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Monday, December 1, 2008

Exaggeration of asthma

We have this patient who comes in on a regular basis and fakes her asthma. It's to the point now that even the doctors are frustrated with her.

But what choice do they have but to treat her as though she were really having bad asthma. What if she was sent home and died. There's a big lawsuit waiting to happen. So, she gets admitted with the diagnosis of "exacerbation of asthma."

We RTs like to call it, "exaggeration of asthma."

There have been many times I've stood outside her room listening to her talk on the phone as though she were home, and as soon as I walk into the room I can hear a forced, audible expiratory wheeze.

"How you doing?" I say.

"Aweful. I was hoping I'd go home today, but I don't feel any better."

"Yeah right," I think. "You like getting waited on hand and foot."

I'm sure all asthmatics have faked asthma from time to time, but I highly doubt there are many asthmatics who actually want to be admitted.

It's stupid too, becasue there are side effects to all that medicine that gets pumped into you for no reason. Or perhaps she really is having bronchospasms, but it's because of her own choice to be noncompliant.

This was evidenced during her most recent visit, when she was having bad stomach pains. Now she's on stomach medicine too.

I wrote about Asthma Actors on my Asthma Blog over at Go ahead and click here and I'll morph you on over there.

Some Asthmatics are Good Actors
by Rick Frea Wednesday, November 12, 2008
See the accompanying comic!

Believe it or not, there are a few asthmatics that really do have asthma, but they exaggerate their symptoms to take advantage of it to the full extent to get what they want. We call these asthmatics the "Actors."

A while ago I had a patient I will refer to as "Carrie" who was admitted frequently with exacerbation of asthma. We RTs knew she was a great actor, so we referred to her diagnosis as "exaggeration of asthma."

When Carrie was a little girl she was adamantly against going to Aunt Bessie's funeral, but her dad was making her go.

"But I can't breathe," she said, faking a gasp.

"Oh, my poor baby," her dad said, "You can stay home."

"Aha," she thinks as she watches her dad's truck roll down the driveway. "This works even better than batting my eyes and begging."

A year later, when she learned she was going to have to play dodge ball in gym class, she took a couple puffs of her inhaler in front of her teacher and panted a little.
She was dismissed from class. (I did this once myself. The two class bullies who wanted me dead were threatening to throw the ball at my head.)

One night in college Carrie had a ton of homework and three tests to study for. She ran two laps around the dorm and called her professor before she caught her breath.
Her professor told her to reschedule the exams and take it easy.

Years later, as an adult, she had five kids running around her house and she was getting very stressed. Not only that, but she just found out her husband was having an affair with his secretary. So she quit taking her preventative medicine and bought a cat and a dog knowing she was allergic to both.

When she became short of breath she did not bother taking her inhaler, by golly. What she did instead was have her husband take her to the ER. When the ER doctor sent her home, she simply repeated the steps above until she finally won herself a deluxe hospital suite complete with her own restroom and maid service.

Two weeks later she was fully rested and stress free and returned to her family with all their love and sympathy she earned from being sick.

Shortly after, she returned to the ER. Again she was admitted. Only this time, her respiratory therapist starts to catch on to her. One day she was bored and decided to play Good Samaritan and help her roommate walk to the bathroom. She was unaware that Rick, her RT, was standing outside the door watching her.

"Hey!" he said. She jumped. "You must be feeling better."

"This is hard for me," she said, suddenly faking a wheeze, and closing the bathroom door behind the naked rump of her elderly roommate. "But no one answered her call for help, so I thought I'd help her."

"If you're having trouble breathing, you shouldn't be getting out of bed. You need to be taking it easy."

"Yeah, well," cough-cough, "I think I need a treatment now."

He educates her on taking her medications correctly and avoiding her asthma triggers, but it really doesn't matter. Six weeks later she fools her doctor again.

The problem with actors is a good doctor has no choice but to give a patient the benefit of the doubt. He has to treat her as though she were really sick, and that usually means high doses of oral steroids, which come with side effects. Now she has asthma, stress at home, a puffy face and anxiety from the steroids to boot. She is a mess.

We RTs definitely have empathy for actors, but it gets difficult to take them seriously after a while -- however we always do. Perhaps all of us asthmatics have a little Carrie in us at times. Lord knows I've exaggerated my asthma a time or two, but usually I felt guilty in the end. I also acted once when my dad wanted us boys to stack wood. However, I only did this once because I felt guilty using my asthma to get out of work. I imagine it's guilt that prevents most of us from becoming full time actors like Carrie.

But guilt shouldn't be all. Asthma is not a game. Faking asthma is just plain unwise. The most these folks can expect to gain is a bunch of people feeling sorry
for them.


Steve said...

I agree that there are asthma actors out there(I have several that frequent my site), but I have to disagree that every asthmatic has faked an attack from time to time.
I've never faked an attack, though I have to admit I feel a little guilty if Im not in full blown resp failure when I'm admitted.

Trauma Junkie said...

@Steve that's good that you haven't faked an attack before. I know of several people who have-- and it seems silly to me.

And if they need that much attention that they are going to fake it to be admitted, maybe they just need to see a good shrink. lol We had this lady once, long time COPDer...sounded absolutely terrible. She kept begging and begging and begging to be put on the ventilator for a few days (I kid you not). When asked why, she'd say, "Because my accessory muscles need a, I haven't slept in days." I think it was more the latter than anything else.

Freadom said...

You are right steve, I shouldn't have used the generalization "every." Still, I'm sure "many" asthmatics have used their asthma to their advantage from time to time. I doubt there are many who try to get admitted though. Those patients do need a shrink.

Susannah said...

Yep-I too know rather too many Asthma Exaggerators -but no, I've never faked it, or hammed it up or even used it to gain anything in my huffy luffy life.
Try my hardest to play it down, always detrimentally I hasten to add. I am a totally compliant but severe asthmatic, who the heck would WANT to suffer like this??????


Freadom said...

Except for a few exceptions, I don't think Actors suffer when they fake it, they simply want people to think they are suffering.

Likewise, I don't think any person with a good conscience would ever do this. Mostly, if someone is going to fake asthma, it will be some kid trying to get out of school or hauling wood or something like that.