile properly but she persisted with trying to fake facial weakness. The facial droop in someone having a stroke is quite unmistakable. This wasn't that! This was trying to bend a face into what she thinks a facial droop should look like. It was most bizarre.

I took hold of her hands and held her arms out in front of her. I asked her to keep them where they were. With an air of predictability her left arm shot down with precision and accuracy onto her lap. I repeated it 3 times. At no point did it resemble paralysis in any way shape or form. 

"So tell me about this headache, where is it, how bad is it, when did it start etc?"

"It's an 8/10 on the left side of my head and came on suddenly 20 minutes ago."

Wow, I didn't even ask for a pain score, she must have done this before! 

"And what pain killers have you taken?"


Obviously not. Why take pain killers for a headache?! Not as if they are designed to kill pain or anything. 

At this point the ambulance crew arrived, meaning that with my student and myself and the two community responders there were now 6 ambulance staff in her bedroom. 

"This lady has a 20 minute history of a headache. She hasn't taken any pain killers. She is FAST negative, no facial weakness and good strength on both sides. There is also no slurred speech. All her OBs are normal. She says the pain is 8/10"

"I do have face and weakness."

"You used both arms to push yourself up to sitting and whilst I was just talking to my colleague you reached over and picked up your mobile phone. And look, you facial droop isn't there and the slurring isn't there."

*cue the slurring again and holding one eye shut*

I had seen enough. I packed up my stuff and left the crew to deal with her. Due to her refusal to walk it took them 25 minutes to get her down the stairs with various episodes of throwing herself on the floor. I'm assumed there was also a fake feint and a fake seizure which I must admit, I'm disappointed I missed! 

WHY WOULD ANYONE TRY AND FAKE A STROKE?! Seriously! Do these people really think they can trick us?! Do they think they can trick the neurologists and CT scanners?! What is their end game?! I just don't understand the mentality or rationale behind it?! The cost of the resources that were sent to her was phenomenal, not to mention, that was three resources that couldn't be attending other genuine emergency calls. NHS111 had their hands tied. A patient describing stroke symptoms over the phone, is, for all intents and purposes having a stroke. A patient having a stroke gets all the resources it could need. I can understand why her some looked so annoyed when we arrived. He knew she was playing up and knew his friday night would most likely be ruined by a trip to hospital. 

Why hospital though?! I know I will get the questions! Basically, despite the obvious fake symptoms, she persisted in describing a sudden onset of severe headache causing photophobia. Medically, these are red flags and could signal a number of serious, but unlikely medical conditions. As she insisted on hospital, it would take a very brave medical professional to refuse! 

What annoys me most, is there is no way to stop the madness! 


  1. What a moron some one could have been having a stroke and she held you up for God knows what reason. I had one 7 years ago and I'm still struggling with it but to fake one is deplorable

  2. I hate the fakers. Do I go with the least path of resistance and play with their pantomime as if it were genuine but have them sitting there thinking " this idiot can't tell I'm faking it " when I can OR do I call them on it, risk confrontation and head into complaint territory.
    I started off doing option 1 but now find myself more readily doing option 2.

  3. Could she have Munchausens? I can't understand why some people waste such limited resources, don't they understand that they're risking lives, people who could so easily be their relative one day. I also struggle to understand the appeal of A&E departments - do they enjoy having painful tests and endless waiting around? As you say, who do they think they're fooling? Would they still be faking illnesses if the NHS charged time wasters?

  4. Why do they do it?

    Mental illness - But that's a whole other blog post..


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